This study aimed to evaluate the distribution of superantigen gene profiles and the presence of exfoliative toxin genes in community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) isolated from Chinese children, and simultaneously to assess virulence gene profiles and genetic background. Of the CA-MRSA isolates, 88.9 % (88/99) harboured toxin genes, with sek as the most frequent toxin gene (62.6  %), followed by seq (61.6  %), seb (60.6  %) and sea (35.4  %). The eta gene was detected only in one ST398-IVa-spa t034 strain. The sed and etd genes were not found in any of the isolates tested. A total of 38 virulence genotypes were observed, of which the genotype seb-sek-seq (27.3  %, 24/88) comprised the majority, followed by sea-seb-sek-seq (18.2  %, 16/88). The enterotoxin gene cluster including seg-sei-sem-sen-seo-seu predominated at a rate of 15.1  %. The relationship among toxin genotypes, toxin genes encoding profiles of mobile genetic elements and genetic background was analysed. Among 66 clonal complex (CC) 59 isolates, 87.9 % (58/66) were positive for toxin genes, and 75.8  % (50/66) harboured the toxin gene combination seb-sek-seq. Among seb-sek-seq-positive CC59 strains, 42.0  % (21/50) also carried the sea gene. CC59 corresponded exclusively to accessory gene regulator 1 (agr-1). The data presented here enhance our current knowledge on the virulence determinants of CA-MRSA.

The aim of this study was to investigate the molecular characteristics of community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates from Chinese children. Ninety-nine isolates were collected from eight hospitals, and analyzed by multilocus sequence typing, staphylococcal chromosomal cassette mec (SCCmec) type, and spa typing. The Panton-Valentine leukocidin (PVL) gene was also detected. Overall, 14 sequence types (STs) were obtained, and ST59 (58.6%) was found to be the most prevalent, followed by ST1 (8%) and ST338 (8%). We also first registered the new ST1409. SCCmec type IV was the most predominant type at 67.7%, followed by SCCmec type V at 32.3%. SCCmec subtypes IVa, IVc, and IVg were found among the SCCmec type IV strains. Twentyone spa types were also identified. Four new spa types were found by synchronization with the Ridom SpaServer and referring to the website (http://www.SeqNet. org). ST59-MRSA-IVa with t437 accounted for 40.4% of occurrences, making it the most prevalent clone. The prevalence of PVL genes was 58.6%, and multidrug resistance was observed in 95% of all isolates. This result indicates that CA-MRSA isolates in Chinese children are largely associated with the ST59-MRSA-IV clone, and that the predominant clones of CA-MRSA are spread all over the country.

Detailed molecular analyses of Clonal Complex 59 (CC59) methicillin-resistant Staphylococcus aureus (MRSA) isolates from children in seven major cities across Mainland China were examined. A total of 110 CC59 isolates from invasive and non-invasive diseases were analyzed by multilocus sequence typing (MLST), Staphylococcus cassette chromosome mec (SCCmec) typing, staphylococcal protein A (spa) typing and pulsed-field gel electrophoresis (PFGE). Antibiotics susceptibilities, carriage of plasmids and 42 virulence genes and the expression of virulence factors were examined. ST59 (101/110, 91.8%) was the predominant sequence type (ST), while single locus variants (SLVs) belonging to ST338 (8/110, 7.3%) and ST375 (1/110, 0.9%) were obtained. Three SCCmec types were found, namely type III (2.7%), type IV (74.5%) and type V (22.7%). Seven spa types including t437, which accounted for 87.3%, were determined. Thirteen PFGE types were obtained. PFGE types A and B were the major types totally accounting for 81.8%. The dominant clone was ST59-t437-IVa (65.5%), followed by ST59-t437-V (14.5%). The positive rate of luks-PV and lukF-PV PVL encoding (pvl) gene was 55.5%. Plasmids were detected in 83.6% (92/110) of the strains. The plasmid size ranging from 23.4 kb to 50 kb was most prevalent which accounted for 83.7% (77/92). A significantly lower expression of hla was found in ST59-t437-IVa compared with ST59-t437-V. Among the 110 cases, 61.8% of the patients were less than 1 year old. A total of 90 cases (81.8%) were community-associated (CA) infections whereas 20 cases (18.2%) were hospital-associated (HA) infections. Out of the 110 patients, 36.4% (40/110) were diagnosed with invasive infectious diseases in which ST59-t437-IVa accounted for 67.5% (27/40). In brief, ST59-t437-IVa was proved as the dominant clone in CC59 MRSA strains. The carriage rate of pvl gene was high. CC59 MRSA could result in CA and HA infections. The majortiy of MRSA infection children were in young age.

