Previous Article | Next Article 
Journal of Clinical Microbiology, November 2002, p. 4060-4067, Vol. 40, No. 11
0095-1137/02/$04.00+0 DOI: 10.1128/JCM.40.11.4060-4067.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Analysis of the Genetic Variability of Genes Encoding the RNA III-Activating Components Agr and TRAP in a Population of Staphylococcus aureus Strains Isolated from Cows with Mastitis
Philippe Gilot,1* Gérard Lina,2 Thierry Cochard,1 and Bernard Poutrel1
Laboratoire de Pathologie Infectieuse et Immunologie, Institut National de la Recherche Agronomique, F-37380 Nouzilly,1
Centre National de Référence des Toxémies Staphylococciques, EA1655, Faculté de Médecine Laennec, 69372 Lyon Cedex 08, France2
Received 7 March 2002/
Returned for modification 19 June 2002/
Accepted 25 July 2002

ABSTRACT
The expression of
Staphylococcus aureus virulence proteins is
under the control of RNA III, a central pleiotropic regulator
transcribed from the
agr locus. RNA III is activated by at least
two two-component systems, one encoded by the
agr locus (AgrC-AgrA)
and another encoded outside of this locus (TRAP-RAP). In this
work, we developed new typing methods based on genes encoding
these two systems, which we used to characterize a nonclonal
population of
S. aureus bovine mastitis isolates. Twelve
agr restriction types were identified in this population, but the
majority of strains (56.3%) were grouped in the R III-A1 type.
No strain isolated from humans, whose
agr sequence is available
from GenBank, was found to belong to this major type. Restriction
maps constructed for all of those
agr variants allowed the linking
of all types in an evolution scheme and their grouping in one
of the four
agr interference groups. This analysis indicates
that groups 2, 3, and 4 probably evolved from the more frequently
encountered type, which belongs to group 1.
agr group 1 was
also found to be the most prevalent (69.0% of the strains) and
the most polymorphic interference group. By developing an
agr group-specific multiplex PCR, we confirmed the above classification
of strains in the
agr interference groups. Four allelic variants
of
trap were also identified, indicating that this two-component
system is also polymorphic. The majority of strains was grouped
in the
trap 1 type (71.8%). Whereas no relationships between
agr group and
trap types were found, strains of similar
agr restriction type were also of similar
trap type (with the exception
of strains belonging to the
agr R IV-A5 and R VI-A8 types).
Our analysis indicates that
S. aureus isolated from cows has
predominantly a clonal structure and that the highly prevalent
agr R III-A1,
trap 1 type (56.3% of the strains) probably possesses
a genetic background which endows it with superior ability to
infect the bovine mammary gland.

INTRODUCTION
Staphylococcus aureus is a gram-positive bacterium responsible
for various major diseases in both humans and domestic animals.
In dairy animals,
S. aureus is one of the major causes of intramammary
infections (mastitis) of lactating females, from whose milk
it is frequently isolated. The presence of this bacterium in
raw milk represents a risk for human health and causes serious
economic losses to milk producers around the world (
17,
27).
The pathogenesis of S. aureus is complex and involves both surface-associated proteins implicated in the adhesion of the bacterium to host tissues and the secretion of toxins that not only cause disease but also contribute to the bacterial spread (22). The expression of the virulence proteins is under the control of RNA III, a central pleiotropic regulator transcribed from the accessory gene regulator (agr) locus. RNA III is activated by at least two two-component systems, one (AgrC-AgrA) encoded by agr and another (target of RNA III-activating protein [TRAP]-RNA III-activating protein [RAP]) encoded outside of this locus (3, 22, 23).
The agr system is a quorum-sensing system that, during the transition from the exponential to the stationary phase of growth, down-regulates the transcription of genes encoding some surface proteins and up-regulates the transcription of certain extracellular toxins (14, 22). The agr locus comprises two divergent transcriptional units, under the control of promoters P2 (RNA II) and P3 (RNA III). The P2 operon encodes a two-component signal transduction system (AgrC, transmembrane receptor-histidine kinase; AgrA, cytoplasmic regulator), a propeptide (AgrD), and an integral membrane protein (AgrB) that is probably involved in the processing and/or secretion of the peptide (Fig. 1). The resulting mature autoinducing peptide (AIP) accumulates in the extracellular environment during bacterial growth, reaches a threshold concentration (quorum sensing), and activates the two-component system by phosphorylation. The phosphorylated AgrA sensor then up-regulates the transcription from promoter P2, amplifying the response, and initiates transcription from promoter P3. The P3 transcript, RNA III, mediates up-regulation of secreted virulence factors as well as down-regulation of surface proteins (22). Interestingly, Ji et al. also described that AIP produced by a given strain of S. aureus activates its own agr locus but may inhibit the expression of agr in other strains. This phenomenondue to polymorphism in a variable region of the agr locus comprising nucleotide sequences encoding AgrD, the C-terminal two-thirds of AgrB, and a portion of the N-terminal half of AgrCactually led to the classification of S. aureus isolates in four different interference groups (12, 15). This type of bacterial interference could be implicated in the struggle for the colonization of infected sites (15).
On the other hand, RAP-TRAP, a second two-component system,
was also shown to be able to activate transcription of RNA III
(
3). The proposed model taking into account this second system
suggests that autoinduction of virulence occurs in a two-step
process. At the beginning of the bacterial growth, the autoinducer
RAP accumulates and induces the phosphorylation of the surface-associated
protein TRAP. This results in up-regulation of the
agr locus
to produce RNA II. Once
agr is activated (in the mid-exponential
phase of growth), AIP and AgrC are produced. AIP accumulates
in the environment and induces phosphorylation of AgrC, leading
to phosphorylation of AgrA, up-regulation of RNA III synthesis,
and down-regulation of TRAP phosphorylation (
3,
32). Actually,
it is not known if
trap interstrain variation, similar to what
was found for
agr, does exist.
In this work, we developed new typing methods based on genes encoding the above-cited two-component systems, which we used to characterize the still poorly studied population of S. aureus strains isolated from cows with mastitis.

MATERIALS AND METHODS
Bacterial strains.
