Different Clonal Complexes of Methicillin-Resistant Staphylococcus aureus Are Disseminated in the Euregio Meuse-Rhine Region

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Abstract
The Euregio Meuse-Rhine (EMR) is formed by the border regions of Belgium, Germany, and The Netherlands. Cross-border health care requires infection control measures, in particular since the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs among the three countries. To investigate the dissemination of MRSA in the EMR, 152 MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), SCC mec typing, and multilocus sequence typing. PFGE revealed major clonal groups A, G, L, and Q, suggesting dissemination of MRSA in the EMR. Group A harbored mainly SCC mec type III and sequence types (STs) 239 and 241. The majority of the strains from group G harbored SCC mec type I and ST8 and ST247, whereas most strains from group L carried either SCC mec type IV or type I. Within group L, ST8 and ST228 were found, belonging to clonal complexes 8 and 5, respectively. Most strains from group Q included SCC mec type II and were sequence typed as ST225. Both ST225-MRSA-II and ST241-MRSA-III were novel findings in Germany. In addition, the SCC mec type of two isolates has not been described previously. One strain was classified as SCC mec type III but harbored the pls gene and the dcs region. Another strain was characterized as SCC mec type IV but lacked the dcs region. In addition, one isolate harbored both SCC mec type V and Panton-Valentine leukocidin. Finally, the SCC mec type of the strains was found to be correlated with the antibiotic susceptibility pattern.

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