Correspondence

MRSA USA300 Clone and VREF — A U.S.–Colombian Connection?

N Engl J Med 2008; 359:2177-2179November 13, 2008

Article

To the Editor:

In the United States, the dissemination of a major clone of community-associated methicillin-resistant Staphylococcus aureus (MRSA), designated USA300, and outbreaks of vancomycin-resistant Enterococcus faecalis (VREF) have been described.1,2 Community-associated MRSA infections emerged in Colombia in 2005,3 and a total of 15 community-associated MRSA infections were documented in four cities in 2006 and 2007. All the patients presented with severe skin and soft-tissue infections, which were often complicated by necrotizing fasciitis, bacteremia, paraspinal abscess, arthritis, or meningitis, with a mortality rate of 20%. The first known Colombian VREF isolate was recovered in a hospital in Bogotá in 2001. Since then, additional isolates have been identified from 50 patients in seven Bogotá hospitals.

The Colombian MRSA isolates were susceptible to most antistaphylococcal antibiotics, although 40% were resistant to tetracycline. All isolates had staphylococcal chromosomal cassette mec (SCCmec) type IV, the Panton–Valentine leukocidin genes, and at least one of the toxins associated with USA3004 but did not have the arcA gene as a marker of the ACME (arginine catabolic mobile element) island. Pulsed-field gel electrophoresis and multilocus sequence typing revealed that all but one of the clinical isolates were ST8 and clonally related to USA300. The remaining isolate was a single-locus variant of ST8 (ST923) (Figure 1AFigure 1Representative Isolates of Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) from Colombia and the United States.). The majority of isolates carried SCCmec subtypes other than IVa, which suggests that a similar lineage of virulent, ST8, methicillin-susceptible S. aureus that independently acquired various SCCmec subtypes existed in both Colombia and the United States. To our knowledge, this is the first documentation of the USA300 community-associated MRSA lineage as the predominant (and exclusive) clone in a country other than the United States. No community-associated MRSA isolates belonging to a different clonal cluster have been documented by multilocus sequence typing in Colombia so far.

Pulsed-field gel electrophoresis also indicated that a single clone of vanB VREF has been disseminated in Bogotá (Figure 1B). This clone is genetically related to an ST2 outbreak strain (HV1) of VREF described in Houston in 1994.5 In addition, the allelic profile of the antigenic or resistance-associated genes ace, salA, and lsa (encoding an adhesin, a cell-wall antigen, and quinupristin–dalfopristin resistance, respectively) was identical in the two strains. Furthermore, the Houston and Colombian isolates had the same pathogenicity island profile, which has been suggested as an epidemiologic marker of more virulent clones of E. faecalis.5 To our knowledge, the only two epidemic strains of ST2 vanB-type E. faecalis that have been described are the Houston and Bogotá strains. Our findings suggest a close epidemiologic relationship between Colombia and the United States in these two pathogenic and resistant species.

Cesar A. Arias, M.D., Ph.D.
University of Texas Medical School at Houston, Houston, TX 77030
cesar.arias@uth.tmc.edu

Sandra Rincon, M.Sc.
Universidad El Bosque, Bogota, Colombia

Shahreen Chowdhury, B.S.
University of Texas Medical School at Houston, Houston, TX 77030

Ernesto Martínez, M.D.
Hospital Universitario del Valle, Cali, Colombia

Wilfrido Coronell, M.D.
Hospital Bocagrande, Cartagena, Colombia

Jinnethe Reyes, M.Sc.
Universidad El Bosque, Bogota, Colombia

Sreedhar R. Nallapareddy, M.Sc., Ph.D.
Barbara E. Murray, M.D.
University of Texas Medical School at Houston, Houston, TX 77030

Supported in part by a grant (R37-AI47923, to Dr. Murray) from the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), and by a K99/R00 Pathway to Independence Award (1K99-AI72961, to Dr. Arias) from NIAID.

Dr. Arias reports receiving lecture fees from Pfizer and Merck and grant support from Pfizer; Dr. Martinez, serving on advisory boards for Merck, Wyeth, Janssen Laboratories, Pfizer, and GlaxoSmithKline; Dr. Coronell, receiving consulting fees from Wyeth, GlaxoSmithKline, Merck, and Abbot; and Dr. Murray, receiving grant support from Johnson & Johnson, Astellas, and Intercell and consulting fees from Astellas, Theravance, Cubist, Targanta Therapeutics, Johnson & Johnson, Pfizer, AstraZeneca, and Wyeth. No other potential conflict of interest relevant to this letter was reported.

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Citing Articles (8)

Citing Articles

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   S. Monecke, H. Nitschke, P. Slickers, R. Ehricht, W. Swanston, M. Manjunath, R. Roberts, P. E. Akpaka. (2011) Molecular epidemiology and characterisation of MRSA isolates from Trinidad and Tobago. European Journal of Clinical Microbiology & Infectious Diseases
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   Patrick E Akpaka, Stefan Monecke, William H Swanston, AV Rao, Renee Schulz, Paul N Levett. (2011) Methicillin sensitive Staphylococcus aureus producing Panton-Valentine leukocidin toxin in Trinidad & Tobago: a case report. Journal of Medical Case Reports 5:1, 157
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   Tatsuo Yamamoto, Akihito Nishiyama, Tomomi Takano, Shizuka Yabe, Wataru Higuchi, Olga Razvina, Da Shi. (2010) Community-acquired methicillin-resistant Staphylococcus aureus: community transmission, pathogenesis, and drug resistance. Journal of Infection and Chemotherapy 16:4, 225-254
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   Teresa M. Coque, José L. Martínez. (2010) Diversificación y evolución clonal de patógenos grampositivos: nuevas perspectivas y retos en el siglo xxi. Enfermedades Infecciosas y Microbiología Clínica 28:6, 333-335
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   Carlos Arturo Alvarez, Nancy Yomayusa, Aura Lucia Leal, Jaime Moreno, Sebastian Mendez-Alvarez, Milciades Ibañez, Natasha Vanegas. (2010) Nosocomial infections caused by community-associated methicillin-resistant Staphylococcus aureus in Colombia. American Journal of Infection Control 38:4, 315-318
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   Martha Isabel Alvarez-Olmos, Sandra P. Enríquez, Eduardo Pérez-Roth, Sebastián Méndez-Alvarez, Javier Escobar, Natasha Vanegas, Jaime Moreno. (2009) Pediatric Cases From Colombia Caused by a Panton-Valentine Leukocidin-Positive Community-Acquired Methicillin-Resistant Staphylococcus aureus ST8-SCCmecIVc Clone. The Pediatric Infectious Disease Journal 28:10, 935
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   Henry F. Chambers, Frank R. DeLeo. (2009) Waves of resistance: Staphylococcus aureus in the antibiotic era. Nature Reviews Microbiology 7:9, 629-641
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   F. C. Tenover, R. V. Goering. (2009) Methicillin-resistant Staphylococcus aureus strain USA300: origin and epidemiology. Journal of Antimicrobial Chemotherapy 64:3, 441-446
   CrossRef