A total of 71
S. aureus strains isolated from milk of cows with
mastitis were analyzed. All strains were identified as
S. aureus using standard microbiological techniques (
10). These strains
were isolated from different locations and at different times
and were chosen to be epidemiologically unrelated. Most of the
strains (
n = 65) were isolated from different regions of France
by the Laboratory of Infectious Pathology and Immunology at
the National Institute for Agronomic Research, but six strains
were also isolated from different parts of the world: three
strains were isolated in the United States (comprising strain
305 of Prasad and Newbould [ATCC 29470] [
26]), one strain was
isolated in the United Kingdom (the m strain of Neave and Oliver
[ATCC 27543] [
21]), and two strains were isolated in Japan (strains
125 and 130 of Takeuchi et al. [
28]).
One strain was isolated in the 1950s, 15 strains were isolated in the 1960s, 16 strains were isolated in the 1970s, 12 strains were isolated in the 1980s, and 27 strains were isolated in the 1990s.
S. aureus agr reference strains RN6390 (agr group 1), RN6923 (agr group 2), RN8462 (agr group 3), and A880740 (agr group 4) (12, 15) and strains whose genomes are sequencedN315 and Mu50 (18), COL (http://www.tigr.org/tdb/mdb/mbdinprogress.html), NCTC 8325 (http://www.genome.ou.edu/staph.html), and MRSA-252 and MSSA-476 (http://www.sanger.ac.uk/Projects/S_aureus/)all from human origin, were used as controls.
Nucleic acid purification.
For nucleic acid purification, strains were grown overnight on brain heart infusion agar plates at 37°C for 24 h. Ten to 15 colonies were then scraped from plates, and spheroplasts were prepared as described by van Leeuwen et al. (29). Nucleic acids were then purified from the spheroplasts as described by Boom et al. (4). Briefly, guanidine thiocyanate (catalog no. 50990; Fluka Biochemika) was added for cell lysis and the nucleic acids were purified by affinity chromatography with diatoms (high-purity, analytical grade Celite [catalog no. 16,743-6]; Aldrich). The nucleic acids were finally eluted from the diatom particles with 100 µl of a 10-4 M EDTA-10-2 M Tris · Cl (pH 8.0) solution and stored at -20°C until use.
PCR amplification of the variable region of the agr operon.
PCR amplification of the 1,070-bp variable region of the agr operon was performed with primers B1 (5'-TAT GCT CCT GCA GCA ACT AA-3') and C2 (5'-CTT GCG CAT TTC GTT GTT GA-3') described by van Leeuwen et al. (Fig. 1) (29). The variable agr region was amplified from 2 µl of the purified nucleic acid solution in a 100-µl reaction mixture containing 2.5 U of Taq DNA polymerase (Taq DNA polymerase in storage buffer A [Promega]), 200 µM deoxynucleotide triphosphates (dNTPs) (Promega), 0.5 µM primer B1, 0.5 µM primer C2, 2 mM MgCl2, 50 mM KCl, 0.1% Triton X-100, and 10 mM Tris · Cl (pH 9.0). Amplifications were carried out in a Perkin-Elmer thermocycler (GeneAmp PCR system 9600) through the following temperature program: 1 cycle of 4 min at 94°C; 40 cycles of 1 min at 94°C, 1 min at 50°C, and 2 min at 74°C; and finally 1 cycle at 74°C for 3 min. For some samples that were not amplified with the above protocol, the concentration of MgCl2 in the PCR mixture was increased to 2.5 mM, and the annealing and elongation times were increased to 2 and 3 min, respectively. After precipitation with ethanol and centrifugation, the pellet was dissolved in 70 µl of a 10-4 M EDTA-10-2 M Tris · Cl (pH 9.0) solution. All samples were stored at -20°C before restriction.
Agr group-specific multiplex PCR.
The agr sequences were amplified from 2 µl of the purified nucleic acid solutions in a 25-µl reaction mixture containing 1.25 U of Taq DNA polymerase (Taq DNA polymerase in storage buffer A [Promega]), 200 µM dNTPs (Promega), 5 mM MgCl2, 50 mM KCl, 0.1% Triton X-100, 10 mM Tris · Cl (pH 9.0), and a 0.3 µM concentration of each of the following primers: Pan (5'-ATG CAC ATG GTG CAC ATG C-3'), agr1 (5'-GTC ACA AGT ACT ATA AGC TGC GAT-3'), agr2 (5'-TAT TAC TAA TTG AAA AGT GGC CAT AGC-3'), agr3 (5'-GTA ATG TAA TAG CTT GTA TAA TAA TAC CCA G-3'), and agr4 (5'-CGA TAA TGC CGT AAT ACC CG-3'). These primers allow the amplification of a 441-bp DNA fragment of the agr group 1 strains, of a 575-bp DNA fragment of the agr group 2 strains, of a 323-bp DNA fragment of the agr group 3 strains, and of a 659-bp DNA fragment of the agr group 4 strains. Amplifications were carried out in an MJ Research thermocycler (PTC-100) through the following temperature program: 1 cycle of 5 min at 94°C; 26 cycles of 30 s at 94°C, 30 s at 55°C, and 60 s at 72°C; and finally 1 cycle of 72°C for 10 min. Amplification products were electrophoresed in a 1.5% agarose gel containing ethidium bromide and visualized by transillumination under UV.
PCR amplification of the trap gene.
The entire 504-bp open reading frame of the trap gene was amplified with sense primer 5'-ACA TAA GGG GGA CCT TTC AT-3' (ending 1 nucleotide before the start codon) and antisense primer 5'-ACC AAT GGA AGT TTT CTT CG-3' (ending 4 nucleotides after the stop codon). The trap open reading frame was amplified from 2 µl of the purified nucleic acid solutions in a 100-µl reaction mixture containing 1.25 U of Taq DNA polymerase (Taq DNA polymerase in storage buffer A [Promega]), 200 µM dNTPs (Promega), 1 µM sense primer, 1 µM antisense primer, 1 mM MgCl2, 50 mM KCl, 0.1% Triton X-100, and 10 mM Tris · Cl (pH 9.0). Amplifications were carried out in a Perkin-Elmer thermocycler (GeneAmp PCR system 9600) through the following temperature program: 1 cycle of 45 s at 95°C; 35 cycles of 45 s at 95°C, 60 s at 52°C, and 60 s at 72°C; and finally 1 cycle at 72°C for 10 min. All samples were stored at -20°C before restriction.
Restrictions of the PCR products.
