Abstract
Pulsed-field gel electrophoresis (PFGE) is a valuable molecular typing assay used for methicillin-resistant Staphylococcus aureus (MRSA) surveillance and genotyping. However, there are several limitations associated with PFGE. In Alberta, Canada, the significant increase in the number of MRSA isolates submitted to the Provincial Laboratory for Public Health (ProvLab) for PFGE typing led to the need for an alternative genotyping method. In this study, we describe the transition from PFGE to Staphylococcus protein A (spa), Staphylococcal cassette chromosome (SCCmec), and Panton-Valentine leukocidin (PVL) typing. A total of 1915 clinical MRSA isolates collected from 2005 to 2009 were used to develop and validate an algorithm for assigning PFGE epidemic types using spa, SCCmec, and PVL typing and the resulting data was used to populate a new Alberta MRSA typing database. An additional 12620 clinical MRSA isolates collected from 2010 to 2012 as part of ongoing routine molecular testing at ProvLab were characterized using the new typing algorithm and the Alberta MRSA typing database. Switching to spa, SCCmec, and PVL from PFGE typing substantially reduced hands-on and turn-around times while maintaining historical PFGE epidemic type designations. This led to an approximate $77,000 reduction in costs from 2010 to 2012. PFGE typing is still required for a small subset of MRSA isolates that have spa types that are rare, novel, or associated with more than one PFGE epidemic type.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is widespread in hospital and community settings and has become progressively costly to treat and control [1,2,3,4]
This study evaluates whether SCCmec and Panton-Valentine leukocidin (PVL) data can differentiate MRSA isolates that share the same spa type but are associated with multiple pulsed-field gel electrophoresis (PFGE) epidemic types
This genotyping data was used as the foundation for the Alberta MRSA typing database
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is widespread in hospital and community settings and has become progressively costly to treat and control [1,2,3,4]. In Alberta, Canada, MRSA was designated as a ‘‘pathogen under surveillance’’ since June 2005 by Alberta Health, requesting all regional laboratories to submit the first clinical MRSA isolate from each patient within a one year period to the Provincial Laboratory for Public Health (ProvLab) for molecular typing. Routine MRSA genotyping identifies trends in prevalence, distribution, and epidemiology in an effort to enhance patient outcome and reduce transmission. Global dissemination of MRSA is largely attributed to a small number of epidemic MRSA clones that are often predominant in specific geographic regions [5,6,7]. PFGE characterization is useful, it is a labor-intensive and time-consuming technique. PFGE results are prone to subjective interpretation making inter-laboratory comparisons difficult [10]. The number of MRSA isolates submitted annually to ProvLab for genotyping has increased dramatically
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