The origin of sequence type 72 community-associated methicillin-resistant Staphylococcus aureus (MRSA) and fusidic acid (FA) resistant sequence type 5 MRSA: Analysis of FA resistance and spa type in a single center in South Korea.

We investigated the prevalence of fusidic acid (FA) resistance in MSSA and MRSA stratified by sequence (ST) and spa types, and determined the prevalence of FA resistance mechanisms. From August 2014 to April 2020, S. aureus blood isolates were collected in Asan Medical Center, Seoul, South Korea. Antimicrobial susceptibility tests were performed using broth microdilution and interpreted according to EUCAST's FA criteria. We performed spa typing for fusA mutation presence and acquired FA resistance determinants (fusB , fusC , and fusD) by PCR. Of the 590 MRSA isolates, 372 were FA resistant, and among 425 MSSA isolates, 136 were resistant. Of the 380 ST5-MRSA isolates, 350 were FA resistant, whereas only 1 of 14 ST5-MSSA isolates was FA resistant. Conversely, of the 163 ST72-MRSA isolates, only 8 were resistant, whereas 37 of 42 ST72-MSSA were resistant. The fusA mutation (80%) was the most common determinant. The one FA resistant ST5-MSSA isolate belonged to the t 2460 spa type, the most common spa type (24 of 35 isolates) of FA resistant ST5-MRSA. In addition, t 324 and t 148, which are minor spa types of ST72-MSSA, were susceptible to FA, in contrast to other ST72-MSSA spa types, and the major spa type of ST72-MRSA (110 of 163 isolates). FA resistance was common in ST5-MRSA and ST72-MSSA, and rare in ST5-MSSA and ST72-MRSA. Our findings suggest that minor clones of ST5-MSSA isolates, with the fusA mutation and minor clones of ST72-MSSA susceptible to FA, may have evolved to harbor the mecA gene. • Fusidic acid (FA) resistance was more common in MRSA than MSSA, and the most common determinant was the fusA mutation (80%). • The majority (92%) of ST5-MRSA strains were FA resistant, while only 7% of ST5-MSSA isolates were resistant. • Conversely, most ST72-MRSA isolates (95%) were susceptible to FA, while most ST72-MSSA strains (88%) were resistant. • The only FA resistant ST5-MSSA isolate belonged to the t 2460 spa type, which is the most common spa type among FA resistant ST5-MRSA. • The minor spa types t 324 and t 148 of ST72-MSSA (which are susceptible to FA) were the major spa type of ST72-MRSA. [ABSTRACT FROM AUTHOR]