The trap amplicons were restricted with MseI (New England Biolabs), whereas the agr amplicons were restricted with RsaI (Roche Molecular Biochemicals) and AluI (Roche Molecular Biochemicals), according to manufacturer's instructions. The restriction fragments were then separated by electrophoresis on a 3% agarose gel (SeaKel HGT agarose; FMC, Rockland, Maine) containing ethidium bromide and visualized by transillumination under UV.

RESULTS
agr restriction fragment length polymorphism.
The polymorphism of the
agr operon was analyzed by restriction
endonuclease PCR in a population of 71 epidemiologically unrelated
S. aureus bovine mastitis isolates. To this end, the 1,070-bp
variable region of the
agr operon was amplified by PCR with
primers B1 and C2 (Fig.
1). Sixty-eight of the tested strains
gave an amplicon of the expected molecular weight, and one strain
gave an amplicon of around 740 bp, whereas no amplicon could
be amplified from two strains (results not shown). The PCR products
were then restricted with
RsaI or
AluI, giving 10 different
profiles for each enzyme (Table
1; Fig.
2). The combination
of these two restriction patterns allows the definition of 12
unique
agr restriction types (Table
1). Most of the strains
belong to the R III-A1 type (56.3%), the R IV-A5 type (12.7%),
and the R IV-A7 type (8.4%). The other nine restriction types
are shared by only one to three strains (Table
1). The numerical
index of the discriminatory ability of the
agr typing, calculated
as described by Hunter and Gaston (
11), indicates that if two
strains were sampled randomly from the analyzed populations,
then on 66.2% of occasions they would fall into different restriction
types.
View this table:
[in this window]
[in a new window]
|
TABLE 1. Characteristics of different restriction types of the agr operon identified among the analyzed S. aureus strains isolated from cows with mastitis
|
Relationship between restriction types of the agr operon.
Restriction maps were constructed to know the relationship between
the unique restriction types of the
agr locus identified in
the collection of strains isolated from cows with mastitis.
To this end, partial hydrolysis was also conducted to correctly
assign the position of some restriction fragments (results not
shown). The maps were then compared with those corresponding
to the same region of the
agr operon sequenced from strains
isolated from humans and available from nucleic acid databases
(Fig.
3). The
agr interference group reference strains isolated
from humans were found to be type R I'-A1 for group 1 (GenBank
accession no.
X52543), type R IV-A9 for group 2 (GenBank accession
no.
AF001782), type R VI-A10 for group 3 (GenBank accession
no.
AF001783), and type R I-A6 for group 4 (GenBank accession
no.
AF288215). Strain CMRSA-1 (GenBank accession no.
AF210055)
classified by Papakyriacou et al. (
25) as being a variant of
the
agr interference group 1 reference strain (Ia) was identified
to be type R III-A2. It is worth noting that no type R VI-A10
and R IV-A9 were identified among the strains isolated from
cows with mastitis. Similarly, after amplification and restriction
of the
agr operon, the restriction maps of six strains of human
origin whose genomes are sequenced were also constructed. Strains
N315 and Mu50 are type R IV-A9, strains NCTC 8325 and COL are
type R I'-A1, strain MRSA-252 is type R VI-A10, and strain MSSA-476
is type R VI-A8.
All restriction types were classified in one of the four
agr groups on the basis of the presence or absence of a combination
of restriction sites characteristic of each of the interference
group reference sequences (Fig.
3 [types in grey]). All types
were then linked one to the other inside each group, trying
to produce the least gain or loss of restriction sites when
evolving from one type to another (Fig.
3). This analysis allows
the classification of all
agr restriction types into the four
previously known
agr groups (Table
1). Nevertheless, it is of
interest that the 3' extremity of the variable region of the
agr locus (plus or minus two-thirds of the molecules) of two
strains isolated from cows in Japan, the strain 125 (type R
IX-A11) and the strain 130 (type R VIII-A12), possess the characteristic
restriction sites of the
agr group 1 strains, whereas the 5'
extremity of this region (plus or minus one-third of the molecule)
contains restriction sites characteristic of the
agr group 2
and of the
agr group 3 strains, respectively (Fig.
3). As the
agr loci of both strains were sequenced (GenBank accession no.
AB043555 and
AB043554), this property was verified by aligning
the nucleotide sequences of their variable
agr region with those
of the
agr group 1 to 3 reference strains (results not shown).
The entire agr variable region of strains 125 and 130 being nevertheless more similar to the agr group 1 reference sequence (88.2 and 91.1% of nucleotides identical, respectively) than to the agr reference sequences of group 2 (69.7 and 59.0% of nucleotides identical, respectively) or group 3 (64.9 and 76.0% of nucleotides identical, respectively), we tentatively classified these two strains in agr group 1, at the junction between groups 2 and 3, respectively (Fig. 3). Our analysis also showed that the isolate giving an agr amplicon of reduced length is an agr group 1 strain (type R VII-A3 [Fig. 3]) with a deletion of a 330-bp region comprising the entire agrD gene.
The restriction map analysis indicates that group 1 is the most diverse agr group. This group contains 8 out of the 14 restriction types identified, whereas group 2, group 3, and group 4 contain only 3 types, 2 types, and 1 type, respectively. Finally, we found that the sequenced human strains COL and NCTC 8325 belong to agr group 1, that strains N315 and Mu50 belong to agr group 2, and that strains MRSA-252 and MSSA-476 belong to agr group 3 (Fig. 3).
Development of an agr group-specific multiplex PCR.
The analysis of the restriction maps of the variable region of the agr operon (Fig. 3) suggests that agr group-specific primers could be found in this region and used in an agr group-specific multiplex PCR. We thus analyzed in detail the nucleotide sequences of each of the four different agr operons obtained from GenBank (accession no. X52543, AF001782, AF001783, and AF288215) by using the Gene Jockey software (Biosoft, Cambridge, United Kingdom). One consensus forward primer (Pan) and four group-specific reverse primers (agr1, agr2, agr3, and agr4), which would allow the identification of the agr group on the basis of the molecular weight of its PCR product, were identified (Fig. 1). These primers were then tested experimentally in a multiplex PCR and shown to correctly identify the agr group of the agr reference strains RN6390 (group 1), RN6923 (group 2), RN8462 (group 3), and A880740 (group 4) (Fig. 4). We then used the above multiplex PCR to analyze the population of strains isolated from cows with mastitis. All of the 71 strains but 1 gave an amplifiable product. The latter strain is the one giving an agr amplicon of reduced length and was shown by restriction analysis to have a deletion of the sequence corresponding to the agr group 1- and group 3-specific primers (Fig. 3). As the 3' extremity of this amplicon possesses the characteristic restriction sites of group 1 strains and not those of group 3 strains, we definitely classify this strain in the agr group 1.
