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Transferable vancomycin resistance in a community-associated MRSA lineage.
N Engl J Med
April 2014
From the Department of Pathology, Division of Microbiology of the Central Laboratory (LIM 03) and Department of Infectious Disease (LIM 54), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (F.R., T.S.R.D.G., A.D., D.B., I.M.H.); Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota (L.D., D.P., S.R., J.R., L.P.C., C.A.A.), and Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Cali (A.H.-R.) - both in Colombia; Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile (J.M.M.); the Department of Internal Medicine, Division of Infectious Diseases (L.D., D.P., T.T.T., J.R., J.M.M., A.H.-R., B.E.M, C.A.A.), and the Department of Microbiology and Molecular Genetics (B.E.M., C.A.A.), University of Texas Medical School at Houston, and the University of Houston College of Pharmacy (T.T.T.) - both in Houston; the Genome Institute, Washington University at St. Louis, St. Louis (A.W., Y.Z., G.M.W.); and Sackler Institute for Comparative Genomics, American Museum of Natural History (A.N., P.J.P.), and Division of Pediatric Infectious Diseases, Columbia University (G.X., P.J.P.) - both in New York.
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.
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