Molecular epidemiology studies have allowed the identification of the methicillin (meticillin)-resistant (MRSA) and methicillin-susceptible (MSSA) clonal complexes (CCs) and clones of, and CC59 were also detected. Many exotoxin genes were present in each of the 81 isolates, independent of whether they were involved in sepsis (11 to 22) or other types of infections (13 to 21), and they appeared in 73 combinations. The relevant data are that (i) all isolates were positive for hemolysin and leukotoxin genes (98.8% for lukED and 25.9% for lukPV); (ii) all contained an enterotoxin gene cluster (egc with or without seu), frequently with one or more genes encoding classical enterotoxins; (iii) about half were positive for tst and 95% were positive for exfoliatin-encoding genes (eta, etb, and/or etd); and (iv) the four agr groups were detected, with agrII (55.6%) and agrIII (23.5%) being the most frequent. Taken together, results of the present study suggest a frequent acquisition and/or loss of exotoxin genes, which may be mediated by efficient intralineage transfer of mobile genetic elements and exotoxin genes therein and by eventual breakage of interlineage barriers.Staphylococcus aureus is both a commensal bacterium and an extremely versatile pathogen that causes a wide range of diseases in humans, including superficial, deep-seated, and systemic infections, as well as a variety of toxemic syndromes, such as toxic shock syndrome (TSS), staphylococcal scaldedskin syndrome (SSSS), and staphylococcal food poisoning (36). S. aureus produces a wide range of virulence factors that mediate host colonization, invasion of damaged skin and mucosa, dissemination through the body, and evasion of host defense mechanisms (8,12). Relevant among them are a variety of exotoxins that comprise ␣-, -, ␥-, and ␦-hemolysins, leukotoxins (the classical LukS-PV-LukF-PV Panton-Valentine leukocidin [LukPV], LukE-LukD [LukED] and LukM-LukFЈ-PV [LukM]), exfoliative toxins, and pyrogenic toxin superantigens, such as the staphylococcal TSS toxin (TSST-1, first referred to as SEF) and staphylococcal enterotoxins (SEs) (14,29,43). Five major serological types of SEs, SEA through SEE (known as classical enterotoxins, encoded by the sea to see genes, respectively) have been initially identified. However, new types of SEs and their coding genes (seg through seu) were later reported. Several SE genes (seg, sei, sem, sen, and seo) are part of an operon termed the enterotoxin gene cluster (egc