ABSTRACT
USA300 methicillin-resistant Staphylococcus aureus (MRSA) isolates are usually resistant only to oxacillin, erythromycin, and, increasingly, levofloxacin. Of these, oxacillin and levofloxacin resistances are chromosomally encoded. Plasmid-mediated clindamycin, mupirocin, and/or tetracycline resistance has been observed among USA300 isolates, but these descriptions were limited to specific patient populations or isolated occurrences. We examined the antimicrobial susceptibilities of invasive MRSA isolates from a national surveillance population in order to identify USA300 isolates with unusual, possibly emerging, plasmid-mediated antimicrobial resistance. DNA from these isolates was assayed for the presence of resistance determinants and the presence of a pSK41-like conjugative plasmid. Of 823 USA300 isolates, 72 (9%) were tetracycline resistant; 69 of these were doxycycline susceptible and tet
K positive, and 3 were doxycycline resistant and tet
M positive. Fifty-one (6.2%) isolates were clindamycin resistant and erm
C positive; 22 (2.7%) isolates were high-level mupirocin resistant (mup
A positive); 5 (0.6%) isolates were trimethoprim-sulfamethoxazole (TMP-SMZ) resistant, of which 4 were dfr
A positive; and 7 (0.9%) isolates were gentamicin resistant and aac
6′-aph
2″ positive. Isolates with pSK41-like plasmids (n = 24) were positive for mup
A (n = 19), dfr
A (n = 6), aac
6′-aph
2″ (n = 6), tet
M (n = 2), and erm
C (n = 8); 20 pSK41-positive isolates were positive for two or more resistance genes. Conjugative transfer of resistance was demonstrated between four gentamicin- and mupirocin-resistant and three gentamicin- and TMP-SMZ-resistant USA300 isolates; transconjugants harbored a single pSK41-like plasmid, which was PCR positive for aac
6′-aph
2″ and either mup
A and/or dfr
A. USA300 and USA100 isolates from the same state with identical resistance profiles contained pSK41-like plasmids with indistinguishable restriction and Southern blot profiles, suggesting horizontal plasmid transfer between USA100 and USA300 isolates.
Detection of an Integrated Tetracycline Resistance Plasmid in the Chromosome of Methicillin-resistant Staphylococcus aureus
