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Genetic Analysis of a High-Level Vancomycin-Resistant Isolate of Staphylococcus aureus
Linda M. Weigel,1*Don B. Clewell,2Steven R. Gill,3Nancye C. Clark,1Linda K. McDougal,1Susan E. Flannagan,2James F. Kolonay,3Jyoti Shetty,4George E. Killgore,1Fred C. Tenover1
Vancomycin is usually reserved for treatment of serious infections,including those caused by multidrug-resistant Staphylococcusaureus. A clinical isolate of S. aureus with high-level resistanceto vancomycin (minimal inhibitory concentration = 1024 µg/ml)was isolated in June 2002. This isolate harbored a 57.9-kilobasemultiresistance conjugative plasmid within which Tn1546 (vanA)was integrated. Additional elements on the plasmid encoded resistanceto trimethoprim (dfrA), ß-lactams (blaZ), aminoglycosides(aacA-aphD), and disinfectants (qacC). Genetic analyses suggestthat the long-anticipated transfer of vancomycin resistanceto a methicillin-resistant S. aureus occurred in vivo by interspeciestransfer of Tn1546 from a co-isolate of Enterococcus faecalis.
1 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. 2 Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA. 3 The Institute for Genomic Research, Rockville, MD 20850, USA. 4 J. Craig Venter Science Foundation Joint Technology Center, Rockville, MD 20850, USA.
* To whom correspondence should be addressed. E-mail: lweigel{at}cdc.gov
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