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Journal of Clinical Microbiology, October 2004, p. 4735-4743, Vol. 42, No. 10
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.10.4735-4743.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Genetic Diversity among Community Methicillin-Resistant Staphylococcus aureus Strains Causing Outpatient Infections in Australia

Geoffrey W. Coombs,1 Graeme R. Nimmo,2* Jan M. Bell,3 Flavia Huygens,4 Frances G. O'Brien,1,5 Mary J. Malkowski,1 Julie C. Pearson,1 Alex J. Stephens,4 Philip M. Giffard,4 and the Australian Group for Antimicrobial Resistance{dagger}

Gram-Positive Bacteria Typing and Research Unit, Royal Perth Hospital,1 School of Biomedical Sciences, Curtin University, Perth,5 Microbiology Division, Queensland Health Pathology Service, Princess Alexandra Hospital,2 Cooperative Research Centre for Diagnostics, Queensland University of Technology, Brisbane,4 Microbiology and Infectious Diseases Department, Women's and Children's Hospital, Adelaide, Australia3

Received 15 May 2004/ Returned for modification 14 June 2004/ Accepted 5 July 2004

Increasing reports of the appearance of novel nonmultiresistant methicillin-resistant Staphylococcus aureus MRSA (MRSA) strains in the community and of the spread of hospital MRSA strains into the community are cause for public health concern. We conducted two national surveys of unique isolates of S. aureus from clinical specimens collected from nonhospitalized patients commencing in 2000 and 2002, respectively. A total of 11.7% of 2,498 isolates from 2000 and 15.4% of 2,486 isolates from 2002 were MRSA. Approximately 54% of the MRSA isolates were nonmultiresistant (resistant to less than three of nine antibiotics) in both surveys. The majority of multiresistant MRSA isolates in both surveys belonged to two strains (strains AUS-2 and AUS-3), as determined by pulsed-field gel electrophoresis (PFGE) and resistogram typing. The 3 AUS-2 isolates and 10 of the 11 AUS-3 isolates selected for multilocus sequence typing (MLST) and staphylococcal chromosomal cassette mec (SCCmec) analysis were ST239-MRSA-III (where ST is the sequence type) and thus belonged to the same clone as the eastern Australian MRSA strain of the 1980s, which spread internationally. Four predominant clones of novel nonmultiresistant MRSA were identified by PFGE, MLST, and SCCmec analysis: ST22-MRSA-IV (strain EMRSA-15), ST1-MRSA-IV (strain WA-1), ST30-MRSA-IV (strain SWP), and ST93-MRSA-IV (strain Queensland). The last three clones are associated with community acquisition. A total of 14 STs were identified in the surveys, including six unique clones of novel nonmultiresistant MRSA, namely, STs 73, 93, 129, 75, and 80slv and a new ST. SCCmec types IV and V were present in diverse genetic backgrounds. These findings provide support for the acquisition of SCCmec by multiple lineages of S. aureus. They also confirm that both hospital and community strains of MRSA are now common in nonhospitalized patients throughout Australia.

* Corresponding author. Mailing address: Microbiology Division, Queensland Health Pathology Service, Princess Alexandra Hospital, Brisbane, Australia. Phone: 61 7 3240 2389. Fax: 61 7 3240 5786. E-mail: Graeme_Nimmo{at}health.qld.gov.au.

{dagger} Contributing members of the Australian Group for Antimicrobial Resistance are listed in Acknowledgments.

Journal of Clinical Microbiology, October 2004, p. 4735-4743, Vol. 42, No. 10
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.10.4735-4743.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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