Dissemination Of t437-SCCmecIV And Coagulase-Negative t037-SCCmecIII Types Among Borderline Oxacillin-Resistant Staphylococcus aureus Isolated From Skin Infections And Diabetic Foot Ulcers

BACKGROUND: In a recent decade, the occurrence of S. aureus isolates with low-level oxacillin resistance, have been reported increasingly. The aim of this study was to estimate the prevalence of S. aureus with low-level of oxacillin resistance and to determine their molecular characteristics, including spa types, SCCmec types and presence of toxin genes. METHODS: A total of 249 S. aureus strains were analyzed. Antimicrobial susceptibility was preliminarily tested by the disk diffusion method, and further was verified with the E-test and agar dilution methods. All borderline oxacillin-resistant strains (BORSA) were screened for the mecA gene and virulence factors, including Panton-Valentine leukocidin (PVL). Staphylococcal cassette chromosome mec (SCCmec) typing and spa typing were also carried out. RESULTS: Twelve (4.8%) borderline oxacillin-resistant strains with MIC ≤4 µg/mL were identified. Almost all strains (11/12) were oxacillin-susceptible methicillin resistant S. aureus carrying mecA gene (OS-MRSA). Among the 12 bordeline strains, five spa types (t437, t037, t015, t216, t267) and two SCCmec types (III, IV) were identified, with the most prevalent being t437-SCCmecIV pvl-positive. The second most frequent spa type, t037-SCCmecIII, was sea-positive and did not produce coagulase. The majority of borderline strains originated from skin infections and diabetic foot ulcers and were multidrug-resistant (macrolides, lincosamides and chloramphenicol). CONCLUSION: This study demonstrated that S. aureus with borderline resistance to oxacillin represented primarily SCCmecIV spa type t437 and coagulase-negative SCCmecIII spa type t037 and were isolated from skin infections and diabetic foot ulcers.