A fusidic acid-resistant (PVL+) clone is associated with the increase in methicillin-resistant Staphylococcus aureus

Alexandre Bourles1, Anne Tristan2, François Vandenesch2

  • 1Institut Pasteur de Nouvelle-Calédonie, Institut Pasteur International Network, Medical and Environmental Bacteriology Group - Bacteriology Unit, Noumea, New Caledonia.

Abstract

Insights

Methicillin-resistant Staphylococcus aureus (MRSA) is increasing in New Caledonia. A dominant clone (CC6-MRSA) with high fusidic acid resistance was identified, suggesting topical fusidic acid misuse drives MRSA emergence.

Area of Science:

  • Microbiology
  • Epidemiology
  • Genetics

Background:

  • Methicillin-resistant Staphylococcus aureus (MRSA) has shown a rapid increase in New Caledonia since 2014.
  • This rise in MRSA is linked to significant clinical complications.

Purpose of the Study:

  • To investigate the epidemiology of MRSA in New Caledonia.
  • To identify the potential emergence of a specific clonal strain.

Main Methods:

  • Analysis of 171 clinical MRSA isolates from New Caledonia in 2019.
  • Genetic characterization of 49 representative isolates using StaphyType DNA microarray by the French National Reference Center for Staphylococci.

Main Results:

  • In 2019, 39% of Staphylococcus aureus isolates were MRSA (442/1144).
  • 62% of MRSA isolates exhibited resistance to fusidic acid (FA).
  • Clonal complex 6 (CC6) was predominant (70%), with CC6-MRSA-[IV+fus] (PVL+) identified in 53% of these.

Conclusions:

  • Low MRSA diversity was observed, dominated by a previously unreported clonal complex.
  • High FA resistance correlated with the fusC gene, suggesting FA misuse as a selection driver.
  • Recommendations include halting topical FA use to control this MRSA clone and reduce overall MRSA rates.