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Clonal complex 59 (CC59) S taphylococcus aureus  in Taiwan includes both methicillin-susceptible  S .  aureus  (MSSA) and methicillin-resistant  S .  aureus  (MRSA). As the most prominent community-associated MRSA (CA-MRSA) in Taiwan, CC59 has two major clones characterized as PVL-negative SCC mec  IV (carrying the staphylococcal cassette chromosome  mec  IV but Panton-Valentine leukocidin-negative) and PVL-positive SCC mec  V (5C2&5). We investigated the drug resistance, phylogeny and the distribution and sequence variation of SCC mec , staphylococcal bacteriophage φSA3, genomic island νSaβ and MES (an enterococcal mobile genetic element conferring multidrug resistance) in 195 CC59  S .  aureus . Sequencing and PCR mapping revealed that all of the CC59/SCC mec  V (5C2&5) MRSA strains had acquired MES PM1  or its segregants, and obtained a φSA3-related fragment in νSaβ. In contrast, MES 6272-2  and MES 4578 , which showed gentamicin resistance that was not encoded by MES PM1 , were dominant in SCC mec  IVg MRSA. Translocation of a whole φSA3 into νSaβ instead of only a φSA3-related fragment was common in SCC mec  IVg MRSA. However, the non-subtype-g SCC mec  IV MRSA (SCC mec  IVa is the major) still carried MES and νSaβ structures similar to those in SCC mec  V (5C2&5) MRSA. A minimum spanning tree constructed by multiple-locus variable-number tandem repeat analysis revealed that SCC mec  IVg MRSA and SCC mec  V (5C2&5) MRSA grouped respectively in two major clades. The CC59 MSSA was equally distributed among the two clades, while the non-subtype-g SCC mec  IV MRSA mostly clustered with SCC mec  V (5C2&5) MRSA. Our findings strongly suggest that CC59 MSSA acquired divergent mobile genetic elements and evolved to SCC mec  IVg MRSA and SCC mec  V (5C2&5) MRSA/non-subtype-g SCC mec  IV MRSA independently. The evolutionary history of CC59  S .  aureus  explains how mobile genetic elements increase the antimicrobial resistance and virulence and contribute to the success of CA-MRSA in Taiwan.

plos one

Molecular Evolutionary Pathways toward Two Successful Community-Associated but Multidrug-Resistant ST59 Methicillin-Resistant Staphylococcus aureus Lineages in Taiwan: Dynamic Modes of Mobile Genetic Element Salvages