The
agr group-specific multiplex PCR confirms the above
agr group classification of strains made by restriction analysis.
Nevertheless, strains 125 and 130 isolated in Japan, tentatively
classified by restriction analysis in group 1, are now classified
by multiplex PCR in groups 2 and 3, respectively. This is due
to the fact that primers agr2 and agr3 are not localized in
the 3' extremity of the
agr variable region, which for these
two strains is characteristic of group 1. These two strains
are probably in a process of evolution from group 1 to groups
2 and 3, respectively. The classification of all six human strains
used as controls into
agr groups was also confirmed. The majority
of strains isolated from cows with mastitis belong to
agr group1
(69.0%) and to
agr group 2 (23.9%). Groups 3 and 4 contain only
2.8 and 1.4% of the analyzed strains, respectively. As discussed
above, the classification of two strains (strains 125 and 130)
is uncertain.
trap restriction fragment length polymorphism.
As TRAP has been proved to be a component of a membrane-associated sensor able to induce the synthesis of RNA III via a signal transduction pathway other than agr, we analyzed whether trap interstrain variation, similar to that which was found for agr, does exist. To this end, we first aligned the trap sequences of six strains whose genomes are sequenced. Theoretical restrictions with MseI (a frequently cutting enzyme in trap) show that the agr group 1 or 2 strains COL, NCTC 8325, N315, and Mu50 have a similar MseI restriction profile and that this profile is different from those of the agr group 3 strains MRSA-252 and MSSA-476 (results not shown). These preliminary results indicate that trap is polymorphic and suggest that a relation between trap types and agr group could perhaps exist. This prompted us to analyze the entire S. aureus population isolated from cows with mastitis for trap polymorphism.
trap genes were amplified from all strains by PCR and restricted with MseI. This allowed the identification of four different restriction types among the analyzed population (Fig. 5). The vast majority of strains isolated from cows belong to trap type 1 (71.8%). Types 2, 3, and 4 account for 18.3, 7.0, and 2.8% of the analyzed strains, respectively (Table 1). It is worth noting that we were previously unable to amplify the variable region of the agr locus in the only two strains of trap type 4 identified (Table 1). The human sequenced strains COL, NCTC 8325, Mu50, and N315 belong to trap type 1, whereas strains MRSA-252 and MSSA-476 belong to trap types 2 and 3, respectively.
No particular relationship between unique
agr group and
trap type could be displayed. Indeed, our experiments showed that
the
agr groups 2, 1, and 3 contain strains of
trap types 1 to
4, strains of
trap types 1 to 3, and strains of
trap types 2
and 3, respectively. The
agr group 4 contains a unique strain
of
trap type 2 (Table
1). Whereas no relationship was found
between
agr groups and
trap types, strains possessing a similar
agr restriction type were also found to possess a similar
trap type. Agr types R IV-A5 (containing strains of
trap types 1
and 3) and R VI-A8 (containing strains of
trap types 2 and 3)
are nevertheless an exception to this rule (Table
1).

DISCUSSION
Polymorphism in the
agr locus was first described by Ji et al.
(
15). This led to the classification of
S. aureus isolates into
four different interference groups (
12,
15). Later, sequence
variations within groups were also found (
20,
25,
28,
29). In
this work, we identified 14 different
agr restriction types
among the analyzed strains. Nevertheless, only 12 of them were
present in our collection of bovine mastitis isolates. On the
basis of the restriction maps of the
agr variable region, we
classified all
agr types in one of the four interference groups
(Fig.
3). This classification was confirmed by the
agr group-specific
PCR also developed in this work. Whereas strains belonging to
each of the four
agr groups were found, most of them (69.0%)
were assigned to group 1. This repartition of strains among
interference groups is quite similar to what was described by
Moore and Lindsay for methicillin-sensitive hospital strains
(
19). The restriction sites used as markers to discriminate
agr alleles indicate that the
agrD sequences are stable within
each interference group. Most mutations within groups appear
to arise in
agrC, the gene encoding the receptor of the AIP.
Those mutations are probably not in sequences coding for amino
acids interacting with the inducing peptide. The position of
the
AluI and
RsaI sites in
agrD seems to be sufficient to assign
a strain to a particular
agr group, whereas restriction sites
characteristic of each group can also be found in other genes
of this region (Fig.
3). This adds to previous reports showing
that genes of the
agr locus are submitted to a coevolutionary
pressure, allowing the binding of a modified AIP to the receptor
(
15,
22). Our classification indicates that type R VII-A12 and
type R IX-A11 are particular with respect to the coevolution
of the propeptide and its receptor. Indeed, the receptor-encoding
genes of type R VII-A12 and R IX-A11 are highly similar to those
of the
agr group 1 strains, whereas their propeptide-encoding
genes are highly similar to those of groups 3 and 2, respectively.
The fact that the propeptide and its receptor belong to different
interference groups suggests that strains of type R VII-A12
and type R IX-A11 are impaired in the activation of RNA III
by the
agr system. We postulate that these two types are in
a process of evolution from group 1 to groups 2 and 3, respectively.
We also identified a strain (type R VII-A3) which has a deletion
of the complete
agrD gene and which should thus also be impaired
in the activation of RNA III by the
agr system. Strains of types
R VII-A12, R IX-A11, and R VII-A3 are nevertheless virulent,
because they were all isolated from the milk of cows with mastitis.
In connection with this, Wesson et al. showed that a strain
mutated in
agr was internalized by cultured bovine mammary epithelial
cells at a level greater than the wild-type strain but contrary
to the wild type failed to induce apoptosis (
31). Others have
also isolated virulent
S. aureus strains with an inactivated
agr system (
30). These strains show increased adherence and
biofilm formation, and these properties were considered important
for the development of chronic infection (
24).
