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Chávez, M. ., Erazo, N. C. ., Reina, D. A. ., & Esparza, M. . (2015). Métodos de tipificación y epidemiología molecular de Staphylococcus aureus con resistencia a la meticilina. Biosalud, 14(2), 81–90. https://doi.org/10.17151/biosa.2015.14.2.8
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El interés actual del estudio de Staphylococcus aureus deriva de su elevada frecuencia de cepas resistentes a los antibióticos que causa frecuentes brotes de infección, especialmente, el S. aureus con resistencia a meticilina (SARM). El objetivo de esta revisión fue estudiar la estructura genética poblacional y el origen de los aislamientos de SARM. La tipificación del cassette cromosómico mec estafilocócico es el método más importante para identificar y definir la naturaleza clonal del S. aureus con resistencia a meticilina. Los estudios de epidemiología molecular evidencian un patrón de diseminación de unas pocas cepas que son las responsables del importante problema mundial. Existe el predominio de clones pandémicos de SARM asociado a infecciones hospitalarias (SARM-AH), que ha han sido reemplazados en la actualidad por clones de origen comunitario (SARM-AC). En Colombia, predomina el clon pediátrico y el chileno entre los aislamientos hospitalarios. Sin embargo, en la actualidad una variante del clon comunitario USA300 prevalece en las infecciones adquiridas en la comunidad y en el hospital, desplazando los clones hospitalarios como ocurre en el resto de mundo. El entendimiento de la epidemiología y clonalidad de las infecciones por S. aureus tiene importantes implicaciones en el control de la emergencia de cepas con multirresistencia y el esparcimiento de clones resistentes y sensibles a meticilina.
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2. Li M, Diep BA, Villaruz AE. Evolution of virulence in epidemic community-associated methicillinresistant Staphylococcus aureus. Proc Natl Acad Sci USA 2009; 106:5883.
3. Appelbaum PC. Microbiology of Antibiotic Resistance in Staphylococcus aureus. Clin Infect Dis 2007; 45(Suppl 3):S165-S170. DOI: 10.1086/519474
4. Chongtrakool P, Ho T, Xue X, Kondo Y, Trakulsomboon S, Tiensasitorn C, et al. Staphylococcal cassette chromosome mec (SCCmec) typing of methicillin-resistant Staphylococcus aureus strains isolated in 11 Asian countries: a proposal for a new nomenclature for SCCmec elements. Antimicrob Agents Chemother 2006; 50:1001-12.
5. Deurenberg RH, Stobberingh EE. The evolution of Staphylococcus aureus. Infect Genet Evol 2008; 8:747-63. http://dx.doi.org/10.1016/j.meegid 2008.07.007
6. Gordon RJ, Lowy FD. Pathogenesis of methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008; 46(Suppl 5):S350-9. http://dx.doi.org/10.1086/533591
7. Ochoa V, Guzmán AR, Caicedo Y. Infección por Staphylococcus aureus meticilino resistente adquirido en la comunidad. Biomédica 2012; 14(2):47.
8. Durand G, Bes M, Meugnier H, Enright M, Forey F, Liassine N, et al. Detection of new methicillinresistant Staphyloccus aureus clones containing the toxic shock syndrome toxin 1 gene, responsible for hospital -and community- acquired infections in France. J Clin Microbiol 2006; 44:847-53.
9. Datta P, Gulati N, Singla N, Vasdeva HR, Bala K, Chander J, et al. Evaluation of various methods for the detection of methicillin-resistant Staphylococcus aureus strains and susceptibility patterns. J Med Microbiol 2011; 60:1613-16.
10. Velasco D, del Mar Tomas M, Cartelle M, Beceiro A, Pérez A, Molina F, et al. Evaluation of different methods for detecting methicillin (oxacillin) resistance in Staphylococcus aureus. J Antimicrob Chemother 2005; 55(3):379-382.
11. Brown DFJ, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner KJ. Wren MWD on behalf of the Joint Working Party of the British Society for Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistan Staphylococcus aureus (MRSA). J Antimicrob Chemother 2005; 56:1000-18.
12. Horna G, Astocondor L, Jacobs J, García C. Phenotypic methods for detection of methicillin-resistant Staphylococcus aureus. Rev Esp Quimioter 2015; 28(2):98-100.
13. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-third Informational Supplement. 2013; M100-S23. CLSI, Wayne, PA, USA.
14. Akcam FZ, Tinaz GB, Kaya O, Tigli A, Ture E, Hosoglu S. Evaluation of methicillin resistance by cefoxitin disk diffusion and PBP2 a latex agglutination test in mecA positive Staphylococcus aureus, and comparison of mecA with femA, femB, femX positivities. Microbiol Res 2009; 164:400-03.
