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Brief report
Phenotypic and genotypic characterization of oxacillin-susceptible and mecA positive Staphylococcus aureus strains isolated in Uruguay
Caracterización fenotípica y genotípica de cepas de Staphylococcus aureus sensibles a oxacilina y mecA positivas aisladas en Uruguay
Lorena Pardoa, Guillermina Giudicea, María Inés Motaa,b, Claudia Gutiérrezc, Adriana Varelab, Gabriela Algortab, Verónica Seijac, Antonio Galianad, Paula Aguerreberee, Mónica Kleinf, Gustavo Varelaa,
Corresponding author
a Departamento de Bacteriología y Virología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
b Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
c Departamento de Laboratorio Clínico, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
d Laboratorio de Bacteriología, Hospital Maciel, Montevideo, Uruguay
e Laboratorio de Bacteriología, Instituto Asistencial Colectivo, Treinta y Tres, Uruguay
f Laboratorio de Bacteriología, Centro Asistencial Médico, Durazno, Uruguay
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus aureus</span> is responsible for a wide range of both community- and healthcare-acquired human diseases&#46; It is a main cause of skin and soft tissue infections but can also produce life-threatening illnesses&#46; &#946;-lactam antibiotics are widely used in medicine being generally effective for the treatment of illnesses caused by this bacterium&#46; However&#44; there are methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;MRSA&#41; strains circulating around the world&#44; questioning the empirical use of these antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Methicillin resistance in <span class="elsevierStyleItalic">S&#46; aureus</span> is mostly mediated by the expression of an additional penicillin-binding-protein 2a &#40;PBP2a&#41; with low affinity for &#946;-lactam antibiotics &#40;except ceftobiprole and ceftaroline&#41;&#44; encoded by the <span class="elsevierStyleItalic">mecA</span> gene or less frequently by the <span class="elsevierStyleItalic">mecC</span> gene&#46; This fact determines oxacillin minimum inhibitory concentrations &#40;MICs&#41; of &#8805;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#46; However&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> carrying the <span class="elsevierStyleItalic">mec</span>A gene but oxacillin-susceptible &#40;OS-MRSA&#41; &#40;MICs &#8804;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#41; has been described worldwide&#44; challenging its detection and treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;3&#44;11&#44;13</span></a> The difference between the phenotypic and genotypic results could be explained by two previously known phenomena&#58; the existence of strains with inducible resistance and strains with high heteroresistance to oxacillin&#46; In the former case&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> carrying the <span class="elsevierStyleItalic">mecA</span> gene becomes phenotypically oxacillin-resistant after exposure to oxacillin or cefoxitin&#59; in the second case&#44; gene expression and&#44; therefore&#44; oxacillin resistance&#44; occur in a few cells in the original bacterial population that are selected when the entire population is exposed to the antibiotic&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; nucleotide changes within the <span class="elsevierStyleItalic">mecA</span> gene&#44; determining the emergence of a premature stop codons that reverted by point mutations after exposure to cefoxitin&#44; restoring the gene expression and therefore the resistant phenotype&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> were described in OS-MRSA <span class="elsevierStyleItalic">mecA</span> positive and PBP2a negative strains &#40;known as &#8220;stealth methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span>&#8221;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Uruguay&#44; an OS-MRSA strain was previously reported in a case of infantile septic arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore&#44; we set out to investigate whether other OS-MRSA strains were circulating in our country and to know their phenotypic and genotypic characteristics&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Between January and June 2018&#44; we analyzed a set of 27&#44; consecutive&#44; non-duplicate <span class="elsevierStyleItalic">S&#46; aureus</span> strains with oxacillin MIC values between 1 and 2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml and negative cefoxitin screening test according to the Vitek 2 compact system &#40;bioM&#233;rieux&#44; AST-P577 card&#41;&#44; software version 6&#46;2&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The strains were isolated in different clinical microbiology laboratories at public and private health centers in Montevideo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; and 3 other regions&#58; Treinta y Tres &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; Durazno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; and Canelones &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and were recovered from skin and soft tissue infections &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&#44; blood &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; joint fluid &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and catheter tip &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; The strains were submitted to the Bacteriology and Virology department&#44; Medicine