We were also interested to know if the RAP-TRAP system is polymorphic and ubiquitously associated with S. aureus strains. We identified the trap gene in all strains analyzed, and we proved that at least four different alleles exist. We also tried to learn if different alleles of the RAP-encoding gene exist. As the nucleotide sequence of RAP is unknown, we made BlastN searches with the available RAP NH2-terminal sequence (IKKYKPITN). Curiously, homologies were only found with the well-conserved L2 ribosomal protein of S. aureus (results not shown). The identification of the TRAP activator thus needs further clarification, as it is difficult to understand how a conserved ribosomal protein is able to activate the two-component system. RNA III-inhibiting peptide (RIP), a peptide of sequence YSPXTNF, isolated from culture supernatants of a coagulase-negative Staphylococcus species that is believe to be S. xylosus, was found to compete with RAP on inducing TRAP phosphorylation. This leads to inhibition of RNA III synthesis and to diminution of the virulence phenotype (2, 3, 9). These results need now to be extended to strains belonging to each of the four trap types identified in this work. With the exception of the Newbould 305 and the NCTC 8325 strains that we classified as trap type 1, nothing is known about the allelic variation of trap in the strains previously tested for inhibition by RIP. As we have shown that most of the S. aureus strains (71.8%) are trap type 1, it can be speculated that most, if not all, of the strains tested for inhibition by RIP are also trap type 1. It is thus still possible that RIP is not able to inhibit RNA synthesis in the other three trap types. Furthermore, it is also unknown if RAP purified from strains belonging to each of the four trap types are, as AIPs isolated from each of the four agr types, able to activate RNA III synthesis in strains of the same type and to inhibit this synthesis in strains of different types.
Most of the strains (56.3%) isolated from cows with mastitis belong to the agr R III-A1, trap 1 type. Our data indicate that strains belonging to this type have been able to infect cows from at least the end of the 1950s to date. The agr R III-A1, trap 1 type is also the type of the Newbould 305 strain (ATCC 29470), a strain isolated in the United States and widely used for experimental mastitis. This indicates that this type is not linked to a particular geographical location (under the circumstances of this work, France). The presence at a high prevalence of type agr R III-A1, trap 1 in the population of strains isolated from cows with mastitis suggests that this type has unique characteristics which, in contrast to the other rare types, endow it with superior ability to infect the bovine mammary gland. The agr R III-A1, trap 1 type is thus probably an S. aureus lineage that expands in the bovine population due to its possession of a unique combination of virulence genes. As no strain isolated from humans, whose agr sequence is available from GenBank, was found to belong to the R III-A1 type, it is tempting to think that on the contrary this S. aureus type is rarely isolated in the human population and that other agr and trap types are predominantly associated with human disease. This hypothesis will now be tested by analyzing the polymorphism of agr and trap in a population of S. aureus strains isolated from humans. Previous works using other methods also indicated that S. aureus isolated from humans and from cows has a predominantly clonal structure and that, whereas numerous types could be identified, only few of them are predominantly associated with a particular host and disease (1, 5-8, 13, 16, 33). The identification and characterization of a disease-dominant lineage(s) are very important for the development of vaccines and diagnostic tests. It could be expected that such works will lead in the future to the discovery of genetic determinants responsible for the tropism of different S. aureus lineages for specific hosts and tissues and to the development of new prophylactic and diagnostic tools.

ADDENDUM
The sequence of the whole genome of MW2, a strain of community-acquired
methicillin-resistant
S. aureus, became available after this
paper was submitted (GenBank accession no.
AP004822 to
AP004832).
This strain falls into the classifications
agr group 3 (type
R VI-A8) and
trap type 3.

ACKNOWLEDGMENTS
We thank Mark Enright (University of Bath, Bath, United Kingdom)
for the gift of strains MRSA-252 and MSSA-476, John Iandolo
(University of Oklahoma, Oklahoma City) for the gift of strain
NCTC 8325, Keiichi Hiramatsu (Juntendo University, Tokyo, Japan)
for the gift of strains N315 and Mu50, Philippe Moreillon (Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland) for
the gift of strain COL, and Shotaro Takeuchi (Fukui Prefectural
University, Fukui, Japan) for the gift of strains 125 and 130.
The release of preliminary sequence data by the
S. aureus NCTC
8325 Genome Sequencing Team at the University of Oklahoma Health
Sciences Center, by the
S. aureus MRSA-252 and MSSA-476 Sequencing
Group at the Sanger Institute, and by the
S. aureus COL Sequencing
Team at The Institute for Genomic Research is acknowledged.
We are grateful to Martine Braibant for careful reading of the
manuscript.
This work was supported by a grant (AIP P00060, P00223) from the French association Bureau des Ressources Génétiques (BRG).

FOOTNOTES
* Corresponding author. Mailing address: Laboratoire de Pathologie Infectieuse et Immunologie, Institut National de la Recherche Agronomique (INRA), 37380 Nouzilly, France. Phone: 33-2-47 42 78 78. Fax: 33-2-47 42 77 79. E-mail:
gilot{at}tours.inra.fr.