15. Klaus W, Cimbal AK, Lecke C, Kampf G, Rüden H, Vonberg RP. Evaluation of six agglutination tests for Staphylococcus aureus identification depending upon local prevalence of meticillin-resistant S. aureus (MRSA). J Med Microbiol 2006; 55(3):283-290. DOI: 10.1099/jmm.0.46225-0
16. Cherkaoui A, Renzi G, Schrenzel PF. Comparison of four chromogenic media for culture-based screening of methicillin-resistant Staphylococcus aureus. J Med Microbiol 2007; 56(3):500-503.
17. Girgis SA, Howida Gomaa E, Saad NE, Salem MM. A Comparative Study for Detection of Methicillin Resistance Staphylococci by Polymerase Chain Reaction and Phenotypic Methods. Life Sci J 2013; 10(4): 3711-3718.
18. Pramodhini S, Thenmozhivalli PR, Selvi R, Dillirani V, Vasumathi A, Agatha D. Comparison of variousphenotypic methods and mecA based PCR for the detection of MRSA. J Clin Diag Res 2011; 5(7) (Suppl 2):1359-62.
19. Milheirico C, Duarte O, De Lencastre H. Update to the multiplex PCR strategy for assignment of mec element types in Staphylococcus aureus. Antimicrob Agents Chemother 2007; 51(9):3374-3377.
20. McAleese F, Murphy E, Babinchak T, Singh G, Said-Salim B, Kreiswirth B, et al. Use of ribotyping to retrospectively identify methicillin-resistant Staphylococcus aureus isolates from phase 3 clinical trials for tigecycline that are genotypically related to community-associated isolates. Antimicrob Agents Chemother 2005; 49:4521-9.
21. Karakulska J, Pobucewicz A, Nawrotek P, Muszyńska M, Furowicz AJ, Czernomysy-Furowicz D. Molecular typing of Staphylococcus aureus based on PCR-RFLP of coa gene and RAPD analysis. Polish J Vet Sci 2011; 14(2):285-286.
22. Ostojiæ M. Epidemiologic genotyping of methicillin-resistant Staphylococcus aureus (MRSA) by pulsed-field gel electrophoresis (PFGE). Bosn J Basic Med Sci 2008; 8:259-65.
23. He Y, Xie Y, Reed S. Pulsed-field gel electrophoresis typing of Staphylococcus aureus isolates. Methods Mol Biol 2014; 1085:103-11. DOI: 10.1007/978-1-62703-664-1_6
24. Cockfield J D, Pathak S, Edgeworth JD, Lindsay JA. Rapid determination of hospital-acquired meticillinresistant Staphylococcus aureus lineages. J. Med. Microbiol. 2007; 56:614-619.
25. Larsen J, Enright MC, Godoy D, Spratt BG, Larsen AR, Skov RL. Multilocus Sequence Typing Scheme for Staphylococcus aureus: Revision of the gmk Locus. J. Clin. Microbiol. 2012; 50(7):2538-2539. DOI: 10.1128/JCM.00290-12
26. Saunders NA, Holmes A. Multilocus sequence typing (MLST) of Staphylococcus aureus. Methods Mol Biol 2007; 391:71-85.
27. Brakstad OG, Aasbakk K, Maeland JA. Detection of Methicillin-Resistant Staphylococcus aureus Using mecA /nuc Genes and Antibiotic Susceptibility Profile of Malaysian Clinical Isolates. World J Microbiol Biotech 2006; 22(12):1289-1294.
28. Hallin M, Friedrich AW, Struelens MJ. Spa typing for epidemiological surveillance of Staphylococcus aureus. Methods Mol Biol 2009; 551:189-202. DOI: 10.1007/978-1-60327-999-4_15
29. Najar-Pirayeh S, Azimian A, Nejad QB, Kashi M. Prevalence of agr Specificity Groups Among Staphylococcus aureus Isolates From University Hospitals in Tehran. Lab Medicine 2009; 40:27-29. DOI: 10.1309/LMGB9GB82WKDANWF
30. International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC). Classification of staphylococcal cassette chromosome mec (SCCmec): guidelines for reporting novel SCCmec elements. Antimicrob. Agents Chemother 2009; 53(12):4961-4967.
31. Kondo Y, Ito T, Ma X, Watanabe S, Kreiswirth B, Etienne J, et al. Combination of multiplex PCRs for staphylococcal cassette chromosome mec type assignment: Rapid identification system for mec, ccr, and major differences in junkyard regions. Antimicrob Agents Chemother 2007; 51:264-274.
32. Kim YK, Kim JS, Kim HS, Song W, Cho HC, Lee KM. Molecular typing of Staphylococcus aureus isolated from blood on the basis of coagulase gene polymorphism and toxin genes. Korean J Lab Med 2008; 28:286-90.
33. Francois P, Renzi G, Pittet D, Bento M, Lew D, Harbarth S, et al. A novel multiplex real-time PCR assay for rapid typing of major staphylococcal cassette chromosome mec elements. J Clin Microbiol 2004; 42:3309-3312.