School&#44; Montevideo&#44; Uruguay&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This work was approved by the Ethics Committee of the Centro Hospitalario &#8220;Pereira Rossell&#8221;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We performed the cefoxitin disk diffusion test&#46; Testing for oxacillin and cefoxitin was also done by gradient diffusion tests&#46; Oxacillin MIC values of &#8804;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml and cefoxitin values of &#8804;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml were defined as susceptible&#46; <span class="elsevierStyleItalic">S&#46; aureus</span> ATCC 25923 and 29213 strains were used as quality controls <a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The 27 strains were again analyzed by the Vitek 2 compact system &#40;bioM&#233;rieux&#44; AST-P577 card&#41;&#44; software version 6&#46;2&#44; and also by Phoenix &#40;Becton Dickinson&#41; and MicroScan &#40;Siemens Healthcare Diagnostics&#41; panels&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">PBP2a production was determined by the PBP2a SA culture colony test &#40;Alere Inc&#46;&#44; Scarborough&#44; ME&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Detection of the <span class="elsevierStyleItalic">mecA</span> gene was carried out by PCR using the primers MECA P4 and MECA P7 according to Milheiri&#231;o et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> SCC<span class="elsevierStyleItalic">mec</span> typing was done by a multiplex PCR assay&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The obtained profiles by pulsed field gel electrophoresis &#40;PFGE&#41; with <span class="elsevierStyleItalic">Sma</span>I enzyme were analyzed by the unweighted pair group method with arithmetic average &#40;UPGMA&#41; using BioNumerics v&#46;7&#46;1&#46; The isolates with &#8805;80&#37; similarity were included in the same pulsotype &#40;PT&#41;&#44; while those that showed &#8805;95&#37; similarity were considered to have identical pulsotype&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleItalic">S&#46; aureus</span> subsp&#46; <span class="elsevierStyleItalic">aureus</span> &#40;strain NCTC 8325&#41; was included as reference&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the disk diffusion test&#44; 26 strains showed a cefoxitin inhibition zone of &#8804;21<span class="elsevierStyleHsp" style=""></span>mm &#40;resistant phenotype&#41; whereas only one displayed a diameter of 22<span class="elsevierStyleHsp" style=""></span>mm &#40;susceptible phenotype&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The mean value of the cefoxitin inhibition zone was 19<span class="elsevierStyleHsp" style=""></span>mm &#40;range 12&#8211;22&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">By the gradient diffusion test&#44; 3 strains were susceptible to cefoxitin &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#41;&#44; while the 24 remaining strains were resistant&#44; with MIC values of 6 to 8<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#46; Moreover&#44; 2 strains were resistant to oxacillin&#44; with MIC values of 4 and 8<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#44; one strain showed a MIC value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml and the remaining ones &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41; were defined as susceptible with MIC values of &#8804;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">All the strains &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41; were methicillin-susceptible&#44; 15 displayed the inducible resistance phenotype to macrolides&#44; lincosamides and streptogramin B antibiotics &#40;iMLSB&#41; and one was also resistant to gentamicin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; None of the strains showed resistance to the other antibiotics included in the panels&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Phoenix&#174; and MicroScan&#174; systems detected resistance to methicillin in 25 and 27 strains&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Twenty-six OS-MRSA strains tested positive for PBP2a&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">All strains tested positive for the <span class="elsevierStyleItalic">mecA</span> gene by PCR&#46; Twenty-six OS-MRSA strains carried SCC<span class="elsevierStyleItalic">mec</span> type <span class="elsevierStyleSmallCaps">V</span> and one the SCC<span class="elsevierStyleItalic">mec</span> type <span class="elsevierStyleSmallCaps">IV</span> &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; PFGE analysis showed that 24 strains belonged to a large cluster or pulsotype &#40;named A&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; that carried the SCC<span class="elsevierStyleItalic">mec</span> type <span class="elsevierStyleSmallCaps">V</span>&#46; At the moment and for economic reasons&#44; we performed the MLST assay in only one strain &#40;&#35; 25&#44; isolated from blood culture&#44; SCC<span class="elsevierStyleItalic">mec</span> type <span class="elsevierStyleSmallCaps">V</span> and PT A&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; that corresponded to sequence type 8 &#40;ST8&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">This study shows the spread of a set of <span class="elsevierStyleItalic">mecA</span> gene positive <span class="elsevierStyleItalic">S&#46; aureus</span> strains&#44; all misidentified as MSSA by the Vitek 2 system version 6&#46;2&#46; Similar isolates were previously reported from cases of human and animal infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;3&#44;10&#8211;12&#44;14</span></a> In Uruguay&#44; OS-MRSA was first reported by Giudice <span class="elsevierStyleItalic">et al</span>&#46;&#44; arising from a discrepancy in the methicillin susceptibility results between two isolates of <span class="elsevierStyleItalic">S&#46; aureus</span> recovered from two clinical samples of the same patient &#40;both strains carrying SCC<span class="elsevierStyleItalic">mec</span> type <span class="elsevierStyleSmallCaps">V</span> and with an identical <span class="elsevierStyleItalic">Sma</span>I-PFGE profile&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> Most strains analyzed in this study &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41; showed oxacillin MICs of &#8804;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml by the gradient diffusion test&#46; These data are consistent with the known fact that oxacillin is not reliable for the detection of methicillin resistance mediated by the <span class="elsevierStyleItalic">mecA</span> gene in <span class="elsevierStyleItalic">S&#46; aureus</span>&#46; Cefoxitin is more reliable but may not yet detect heterogeneous resistance to methicillin&#46; In this sense&#44; three strains were also misidentified as MSSA by the cefoxitin gradient diffusion test and one by the cefoxitin disk assay&#46; Anyway&#44; most strains showed cefoxitin inhibition zones close to the breakpoint value&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As we described before&#44; the discrepancy between these genotypic and phenotypic results could be due&#44; among other reasons&#44; to heterogeneously resistant and inducible MRSA strains&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;4&#44;14&#44;15</span></a> We believe that most of the OS-MRSA strains studied here &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#44; all of them PBP 2a-positive&#41; exhibit the oxacillin heteroresistance phenotype&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Only one strain was negative to PBP 2<span class="elsevierStyleHsp" style=""></span>a and could correspond to &#8220;stealth methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus</span>&#8221; <span class="elsevierStyleItalic">aureus</span> due to <span class="elsevierStyleItalic">mecA</span> gene instability&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> However&#44; to rule out or confirm this hypothesis&#44; it is necessary to carry out at least the complete sequencing of the <span class="elsevierStyleItalic">mecA</span> gene&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Additional problems for the correct identification of this MRSA could be related to the use of automated systems for identification and susceptibility testing&#46; In 2018&#44; the United States Food and Drug Administration recalled Vitek 2 Gram-positive antimicrobial susceptibility testing cards due to false results for some strains of MRSA&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Taking care of this matter&#44; the local agent of bio M&#233;rieux in Uruguay updated the Vitek 2 software to version 8&#46;01&#46; The 27 strains of OS-MRSA were subsequently retested using this new version&#44; and all of them were correctly identified as methicillin-resistant strains &#40;data not shown&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Unlike the findings of Andrade-Figueiredo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> in which the OS-MRSA strains analyzed were highly diverse by MLST and <span class="elsevierStyleItalic">Sma</span>I-PFGE&#44; the results of PFGE in this work suggest the dissemination of a cluster of <span class="elsevierStyleItalic">S&#46; aureus</span> with SCC<span class="elsevierStyleItalic">mec</span><span class="elsevierStyleSmallCaps">V</span> in 4 regions of Uruguay&#46; Interestingly&#44; a strain named SA454 with similar phenotypic and genotypic characteristics to most of those described in this work &#40;oxacillin MIC of 1<span class="elsevierStyleHsp" style=""></span>g&#47;ml by the E-test&#44; diameter of the inhibition halo<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>mm to cefoxitin disk&#44; <span class="elsevierStyleItalic">mecA</span> and PBP2a positive with SCC<span class="elsevierStyleItalic">mec</span><span class="elsevierStyleSmallCaps">V</span>&#44; recovered in 2009 from a patient with surgical site infection&#41; was previously reported in Argentina&#46; This suggests that similar or even identical OS-MRSA strains could be present in both countries of the R&#237;o de la Plata&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Other studies that compare in detail the genome of OS-MRSA strains present in both countries are needed to evaluate this hypothesis&#46; One of analyzed 27 strains corresponded to ST8&#59; to better assess the clonality of this set&#44; it would be necessary to carry out this and other procedures of molecular epidemiology on all of them&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">We analyzed 27 <span class="elsevierStyleItalic">S&#46; aureus</span> strains carrying the <span class="elsevierStyleItalic">mecA</span> gene that had laboratory problems to be identified as MRSA&#44; probably due to a heteroresistant phenotype&#46; The majority &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; exhibited SCC<span class="elsevierStyleItalic">mec</span> type <span class="elsevierStyleSmallCaps">V</span> and belonged to the same pulsotype&#46; The cefoxitin disk and the detection of PBP2a after the induction tests appear to be the most reliable to