Appendix Table. 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§

Clinical category¶

PVL

CNA

SEH

TSST1

bac

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 Table 1. Those of the strains not listed in Table 1 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.