Survey of community-associated-methicillin-Resistant Staphylococcus aureus in Slovenia: identification of community-associated and livestock-associated clones.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Slovenia is poorly documented. The aim of this study was to investigate susceptibility patterns, virulence gene profile and clonality among MRSA isolates with positive screened resistance phenotype for CA-MRSA collected from patients in Slovenia, from January 2010 to December 2010. We included only MRSA isolates that were resistant to cefoxitin and oxacillin, and susceptible to at least two of the following four antibiotics: ciprofloxacin, erythromycin, clindamycin or gentamicin (presumptive CA-MRSA). Altogether 151 isolates fulfilled our screening phenotypic definition, 126 MRSA isolates were classified as CA-MRSA and 25 as HA-MRSA. Thirty-six per cent of them were resistant to ciprofloxacin, 24% to clindamycin, 33% to erythromycin and 13% to gentamicin. The mecA gene was detected in 150 isolates, while the mecC gene only in 1 isolate. The MRSA isolates were classified to 19 different clones. The most prevalent sequence types were ST5 (26.4%), ST45 (25.2%), ST22 (10.6%), ST398 (9.9%), ST8 (5.9%), ST7 (4.6%), ST1 (3.9%), ST152/377 (3.3%), ST228 (2.6%) and ST2883 (1.3%). The ST6, ST9, ST30, ST72, ST88, ST111, ST130, ST225 and ST772 were identified sporadically. The Panton-Valentine leukocidin (PVL) gene was detected in 13 (8.6%) isolates that belonged to ST5, ST7, ST8, ST22, ST72, ST88, ST 152/377 and ST772. Our results show high variability of CA-MRSA circulating in Slovenia and also the presence of LA-MRSA clones.