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Staphylococcus aureus  encodes a remarkable number of virulence factors which may contribute to its pathogenicity and ability to cause invasive disease. The main objective of this study was to evaluate the association between  S. aureus  invasiveness and bacterial genotype, in terms of the presence of virulence genes and affiliation to clonal complexes. Also, the significance of different virulence genes, mainly adhesins, for the development of infective endocarditis was investigated.  DNA microarray technology was used to analyze 134  S. aureus  isolates, all methicillin-susceptible, derived from three groups of clinically well-characterized patients: nasal carriers (n=46), bacteremia (n=55), and bacteremia with infective endocarditis (n=33).  Invasive isolates were dominant in four of the major clonal complexes: 5, 8, 15, and 25. Of the 170 virulence genes examined, those encoding accessory gene regulator group II ( agr  II), capsule polysaccharide serotype 5 ( cap 5), and adhesins such as  S. aureus  surface protein G ( sasG ) and fibronectin-binding protein B ( fnbB ) were found to be associated with invasive disease. The same was shown for the leukocidin genes  lukD/lukE , as well as the genes encoding serine protease A and B ( splA/splB ), staphylococcal complement inhibitor ( scn ) and the staphylococcal exotoxin-like protein ( setC or selX ). In addition, there was a trend of higher prevalence of certain genes or gene clusters ( sasG, agr  II,  cap 5) among isolates causing infective endocarditis compared to other invasive isolates. In most cases, the presence of virulence genes was linked to clonal complex affiliation.  In conclusion, certain  S. aureus  clonal lineages harboring specific sets of virulence genes seem to be more successful in causing invasive disease.

Prevalence of Clonal Complexes and Virulence Genes among Commensal and Invasive Staphylococcus aureus Isolates in Sweden