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Transferable Vancomycin Resistance in a Community-Associated MRSA Lineage

2014; Massachusetts Medical Society; Volume: 370; Issue: 16 Linguagem: Inglês

10.1056/nejmoa1303359

1533-4406

Flávia Rossi, Lorena Díaz, Aye Wollam, Diana Panesso, Yanjiao Zhou, Sandra Rincón, Apurva Narechania, Galen Xing, Thais Sabato Romano Di Gioia, André Mário Doi, Truc T. Tran, Jinnethe Reyes, José M. Munita, Lina P Carvajal, Alejandra Hernandez-Roldan, Denise Brandão, Inneke M. van der Heijden, Barbara E. Murray, Paul J. Planet, George M. Weinstock, César A. Arias,

Bacterial Identification and Susceptibility Testing

We report the case of a patient from Brazil with a bloodstream infection caused by a strain of methicillin-resistant Staphylococcus aureus (MRSA) that was susceptible to vancomycin (designated BR-VSSA) but that acquired the vanA gene cluster during antibiotic therapy and became resistant to vancomycin (designated BR-VRSA). Both strains belong to the sequence type (ST) 8 community-associated genetic lineage that carries the staphylococcal chromosomal cassette mec (SCCmec) type IVa and the S. aureus protein A gene (spa) type t292 and are phylogenetically related to MRSA lineage USA300. A conjugative plasmid of 55,706 bp (pBRZ01) carrying the vanA cluster was identified and readily transferred to other staphylococci. The pBRZ01 plasmid harbors DNA sequences that are typical of the plasmid-associated replication genes rep24 or rep21 described in community-associated MRSA strains from Australia (pWBG745). The presence and dissemination of community-associated MRSA containing vanA could become a serious public health concern.