REFERENCES
1 - Akineden, O., C. Annemüller, A. Hassan, C. Lämmler, W. Wolter, and M. Zschöck. 2001. Toxin genes and other characteristics of Staphylococcus aureus isolates from milk of cows with mastitis. Clin. Diagn. Lab. Immunol. 8:959-964.[Abstract/Free Full Text]
2 - Balaban, N., L. V. Collins, J. S. Cullor, E. B. Hume, E. Medina-Acosta, O. Vieira da Motta, R. O'Callaghan, P. V. Rossitto, M. E. Shirtliff, L. Serafim da Silveira, A. Tarkowski, and J. V. Torres. 2000. Prevention of diseases caused by Staphylococcus aureus using the peptide RIP. Peptides 21:1301-1311.[CrossRef][Medline]
3 - Balaban, N., T. Goldkorn, Y. Gov, M. Hirshberg, N. Koyfman, H. R. Matthews, R. T. Nhan, B. Singh, and O. Uziel. 2001. Regulation of Staphylococcus aureus pathogenesis via target of RNAIII-activating protein (TRAP). J. Biol. Chem. 276:2658-2667.[Abstract/Free Full Text]
4 - Boom, R., C. J. Sol, M. M. Salimans, C. L. Jansen, P. M. Wertheim-van Dillen, and J. van der Noordaa. 1990. Rapid and simple method for purification of nucleic acids. J. Clin. Microbiol. 28:495-503.[Abstract/Free Full Text]
5 - Booth, M. C., L. M. Pence, P. Mahasreshti, M. C. Callegan, and M. S. Gilmore. 2001. Clonal associations among Staphylococcus aureus isolates from various sites of infection. Infect. Immun. 69:345-352.[Abstract/Free Full Text]
6 - Day, N. P., C. E. Moore, M. C. Enright, A. R. Berendt, J. M. Smith, M. F. Murphy, S. J. Peacock, B. G. Spratt, and E. J. Feil. 2001. A link between virulence and ecological abundance in natural populations of Staphylococcus aureus. Science 292:114-116.[Abstract/Free Full Text]
7 - Enright, M. C., N. P. Day, C. E. Davies, S. J. Peacock, and B. G. Spratt. 2000. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J. Clin. Microbiol. 38:1008-1015.[Abstract/Free Full Text]
8 - Fitzgerald, J., W. Meaney, P. Hartigan, C. Smyth, and V. Kapur. 1997. Fine-structure molecular epidemiological analysis of Staphylococcus aureus recovered from cows. Epidemiol. Infect. 119:261-269.[CrossRef][Medline]
9 - Gov, Y., A. Bitler, G. Dell'Acqua, J. V. Torres, and N. Balaban. 2001. RNA III inhibiting peptide (RIP), a global inhibitor of Staphylococcus aureus pathogenesis: structure and function analysis. Peptides 22:1609-1620.[CrossRef][Medline]
10 - Hogan, J., R. Gonzalez, R. Harmon, S. Nickerson, S. Oliver, J. Pankey, and K. Smith. 1999. Laboratory handbook on bovine mastitis. National Mastitis Council, Inc., Madison, Wis.
11 - Hunter, P. R., and M. A. Gaston. 1988. Numerical index of the discriminatory ability of typing systems: an application of Simpson's index of diversity. J. Clin. Microbiol. 26:2465-2466.[Abstract/Free Full Text]
12 - Jarraud, S., G. Lyon, A. Figueiredo, G. Lina, F. Vandenesch, J. Etienne, T. Muir, and R. Novick. 2000. Exfoliatin-producing strains define a fourth agr specificity group in Staphylococcus aureus. J. Bacteriol. 182:6517-6522.[Abstract/Free Full Text]
13 - Jarraud, S., C. Mougel, J. Thioulouse, G. Lina, H. Meugnier, F. Forey, X. Nesme, J. Etienne, and F. Vandenesch. 2002. Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect. Immun. 70:631-641.[Abstract/Free Full Text]
14 - Ji, G., R. Beavis, and R. Novick. 1995. Cell density control of staphylococcal virulence mediated by an octapeptide pheromone. Proc. Natl. Acad. Sci. USA 92:12055-12059.[Abstract/Free Full Text]
15 - Ji, G., R. Beavis, and R. P. Novick. 1997. Bacterial interference caused by autoinducing peptide variants. Science 276:2027-2030.[Abstract/Free Full Text]
16 - Kapur, V., W. M. Sischo, R. S. Greer, T. S. Whittam, and J. M. Musser. 1995. Molecular population genetic analysis of Staphylococcus aureus recovered from cows. J. Clin. Microbiol. 33:376-380.[Abstract]
17 - Kluytmans, J., A. van Belkum, and H. Verbrugh. 1997. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin. Microbiol. Rev. 10:505-520.[Abstract]
18 - Kuroda, M., T. Ohta, I. Uchiyama, et al. 2001. Whole genome sequencing of methicillin-resistant Staphylococcus aureus. Lancet 357:1225-1240.[CrossRef][Medline]
19 - Moore, P. C., and J. A. Lindsay. 2001. Genetic variation among hospital isolates of methicillin-sensitive Staphylococcus aureus: evidence for horizontal transfer of virulence genes. J. Clin. Microbiol. 39:2760-2767.[Abstract/Free Full Text]
20 - Mullarky, I. K., C. Su, N. Frieze, Y. H. Park, and L. M. Sordillo. 2001. Staphylococcus aureus agr genotypes with enterotoxin production capabilities can resist neutrophil bactericidal activity. Infect. Immun. 69:45-51.[Abstract/Free Full Text]
21 - Neave, F., and J. Oliver. 1962. The relationship between the number of mastitis pathogens placed on the teats of dry cows, their survival, and the amount of intramammary infection caused. J. Dairy Res. 29:79-93.
22 - Novick, R. 2000. Pathogenicity factors of Staphylococcus aureus and their regulation, p. 392-407. In V. Fischetti (ed.), Gram-positive pathogens. ASM Press, Washington, D.C.