This study aimed to correlate the multidrug resistance (MDR) and sequence type (ST) clones of community-associated (CA) meticillin-resistant Staphylococcus aureus (MRSA) to identify the genes responsible for clindamycin and mupirocin resistance in S. aureus isolates from paediatric hospitals in mainland China. A total of 435 S. aureus isolates were collected. Compared with CA meticillinsusceptible S. aureus (MSSA), the resistance rates of CA-MRSA to ciprofloxacin, chloramphenicol, gentamicin and tetracycline were higher (19.0 vs 2.6 %, P,0.001; 14.7 vs 3.1 %, P,0.001; 14.7 vs 3.1 %, P,0.01; and 46.0 vs 13.3 %, P,0.001, respectively). Compared with hospital-associated (HA)-MRSA, the resistance rates of CA-MRSA to ciprofloxacin, gentamicin, rifampicin, tetracycline and trimethoprim-sulfamethoxazole were lower (19 vs 94.8 %, P,0.001; 14.7 vs 84.4 %, P,0.001; 5.5 vs 88.3 %, P,0.001; 46 vs 94.8 %, P,0.001; and 1.8 vs 9.1 %, P,0.01, respectively). The resistance rates of CA-MRSA, HA-MRSA and CA-MSSA to clindamycin (92.0, 77.9 and 64.1 %, respectively) and erythromycin (85.9, 77.9 and 63.1 %, respectively) were high. The MDR rates (resistance to three or more non-b-lactams) were 49.6, 100 and 14 % in the CA-MRSA, HA-MRSA and CA-MSSA isolates, respectively. Five of seven ST clones in the CA-MRSA isolates, namely ST59, ST338, ST45, ST910 and ST965, had MDR rates of .50 % (67.9, 87.5, 100, 50 and 83.3 %, respectively). The constitutive phenotype of macrolide-lincosamide-streptogramin B (MLS B ) resistance (69 %) and the ermB gene (38.1 %) predominated among the MLS B -resistant CA S. aureus strains. The resistance rate to mupirocin was 2.3 % and plasmids carrying the mupA gene varied in size between 23 and 54.2 kb in six strains with high-level resistance as determined by Southern blot analysis. The present study showed that resistance to non-b-lactams, especially to clindamycin, is high in CA-MRSA isolates from Chinese children and that the profile of resistance is related to clonal type. This study revealed distinctive patterns of MLS B -resistant genes among CA S. aureus isolates.

The aim of this study was to investigate the molecular characteristics of community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates from Chinese children. Ninety-nine isolates were collected from eight hospitals, and analyzed by multilocus sequence typing, staphylococcal chromosomal cassette mec (SCCmec) type, and spa typing. The Panton-Valentine leukocidin (PVL) gene was also detected. Overall, 14 sequence types (STs) were obtained, and ST59 (58.6%) was found to be the most prevalent, followed by ST1 (8%) and ST338 (8%). We also first registered the new ST1409. SCCmec type IV was the most predominant type at 67.7%, followed by SCCmec type V at 32.3%. SCCmec subtypes IVa, IVc, and IVg were found among the SCCmec type IV strains. Twentyone spa types were also identified. Four new spa types were found by synchronization with the Ridom SpaServer and referring to the website (http://www.SeqNet. org). ST59-MRSA-IVa with t437 accounted for 40.4% of occurrences, making it the most prevalent clone. The prevalence of PVL genes was 58.6%, and multidrug resistance was observed in 95% of all isolates. This result indicates that CA-MRSA isolates in Chinese children are largely associated with the ST59-MRSA-IV clone, and that the predominant clones of CA-MRSA are spread all over the country.