MRSA, Close and Personal: Methods for differentiating pathogen isolates are essential for understanding their evolution and spread, as well as for the formulation of effective clinical strategies. Current typing methods for bacterial pathogens focus on a limited set of characteristics providing data with limited resolving power. Harris et al. (p. 469 ) used a high-throughput genome sequencing approach to show that isolates of methicillin-resistant Staphylococcus aureus (MRSA) are precisely differentiated into a global geographic structure. The findings suggest that intercontinental transmission has occurred for nearly four decades. The method could also detect individual person-to-person transmission events of MRSA within a hospital environment.

Staphylococcus aureus is an important nosocomial and community-acquired pathogen. Its genetic plasticity has facilitated the evolution of many virulent and drug-resistant strains, presenting a major and constantly changing clinical challenge. We sequenced the ≈2.8-Mbp genomes of two disease-causing S. aureus strains isolated from distinct clinical settings: a recent hospital-acquired representative of the epidemic methicillin-resistant S. aureus EMRSA-16 clone (MRSA252), a clinically important and globally prevalent lineage; and a representative of an invasive community-acquired methicillin-susceptible S. aureus clone (MSSA476). A comparative-genomics approach was used to explore the mechanisms of evolution of clinically important S. aureus genomes and to identify regions affecting virulence and drug resistance. The genome sequences of MRSA252 and MSSA476 have a well conserved core region but differ markedly in their accessory genetic elements. MRSA252 is the most genetically diverse S. aureus strain sequenced to date: ≈6% of the genome is novel compared with other published genomes, and it contains several unique genetic elements. MSSA476 is methicillin-susceptible, but it contains a novel Staphylococcal chromosomal cassette (SCC) mec -like element (designated SCC ₄₇₆ ), which is integrated at the same site on the chromosome as SCC mec elements in MRSA strains but encodes a putative fusidic acid resistance protein. The crucial role that accessory elements play in the rapid evolution of S. aureus is clearly illustrated by comparing the MSSA476 genome with that of an extremely closely related MRSA community-acquired strain; the differential distribution of large mobile elements carrying virulence and drug-resistance determinants may be responsible for the clinically important phenotypic differences in these strains.

Tst, the gene for toxic shock syndrome toxin‐1 (TSST‐1), is part of a 15.2 kb genetic element in Staphylococcus aureus that is absent in TSST‐1‐negative strains. The prototype, in RN4282, is flanked by a 17 nucleotide direct repeat and contains genes for a second possible superantigen toxin, a Dichelobacter nodosus VapE homologue and a putative integrase. It is readily transferred to a recA⁻ recipient, and it always inserts into a unique chromosomal copy of the 17 nucleotide sequence in the same orientation. It is excised and circularized by staphylococcal phages φ13 and 80α and replicates during the growth of the latter, which transduces it at very high frequency. Because of its site and orientation specificity and because it lacks other identifiable phage‐like genes, we consider it to be a pathogenicity island (PI) rather than a transposon or a defective phage. The tst element in RN4282, near tyrB, is designated SaPI1. That in RN3984 in the trp region is only partially homologous to SaPI1 and is excised by phage 80 but not by 80α. It is designated SaPI2. These PIs are the first in any Gram‐positive species and the first for which mobility has been demonstrated. Their mobility may be responsible for the spread of TSST‐1 production among S. aureus strains.

Staphylococcus aureusis the most common cause of hospital-acquired infection. In healthy hosts outside of the health care setting,S. aureusis a frequent colonizer of the human nose but rarely causes severe invasive infection such as bacteremia, endocarditis, or osteomyelitis. To identify genes associated with community-acquired invasive isolates, regions of genomic variability, and theS. aureuspopulation structure, we compared 61 community-acquired invasive isolates ofS. aureusand 100 nasal carriage isolates from healthy donors using a microarray spotted with PCR products representing every gene from the sevenS. aureussequencing projects. The core genes common to all strains were identified, and 10 dominant lineages ofS. aureuswere clearly discriminated. Each lineage carried a unique combination of hundreds of “core variable” (CV) genes scattered throughout the chromosome, suggesting a common ancestor but early evolutionary divergence. Many CV genes are regulators of virulence genes or known or predicted to be expressed on the bacterial surface and to interact with the host during nasal colonization and infection. Within each lineage, isolates showed substantial variation in the carriage of mobile genetic elements and their associated virulence and resistance genes, indicating frequent horizontal transfer. However, we were unable to identify any association between lineage or gene and invasive isolates. We suggest that theS. aureusgene combinations necessary for invasive disease may also be necessary for nasal colonization and that community-acquired invasive disease is strongly dependent on host factors.