Diversity of SCCmec Elements in Methicillin-Resistant Coagulase-Negative Staphylococci Clinical Isolates

Background Methicillin-resistant coagulase-negative staphylococci (MR-CoNS) are opportunistic pathogens and serve as a large reservoir of staphylococcal cassette chromosome mec (SCC mec ). Characterization of SCC mec in MR-CoNS can generate useful information on the mobilization and evolution of this element. Methodology/Principal Findings Non-repetitive MR-CoNS clinical isolates (n = 84; 39 S. epidermidis , 19 S. haemolyticus , 9 S. hominis , 6 S. capitis , 4 S. warneri , 2 S. cohnii , 2 S. saprophyticus , 1 S. kloosii , 1 S. simulans and 1 S. massiliensis ) were collected. All isolates could grow on plates with 4 mg/L cefoxitin and all had mecA as detected by PCR. Strain typing using RAPD and ERIC-PCR revealed that almost all isolates were of different strains. SCC mec typing was performed using multiplex PCR published previously. For isolates in which SCC mec could not be typed, the mec complex classes were determined by additional PCR and the ccr genes were amplified with published or newly-designed primers and then sequenced. SCC mec types were assigned for 63 isolates by multiplex PCR and were assigned for 14 other isolates by PCR targeting mec and ccr . Among 77 isolates with determined SCC mec types, 54 had a single type, including type III (n = 19), IV (n = 14), V (n = 10), II (n = 2), I (n = 1), VIII (n = 1) and five unnamed types (n = 7), while 23 isolates had two types, III+V (n = 12), II+V (n = 8), II+IV (n = 2) or IV+V (n = 1). The five unnamed types were assigned UT1 (class A mec , ccrA1 / ccrB4 ), UT2 (class C1 mec , ccrA4/ccrB4 ), UT3 (class A mec , ccrA5/ccrB3 ), UT4 (class C2 mec , ccrA2/ccrB2 plus ccrC1 ) and UT5 (class A mec , ccrA1/ccrB1 plus ccrC1 ). Conclusions/Significance SCC mec types III, IV and V were prevalent in MR-CoNS and many isolates could harbor more than one type. Several new types of SCC mec were identified, highlighting the great genetic diversity and the need of developing classification schemes for SCC mec in MR-CoNS.