23 - Novick, R. P., H. F. Ross, S. J. Projan, J. Kornblum, B. Kreiswirth, and S. Moghazeh. 1993. Synthesis of staphylococcal virulence factors is controlled by a regulatory RNA molecule. EMBO J. 12:3967-3975.[Medline]
24 - Otto, M. 2001. Staphylococcus aureus and Staphylococcus epidermidis peptide pheromones produced by the accessory gene regulator agr system. Peptides 22:1603-1608.[CrossRef][Medline]
25 - Papakyriacou, H., D. Vaz, A. Simor, M. Louie, and M. McGavin. 2000. Molecular analysis of the accessory gene regulator (agr) locus and balance of virulence factor expression in epidemic methicillin-resistant Staphylococcus aureus. J. Infect. Dis. 181:990-1000.[CrossRef][Medline]
26 - Prasad, L., and F. Newbould. 1968. Inoculation of the bovine teat duct with Staphylococcus aureus: the relationship of teat duct length, milk yield and milking rate to development of intramammary infection. Can. Vet. J. 9:107-115.[Medline]
27 - Sutra, L., and B. Poutrel. 1994. Virulence factors involved in the pathogenesis of bovine intramammary infections due to Staphylococcus aureus. J. Med. Microbiol. 40:79-89.[Abstract/Free Full Text]
28 - Takeuchi, S., T. Maeda, N. Hashimoto, K. Imaizumi, T. Kaidoh, and Y. Hayakawa. 2001. Variation of the agr locus in Staphylococcus aureus isolates from cows with mastitis. Vet. Microbiol. 79:267-274.[CrossRef][Medline]
29 - van Leeuwen, W., W. van Nieuwenhuizen, C. Gijzen, H. Verbrugh, and A. van Belkum. 2000. Population studies of methicillin-resistant and -sensitive Staphylococcus aureus strains reveal a lack of variability in the agrD gene, encoding a staphylococcal autoinducer peptide. J. Bacteriol. 182:5721-5729.[Abstract/Free Full Text]
30 - Vuong, C., H. L. Saenz, F. Gotz, and M. Otto. 2000. Impact of the agr quorum-sensing system on adherence to polystyrene in Staphylococcus aureus. J. Infect. Dis. 182:1688-1693.[CrossRef][Medline]
31 - Wesson, C. A., L. E. Liou, K. M. Todd, G. A. Bohach, W. R. Trumble, and K. W. Bayles. 1998. Staphylococcus aureus Agr and Sar global regulators influence internalization and induction of apoptosis. Infect. Immun. 66:5238-5243.[Abstract/Free Full Text]
32 - West, A., and A. Stock. 2001. Histidine kinases and response regulator proteins in two-component signaling systems. Trends Biochem. Sci. 26:369-376.[CrossRef][Medline]
33 - Zadoks, R., W. van Leeuwen, H. Barkema, O. Sampimon, H. Verbrugh, Y. H. Schukken, and A. van Belkum. 2000. Application of pulsed-field gel electrophoresis and binary typing as tools in veterinary clinical microbiology and molecular epidemiologic analysis of bovine and human Staphylococcus aureus isolates. J. Clin. Microbiol. 38:1931-1939.[Abstract/Free Full Text]
Journal of Clinical Microbiology, November 2002, p. 4060-4067, Vol. 40, No. 11
0095-1137/02/$04.00+0 DOI: 10.1128/JCM.40.11.4060-4067.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
This article has been cited by other articles:
-
Wang, W.-Y., Lee, S.-Y., Chiueh, T.-S., Lu, J.-J.
(2009). Molecular and Phenotypic Characteristics of Methicillin-Resistant and Vancomycin-Intermediate Staphylococcus aureus Isolates from Patients with Septic Arthritis. J. Clin. Microbiol.
47: 3617-3623
[Abstract]
[Full Text]
-
Smyth, D. S., Feil, E. J., Meaney, W. J., Hartigan, P. J., Tollersrud, T., Fitzgerald, J. R., Enright, M. C., Smyth, C. J.
(2009). Molecular genetic typing reveals further insights into the diversity of animal-associated Staphylococcus aureus. J Med Microbiol
58: 1343-1353
[Abstract]
[Full Text]
-
Ohkura, T., Yamada, K., Okamoto, A., Baba, H., Ike, Y., Arakawa, Y., Hasegawa, T., Ohta, M.
(2009). Nationwide epidemiological study revealed the dissemination of meticillin-resistant Staphylococcus aureus carrying a specific set of virulence-associated genes in Japanese hospitals. J Med Microbiol
58: 1329-1336
[Abstract]
[Full Text]
-
Sun, W., Chen, H., Liu, Y., Zhao, C., Nichols, W. W., Chen, M., Zhang, J., Ma, Y., Wang, H.
(2009). Prevalence and Characterization of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Isolates from 14 Cities in China. Antimicrob. Agents Chemother.
53: 3642-3649
[Abstract]
[Full Text]
-
Moise, P. A., Smyth, D. S., Robinson, D. A., El-Fawal, N., McCalla, C., Sakoulas, G.
(2009). Genotypic and phenotypic relationships among methicillin-resistant Staphylococcus aureus from three multicentre bacteraemia studies. J Antimicrob Chemother
63: 873-876
[Abstract]
[Full Text]
-
Collery, M. M., Smyth, D. S., Tumilty, J. J. G., Twohig, J. M., Smyth, C. J.
(2009). Associations between enterotoxin gene cluster types egc1, egc2 and egc3, agr types, enterotoxin and enterotoxin-like gene profiles, and molecular typing characteristics of human nasal carriage and animal isolates of Staphylococcus aureus. J Med Microbiol
58: 13-25
[Abstract]
[Full Text]
-
McCalla, C., Smyth, D. S., Robinson, D. A., Steenbergen, J., Luperchio, S. A., Moise, P. A., Fowler, V. G. Jr., Sakoulas, G.
(2008). Microbiological and Genotypic Analysis of Methicillin-Resistant Staphylococcus aureus Bacteremia. Antimicrob. Agents Chemother.
52: 3441-3443
[Abstract]
[Full Text]
-
Ruimy, R., Maiga, A., Armand-Lefevre, L., Maiga, I., Diallo, A., Koumare, A. K., Ouattara, K., Soumare, S., Gaillard, K., Lucet, J.-C., Andremont, A., Feil, E. J.
(2008). The Carriage Population of Staphylococcus aureus from Mali Is Composed of a Combination of Pandemic Clones and the Divergent Panton-Valentine Leukocidin-Positive Genotype ST152. J. Bacteriol.
190: 3962-3968
[Abstract]
[Full Text]
-
Chung, H.-J., Jeon, H.-S., Sung, H., Kim, M.-N., Hong, S.-J.
(2008). Epidemiological Characteristics of Methicillin-Resistant Staphylococcus aureus Isolates from Children with Eczematous Atopic Dermatitis Lesions. J. Clin. Microbiol.
46: 991-995
[Abstract]
[Full Text]
-
Collery, M. M., Smyth, D. S., Twohig, J. M., Shore, A. C., Coleman, D. C., Smyth, C. J.
(2008). Molecular typing of nasal carriage isolates of Staphylococcus aureus from an Irish university student population based on toxin gene PCR, agr locus types and multiple locus, variable number tandem repeat analysis. J Med Microbiol
57: 348-358
[Abstract]
[Full Text]
-
Goldsworthy, M. J. H.
(2008). Gene expression of Pseudomonas aeruginosa and MRSA within a catheter-associated urinary tract infection biofilm model. Bioscience Horizons
1: 28-37
[Abstract]
[Full Text]
-
Moise, P. A., Smyth, D. S., El-Fawal, N., Robinson, D. A., Holden, P. N., Forrest, A., Sakoulas, G.
(2008). Microbiological effects of prior vancomycin use in patients with methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother
61: 85-90
[Abstract]
[Full Text]
-
Tsang, L. H., Daily, S. T., Weiss, E. C., Smeltzer, M. S.