identify this OS-MRSA&#46; Both procedures are relatively simple and are available in low-complexity microbiology laboratories&#46; However&#44; we must bear in mind that they can yield false negative results&#59; therefore&#44; when there is a suspicion of MRSA for any clinical reason or in strains isolated from severe diseases&#44; it is advisable to use both tests and also detect the presence of the <span class="elsevierStyleItalic">mecA</span> and <span class="elsevierStyleItalic">mecC</span> genes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">This work was partially supported by a grant of the <span class="elsevierStyleGrantSponsor" id="gs1">Comisi&#243;n Sectorial de Investigaci&#243;n Cient&#237;fica &#40;CSIC&#41;&#44; Universidad de la Rep&#250;blica</span> &#91;initiation to research program &#8211; 2017&#93;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical responsibilities</span><p id="par0150" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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    "highlights" => array:2 [
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      "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0005" class="elsevierStylePara elsevierViewall">This study shows the spread of pathogenic strains of <span class="elsevierStyleItalic">S&#46; aureus</span> misidentified as MSSA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">The majority carried SCCmec type V and were located within the same pulsogroup&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">The cefoxitin disk and PBP 2a detection identified to most isolates such as MRSA&#46;</p></li></ul></p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to characterize phenotypically and genotypically 27 <span class="elsevierStyleItalic">mecA</span> positive <span class="elsevierStyleItalic">Staphylococcus aureus</span> strains with oxacillin MICs of &#8804;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml by Vitek 2&#44; isolated in different regions of Uruguay&#46; Susceptibility to oxacillin and cefoxitin was studied by gradient diffusion&#44; disk diffusion to cefoxitin&#44; and Phoenix and MicroScan systems&#46; PBP2a was determined&#46; SCC<span class="elsevierStyleItalic">mec</span> typing was performed and the isolates were compared by PFGE&#46; Twenty-six isolates were susceptible to oxacillin&#59; one strain was susceptible to cefoxitin by disk diffusion and 3 strains by gradient diffusion&#46; Phoenix and MicroScan panels detected methicillin resistance in 25 and 27 strains&#44; respectively&#46; Twenty-six strains tested positive for PBP2a&#46; Twenty-six strains carried SCC<span class="elsevierStyleItalic">mec</span> V and 24 belonged to pulsotype A&#46; One strain carried SCC<span class="elsevierStyleItalic">mec</span> IV and did not belong to pulsotype A&#46; Cefoxitin disk diffusion test and PBP2a detection correctly identified 26 of these 27 strains as MRSA&#46; PFGE results suggest the dissemination of a cluster of MRSA carrying SCC<span class="elsevierStyleItalic">mec</span> V&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue caracterizar fenot&#237;picamente y genot&#237;picamente 27 cepas de <span class="elsevierStyleItalic">Staphylococcus aureus</span> positivas para <span class="elsevierStyleItalic">mecA</span> y con CIM de oxacilina &#8804;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml seg&#250;n Vitek 2&#44; obtenidas en diferentes regiones del pa&#237;s&#46; La sensibilidad frente a la oxacilina y la cefoxitina se estudi&#243; por difusi&#243;n en gradiente&#44; por disco-difusi&#243;n &#40;cefoxitina&#41; y por los sistemas Phoenix y MicroScan&#46; Se analiz&#243; la portaci&#243;n de PBP2a&#44; se realiz&#243; la tipificaci&#243;n de SCC<span class="elsevierStyleItalic">mec</span> y las cepas se compararon mediante PFGE&#46; Resultaron sensibles a oxacilina por difusi&#243;n en gradiente 26 cepas&#59; una fue sensible a cefoxitina por disco-difusi&#243;n y 3 lo fueron por difusi&#243;n en gradiente&#46; Los sistemas Phoenix y MicroScan detectaron resistencia a meticilina en 25 y 27 cepas&#44; respectivamente&#46; Asimismo&#44; 26 cepas portaban PBP2a y 26 cepas mostraron presencia de SCC<span class="elsevierStyleItalic">mec</span><span class="elsevierStyleSmallCaps">V</span>&#44; 24 correspondieron al pulsotipo A&#46; Una portaba SCC<span class="elsevierStyleItalic">mec</span><span class="elsevierStyleSmallCaps">IV</span> y no perteneci&#243; al pulsotipo A&#46; La prueba de disco-difusi&#243;n con cefoxitina y la detecci&#243;n de PBP2a identificaron 26 de 27 cepas como MRSA&#46; La PFGE sugiere la diseminaci&#243;n de un grupo MRSA con SCC<span class="elsevierStyleItalic">mec</span><span class="elsevierStyleSmallCaps">V</span>&#46;</p></span>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Pulsed-field gel electrophoresis &#40;PFGE&#41; patterns and dendrogram of the <span class="elsevierStyleItalic">Sma</span>I-digested genomic DNA obtained from 27 OS-MRSA strains&#44; showing source and associated resistance profile&#46; Band patterns were analyzed by the unweighted pair group method with arithmetic average &#40;UPGMA&#41; using BioNumerics v&#46;7&#46;1&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Dashed line indicates 80&#37;&#59; main box indicates PG A with &#8805;80&#37; similarity&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">iMLSB&#44; inducible resistance to macrolides&#44; lincosamides and type B streptogramin&#59; GN&#44; resistance to gentamicin&#46;</p>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos