Transferable vancomycin resistance in a community-associated MRSA lineage

N Engl J Med. 2014 Apr 17;370(16):1524-31. doi: 10.1056/NEJMoa1303359.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Bacteremia / microbiology*
  • Brazil
  • Gene Transfer, Horizontal
  • Genome, Bacterial
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus / genetics*
  • Microbial Sensitivity Tests
  • Multigene Family
  • Mycosis Fungoides / complications
  • Plasmids / genetics
  • Sequence Analysis, DNA
  • Vancomycin Resistance / genetics*