Unexpected Predictors of Antibiotic Resistance in Housekeeping Genes of Staphylococcus Aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) is currently the most commonly identified antibiotic-resistant pathogen in US hospitals. Resistance to methicillin is carried by SCCmec genetic elements. Multilocus sequence typing (MLST) covers internal fragments of seven housekeeping genes of S. aureus. In conjunction with mec typing, MLST has been used to create an international nomenclature for S. aureus. MLST sequence types with a single nucleotide polymorphism (SNP) considered distinct. In this work, relationships among MLST SNPs and methicillin/oxacillin resistance or susceptibility were studied, using a public data base, by means of cross-tabulation tests, multivariable (phylogenetic) logistic regression (LR), decision trees, rule bases, and random forests (RF). Model performances were assessed through multiple cross-validation. Hierarchical clustering of SNPs was also employed to analyze mutational covariation. The number of instances with a known methicillin (oxacillin) antibiogram result was 1526 (649), where 63% (54%) was resistant to methicillin (oxacillin). In univariable analysis, several MLST SNPs were found strongly associated with antibiotic resistance/susceptibility. A RF model predicted correctly the resistance/susceptibility to methicillin and oxacillin in 75% and 63% of cases (cross-validated). Results were similar for LR. Hierarchical clustering of the aforementioned SNPs yielded a high level of covariation both within the same and different genes; this suggests strong genetic linkage between SNPs of housekeeping genes and antibiotic resistant associated genes. This finding provides a basis for rapid identification of antibiotic resistant S. arues lineages using a small number of genomic markers. The number of sites could subsequently be increased moderately to increase the sensitivity and specificity of genotypic tests for resistance that do not rely on the direct detection of the resistance marker itself.