Molecular typing of methicillin-resistant Staphylococcus aureus on the basis of protein A gene polymorphism.

The polymorphic X-region of the protein A gene (spa) was used for molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains. The X-region is characterized by a variable number (between 3 and 15) of small repeats. DNA sequencing of MRSA strains revealed 25 distinct repeats. Analysis of MRSA strains grown in vitro and in vivo revealed that the X-region was sufficiently stable for epidemiologic typing of MRSA strains. Spa typing of MRSA strains was compared to phage typing and, in general, concordance was found between the two methods. However, spa typing was more sensitive, allowing differentiation of strains within a particular phage type. Results obtained with spa typing suggest that hospital outbreaks may be caused by two or more MRSA strains. Spa typing may be an important tool in unravelling the spread of MRSA strains within and between hospitals.