Restriction Endonuclease Analysis of Plasmid DNA from Methicillin-Resistant Staphylococcus aureus: Clinical Application over a Three-Year Period

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Abstract
Objective: To investigate trends in plasmid types of methicillin-resistant Staphylococcus aureus over a 3-year period and determine the clinical impact of plasmid typing. Design: Restriction endonuclease analysis of plasmid DNA (REAP) was used to type 270 clinical isolates. Setting: A Veterans Affairs Medical Center. Results: Forty-four different REAP types were identified and, of these, 23 appeared only once. Types designed as V1 and V2 were more commonly found in nosocomial cases than in community-acquired cases (p<.05); whereas the K and D types were more common in isolates from community-acquired cases (p<.05). In 30 (11%) isolates, no plasmid was detected. When combined with epidemiological data, REAP typing revealed 4 small outbreaks that would have been missed using traditional epidemiological methods alone. In large outbreaks involving 10 or more cases, REAP typing data revealed unsuspected patterns of transmission. Conclusions: Multiple plasmid types were present in this endemic setting. Restriction endonuclease analysis of plasmid DNA was a practical and valuable adjunct to traditional epidemiological methods.

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