A significant increase in the incidence of isolates of methicillin-resistant Staphylococcus aureus (MRSA), that were also resistant to lincosamides and streptogramin A (LSA-MRSA), was observed in a French university hospital. Twenty-seven isolates from the outbreak were characterised, including 17 isolates from a plastic surgery ward and six control strains of MRSA. The strains were examined by antibiotyping and biotyping, and by three molecular methods: plasmid analysis, ribotyping and insertion sequence (IS) typing with IS256 sequence as a probe. Antibiotyping (five antibiotypes) was discriminatory because of the uncommon resistance phenotype of the epidemic strain. Biotyping (three biotypes), DNA plasmid analysis (four profiles) and ribotyping (two profiles) were poorly sensitive, in contrast to IS-typing (12 profiles). By the latter method, a coefficient of similarity (percentage similarity) compared to the predominant IS profile was calculated. Strains with a coefficient of similarity ⩾ 82% were considered as highly related to the epidemic strain, while those with a coefficient of similarity ⩽ 40% were regarded as distant. Results obtained with the five markers confirmed that an outbreak of hospital infection had occurred in the plastic surgery ward, with spread of the epidemic strain throughout the hospital.
LaceyR. W.,
GrinstedJ. Genetic analysis of methicillin-resistant strains of Staphylococcus aureus: evidence for their evolution from a single clone. J Med Microbiol1973; 6:511–526
LeclercqR.,
CourvalinP. Intrinsic and unusual resistance to macrolide, lincosamide, and streptogramin antibiotics in bacteria. Antimicrob Agents Chemother1991; 35:1273–1276
ArcherG. L.,
MayhallC. G. Comparison of epidemiological markers used in the investigation of an outbreak of methicillin-resistant Staphylococcus aureus infections. J Clin Microbiol1983; 18:395–399
GoeringR. V.,
DuensingT. D. Rapid field inversion gel electrophoresis in combination with an rRNA gene probe in the epidemiological evaluation of staphylococci. J Clin Microbiol1990; 28:426–429
ZuccarelliA. J.,
RoyI.,
HardingG. P.,
CouperusJ. J. Diversity and stability of restriction enzyme profiles of plasmid DNA from methicillin-resistant Staphylococcus aureus. J Clin Microbiol1990; 28:97–102
BrosiusJ.,
UllrichA.,
RakerM. A. Construction and fine mapping of recombinant plasmids containing the rrnB ribosomal RNA operon of E. coli. Plasmid1981; 6:112–118
MahairasG. G.,
MinionF. C. Transformation of Mycoplasma pulmonis: demonstration of homologous recombination, introduction of cloned genes, and preliminary description of an integrating shuttle system. J Bacteriol1989; 171:1775–1780
De BuyserM. L.,
MorvanA.,
GrimontF.,
El SolhN. Characterization of Staphylococcus species by ribosomal RNA gene restriction patterns. J Gen Microbiol1989; 135:989–999
GrimontF.,
GrimontP. A. D. Ribosomal ribonucleic acid gene restriction patterns as potential taxonomic tools. Ann Inst Pasteur Microbiol1986; 137B:165–175
CollinsJ. K.,
SmithJ. S.,
KellyM. T. Comparison of phage typing, plasmid mapping and antibiotic resistance patterns as epidemiologic markers in a nosocomial outbreak of methicillin-resistant Staphylococcus aureus infections. Diagn Microbiol Infect Dis1984; 2:233–245
MulliganM. E.,
ArbeitR. D. Epidemiologic and clinical utility of typing systems for differentiating among strains of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol1991; 12:20–28
PfallerM. A. Typing methods for epidemiologic investigation. In
BalowsA.,
HauslerW. J.,
HerrmannK. L.,
IsenbergH. D.,
ShadomyH. J.
(eds) Manual of clinical microbiology 5th edn Washington, DC: American Society for Microbiology; 1991171–182
CristinoJ. A.,
PereiraA. T. Plasmid analysis of 219 methicillin-resistant Staphylococcus aureus strains with uncommon profiles isolated in Lisbon. J Hosp Infect1989; 13:133–141
BlumbergH. M.,
RimlandD.,
KiehlbauchJ. A.,
TerryP. M.,
WachsmuthI. K. Epidemiologic typing of Staphylococcus aureus by DNA restriction fragment length polymorphisms of rRNA genes: elucidation of the clonal nature of a group of bacteriophage-nontypeable, ciprofloxacinresistant, methicillin-susceptible S. aureus isolates. J Clin Microbiol1992; 30:362–369
Monzon-MorenoC.,
AubertS.,
MorvanA.,
El SolhN. Usefulness of three probes in typing isolates of methicillin-resistant Staphylococcus aureus (MRSA). J Med Microbiol1991; 35:80–88
Walcher-SalesseS.,
Monzon-MorenoC.,
AubertS.,
El SolhN. An epidemiological assessment of coagulase-negative staphylococci from an intensive care unit. J Med Microbiol1992; 36:321–331
LoncleV.,
CasettaA.,
Buu-HoiA.,
El SolhN. Analysis of pristinamycin-resistant Staphylococcus epidermidis isolates responsible for an outbreak in a Parisian Hospital. Antimicrob Agents Chemother1993; 37:2159–2165
GalasD. J.,
ChandlerM. Bacterial insertion elements. In
BergD. E.,
HoweM. M.
(eds) Mobile DNA Washington, DC: American Society for Microbiology; 1989109–162
TenoverF. C.,
ArbeitR.,
ArcherG. Comparison of traditional and molecular methods for typing isolates of Staphylococcus aureus. J Clin Microbiol1994; 32:407–415
StruelensM. J.,
DeplanoA.,
GodardC.,
MaesN.,
SerruysE. Epidemiologic typing and delineation of genetic relatedness of methicillin-resistant Staphylococcus aureus by macrorestriction analysis of genomic DNA by using pulsed-field gel electrophoresis. J Clin Microbiol1992; 30:2599–2605
SaulnierP.,
BoumeixC.,
PrévostG.,
AndremontA. Random amplified polymorphic DNA assay is less discriminant than pulsed-field gel electrophoresis for typing strains of methicillin-resistant Staphylococcus aureus. J Clin Microbiol1993; 31:982–985