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Volume 11, Number 6—June 2005
Dispatch

Community-acquired Methicillin-resistant Staphylococcus aureus, Uruguay

Xiao Xue Ma*, Antonio Galiana†, Walter Pedreira†‡, Martin Mowszowicz§, Inés Christophersen†, Silvia Machiavello†, Liliana Lope†, Sara Benaderet‡, Fernanda Buela‡, Walter Vicentino‡, María Albini¶, Olivier Bertaux†, Irene Constenla†, Homero Bagnulo†, Luis Llosa§, Teruyo Ito*, and Keiichi Hiramatsu*Comments to Author 
Author affiliations: *Juntendo University, Tokyo, Japan; †Hospital Maciel, Montevideo, Uruguay; ‡Centro de Asistencia del Sindicato Médico del Uruguay, Montevideo, Uruguay; §Ministerio del Interior, Montevideo, Uruguay; ¶Ministry of Public Health, Montevideo, Uruguay

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Table A1

Characteristics of 51 MRSA strains isolated in the study period and 17 MRSA strains isolated in prisons*

Pulsotype SCCmec type† No. of isolates Coagulase-isotype‡ Exotoxine genes§
PVL CNA SEH TSST1 bac Clinical category¶
MRSA strain isolated from patients
A1 IVc 28 4 + + – – – C-abscess(A-3[died, 1#], P-1), C-boils(A-5, P-1) C-cellulitis (A-1, P-1#) H-cellulitis(A-2[1#]), H-wound infection(A-3) C-hidradenitis (A-2) C-myositis (A-1) C-necro pneumo(A-2[died, 2#]), H-VAP(A-2) H-bone joint (A-1[died, 1#]), C-sepsis (A- 3[died, 1#])
A1 IVc 1 4 + – – – – C-wound infection (A-1)
A1 IVc 1 4 – – – – – H-VAP(A-1)
A1 IVc 1 4 – + – – – C-sepsis(A-1)#¶
A2 IVc 5 4 + + – – – C-abscess (A-1, P-2) C-cellulitis (A- 1) C-bone joint(A- 1)
A3 IVc 1 4 + + – – – C- necro pneumo (A-1[died, 1] #)
A4 IVc 1 4 + + – – – C-cellulitis (A-1)
B V 1 7 – + – + – H-atopic dermatitis (P-1)#¶
C1 IVa 2 2 – – – - – H-catheter-associated infection(P-1)# H-cer spin fluid shunt (P-1)
C2 IVc 1 2 – – – + – C-wound infection(A-1)
C2 V 1 2 – + – + – C-wound infection (A-1)
C3 II 2 2 – – – – – H-VAP (A-1), U-sepsis syndrome (A-1)#¶
C4 IVa 1 2 – – – + – U-sepsis syndrome (A-1)#
D IVc 1 5 – – – – – C-up resp tract (P-1)
E1 IVa 1 7 – + + – + C-pneumonia (A-1)
E2 V 1 7 – + + – + H-pneumonia (A-1)#
F IVa 2 NT – – – – – H-respiratory tract colonization (A-2)
MRSA strains isolated from prison
A1 IVc 13 4 + + – – – C-cellulitis (A-11), C-hidradenitis(A-2)
Reference strains
G III 4 – + – – + H-VAP(A-1)
(J4) IVa 7 + + + – + C-necro pneumo (died)

*MRSA, methicillin-resistant Staphylococcus aureus; hidradenitis, hidradenitis suppurativa; necro pneumo, necrotizing pneumonia; bone joint, bone and joint infection; VAP, ventilator-associated pneumonia; up resp tract, upper respiratory tract infection.
†SCCmec type was determined by polymerase chain reaction (PCR) amplification using the primer's sets described previously (6–8). The primers used for type IVc SCCmec element, 4c1 (5´-TCTATTCAATCGTTCTCGTATTT-3´) and 4c2 (5´-TCGTTGTCATTTAATTCTGAACT-3´), were designed based on the nucleotide sequence of type IVc SCCmec element of strain 81/108, deposited in DDBJ/EMBL/GenBank databases accession no. AB096217.
‡Coagulase isotyping: the type of coagulase was determined by coagulation inhibition test using commercially available neutralizing antisera specific to each of the 8 coagulase types I to VIII, according to the method recommended by manufacturer (Denka Seiken Co. Ltd, Niigata, Japan).
§Exotoxin genes were identified by PCR with sets of primers as follows:PVL (Panton-Valentine leukocidin), PVL-F (5´-ATGTCTGGACATGATCCAA-3´) and PVL-R (5´-AACTATCTCTGCCATATGGT-3´); CNA (collagen-binding protein), cna1 (5´-ACACCAGACGGTGCAACAATTA-3´) and cna2 (5´-AGCAATACCGTTTGCATCTGTTA-3´); SEH (staphylococcal enterotoxin H ), entH-F (5´-ATTCACATCATATGCGAAAGCAG-3´), and entH-R (5´-ATGTCGAATGAGTAATCTCTAG-3´); TSST1 (toxic shock syndrome toxin-1), TSST1A (5´-TGATATGTGGATCCGTCAT-3´), and TSST1B (5´-AAACACAGATGGCAGCAT-3´); bac (bacteriocine gene found in MW2), epiA-F (5´-GACGAACGTATTACAAGTCATA-3´), and epiB-R (5´-TAAGTACGCTGCTTCAGATATA-3´).
¶Clinical categories are based on the Table . Those of the strains not listed in the Table are in italic Onset: onset of infection in either community(C), hospital (H), or unknown (U). Numbers in parenthesis indicate the number of cases: A, adult cases; P, pediatric cases. The number of cases in which patient died is indicated in brackets.
#Patient had bacteremia.

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