(2007). Mutation of traP in Staphylococcus aureus Has No Impact on Expression of agr or Biofilm Formation. Infect. Immun.
75: 4528-4533
[Abstract]
[Full Text]
-
Rossney, A. S., Shore, A. C., Morgan, P. M., Fitzgibbon, M. M., O'Connell, B., Coleman, D. C.
(2007). The Emergence and Importation of Diverse Genotypes of Methicillin-Resistant Staphylococcus aureus (MRSA) Harboring the Panton-Valentine Leukocidin Gene (pvl) Reveal that pvl Is a Poor Marker for Community-Acquired MRSA Strains in Ireland. J. Clin. Microbiol.
45: 2554-2563
[Abstract]
[Full Text]
-
Hallin, M., Denis, O., Deplano, A., De Mendonca, R., De Ryck, R., Rottiers, S., Struelens, M. J.
(2007). Genetic relatedness between methicillin-susceptible and methicillin-resistant Staphylococcus aureus: results of a national survey. J Antimicrob Chemother
59: 465-472
[Abstract]
[Full Text]
-
Buzzola, F. R., Alvarez, L. P., Tuchscherr, L. P. N., Barbagelata, M. S., Lattar, S. M., Calvinho, L., Sordelli, D. O.
(2007). Differential Abilities of Capsulated and Noncapsulated Staphylococcus aureus Isolates from Diverse agr Groups To Invade Mammary Epithelial Cells. Infect. Immun.
75: 886-891
[Abstract]
[Full Text]
-
Deplano, A., De Mendonca, R., De Ryck, R., Struelens, M. J.
(2006). External Quality Assessment of Molecular Typing of Staphylococcus aureus Isolates by a Network of Laboratories.. J. Clin. Microbiol.
44: 3236-3244
[Abstract]
[Full Text]
-
van Wamel, W. J. B., Rooijakkers, S. H. M., Ruyken, M., van Kessel, K. P. M., van Strijp, J. A. G.
(2006). The Innate Immune Modulators Staphylococcal Complement Inhibitor and Chemotaxis Inhibitory Protein of Staphylococcus aureus Are Located on {beta}-Hemolysin-Converting Bacteriophages. J. Bacteriol.
188: 1310-1315
[Abstract]
[Full Text]
-
Robinson, D. A., Monk, A. B., Cooper, J. E., Feil, E. J., Enright, M. C.
(2005). Evolutionary Genetics of the Accessory Gene Regulator (agr) Locus in Staphylococcus aureus. J. Bacteriol.
187: 8312-8321
[Abstract]
[Full Text]
-
Denis, O., Deplano, A., De Beenhouwer, H., Hallin, M., Huysmans, G., Garrino, M. G., Glupczynski, Y., Malaviolle, X., Vergison, A., Struelens, M. J.
(2005). Polyclonal emergence and importation of community-acquired methicillin-resistant Staphylococcus aureus strains harbouring Panton-Valentine leucocidin genes in Belgium. J Antimicrob Chemother
56: 1103-1106
[Abstract]
[Full Text]
-
Wright, J. S. III, Traber, K. E., Corrigan, R., Benson, S. A., Musser, J. M., Novick, R. P.
(2005). The agr Radiation: an Early Event in the Evolution of Staphylococci. J. Bacteriol.
187: 5585-5594
[Abstract]
[Full Text]
-
van Leeuwen, W. B., Melles, D. C., Alaidan, A., Al-Ahdal, M., Boelens, H. A. M., Snijders, S. V., Wertheim, H., van Duijkeren, E., Peeters, J. K., van der Spek, P. J., Gorkink, R., Simons, G., Verbrugh, H. A., van Belkum, A.
(2005). Host- and Tissue-Specific Pathogenic Traits of Staphylococcus aureus. J. Bacteriol.
187: 4584-4591
[Abstract]
[Full Text]
-
Cassat, J. E., Dunman, P. M., McAleese, F., Murphy, E., Projan, S. J., Smeltzer, M. S.
(2005). Comparative Genomics of Staphylococcus aureus Musculoskeletal Isolates. J. Bacteriol.
187: 576-592
[Abstract]
[Full Text]
-
Gomes, A. R., Vinga, S., Zavolan, M., de Lencastre, H.
(2005). Analysis of the Genetic Variability of Virulence-Related Loci in Epidemic Clones of Methicillin-Resistant Staphylococcus aureus. Antimicrob. Agents Chemother.
49: 366-379
[Abstract]
[Full Text]
-
Renzoni, A., Francois, P., Li, D., Kelley, W. L., Lew, D. P., Vaudaux, P., Schrenzel, J.
(2004). Modulation of Fibronectin Adhesins and Other Virulence Factors in a Teicoplanin-Resistant Derivative of Methicillin-Resistant Staphylococcus aureus. Antimicrob. Agents Chemother.
48: 2958-2965
[Abstract]
[Full Text]
-
Velazquez-Meza, M. E., Aires de Sousa, M., Echaniz-Aviles, G., Solorzano-Santos, F., Miranda-Novales, G., Silva-Sanchez, J., de Lencastre, H.
(2004). Surveillance of Methicillin-Resistant Staphylococcus aureus in a Pediatric Hospital in Mexico City during a 7-Year Period (1997 to 2003): Clonal Evolution and Impact of Infection Control. J. Clin. Microbiol.
42: 3877-3880
[Abstract]
[Full Text]
-
Corkill, J. E., Anson, J. J., Griffiths, P., Anthony Hart, C.
(2004). Detection of elements of the staphylococcal cassette chromosome (SCC) in a methicillin-susceptible (mecA gene negative) homologue of a fucidin-resistant MRSA. J Antimicrob Chemother
54: 229-231
[Abstract]
[Full Text]
-
Gov, Y., Borovok, I., Korem, M., Singh, V. K., Jayaswal, R. K., Wilkinson, B. J., Rich, S. M., Balaban, N.
(2004). Quorum Sensing in Staphylococci Is Regulated via Phosphorylation of Three Conserved Histidine Residues. J. Biol. Chem.
279: 14665-14672
[Abstract]
[Full Text]
-
Gilot, P., van Leeuwen, W.
(2004). Comparative Analysis of agr Locus Diversification and Overall Genetic Variability among Bovine and Human Staphylococcus aureus Isolates. J. Clin. Microbiol.
42: 1265-1269
[Abstract]
[Full Text]