34. Chlebowicz MA, van Dijl JM, Buist G. Considerations for the Distinction of ccrC-Containing Staphylococcal Cassette Chromosome mec Elements. Antimicrob Agents Chemother 2011; 55:1823-1824.
35. Oliveira DC, Milheirico C, De Lencastre H. Redefining a structural variant of staphylococcal cassette chromosome mec, SCCmec type VI. Antimicrob Agents Chemother 2006; 50:3457-3459.
36. Li S, Skov RL, Han X, Larsen AR, Larsen J, et al. Novel types of staphylococcal cassette chromosome mec elements identified in clonal complex 398 Methicillin-Resistant Staphylococcus aureus Strains. Antimicrob Agents Chemother 2011; 55:3046-3050.
37. Nübel U, Roumagnac P, Feldkamp M, Song JH, Ko KS, Huang YC, et al. Frequent emergence and limited geographic dispersal of methicillin-resistant Staphylococcus aureus. Proc Natl Acad Sci 2008; 105(37):14130-14135.
38. Sola C, Cortes P, Saka HA, Vindel A, Bocco JL. Evolution and molecular characterization of methicillinresistant Staphylococcus aureus epidemic and sporadic clones in Cordoba, Argentina. J Clin Microbiol 2006; 44:192-200.
39. Guzmán-Blanco M, Mejía C, Istúriz R, Álvarez C, Bavestrello L, Gotuzzo E, et al. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Latin America. Int J Antimicrob Agents 2009; 34(4):304-8.
40. Mejía C, Zurita J, Guzmán-Blanco M. Epidemiology and surveillance of methicillin-resistant Staphylococcus aureus in Latin America. Braz J Infect Dis 2010; 14(Suppl 2):S79-S86.
41. Mayor L, Ortellado J, Menacho C, Lird G, Courtier C, Gardon C, et al. Molecular characterization of methicillin-resistant Staphylococcus aureus isolates collected in Asunción, Paraguay. J Clin Microbiol 2007; 45(7):2298-300.
42. Rodríguez-Noriega E, Seas C, Guzmán-Blanco M, Mejía C, Álvarez C, Bavestrello L, et al. Evolution of methicillin-resistant Staphylococcus aureus clones in Latin America. Int J Infect Dis 2010; 14:e560-e566.
43. Echániz-Aviles G, Velázquez-Meza ME, Aires-de-Sousa M, Moríin-Otero R, Rodríguez-Noriega E, Carnalla-Barajas N, et al. Molecular characterisation of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone in a Mexican hospital (1999-2003). Clin Microbiol Infect 2006; 12:22-28.
44. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298:1763-1771.
45. Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, et al. Complete genome sequence of USA300, an epidemic clone of community-acquired methicillin-resistant Staphylococcus aureus. Lancet 2006; 367:731-9.
46. Highlander SK, Hultén KG, Qin X, Jiang H, Yerrapragada S, Mason EO, et al. Subtle genetic differences enhance virulence of methicillin resistant and susceptible Staphylococcus aureus. BMC Microbiol 2007; 7:99.
47. Seybold U, Kourbatova EV, Johnson JG, Halvosa SJ, Wang YF, King MD, et al. Emergence of communityassociated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006; 42:647-56. [PMID: 16447110].
48. Wang J-T, Fang C-T, Chen Y-C, Wu C-L, Chen M-L, Chang S-C. Staphylococcal Cassette Chromosome mec in MRSA, Taiwan. Emerg Infect Dis 2007; 13(3):494-497. DOI: 10.3201/eid1303.060247
49. Tietz A, Frei R, Widmer AF. Transatlantic spread of the USA300 clone of MRSA. N Engl J Med 2005; 353:532-3.
50. Chambers HF, Deleo FR. Waves of resistance: Staphycococcus aureus in the antibiotic era. Nat Rev Microbiol 2009; 7:629-41. http://dx.doi.org/10.1038/nrmicro2200
51. Noriega L, González P, Hormazábal J, Pinto C, Canals M, Munita J, et al. Staphylococcus aureus comunitario resistente a cloxacilina. Comunicación de los primeros cinco casos descritos en Chile. Rev Med Chil 2008; 136: 885-91.
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59. Hsiao C-H, Ong SJ, Chuang C-C, Ma DHK, Huang Y-C. A Comparison of Clinical Features between Community-Associated and Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Keratitis. J Ophthal 2015, Article ID 923941, 7 pages. DOI: 10.1155/2015/923941
60. Tsompanidou E, Sibbald MJJB, Chlebowicz M, Dreisbach A, Back J, Dijl M, et al. Requirement of the agr Locus for Colony Spreading of Staphylococcus aureus. J Bacteriol 2011; 193(5):1267-1272.
61. Azimian A, Najar-Pirayeh S, Mirab S, Naderi M. Occurrence of methicillin resistant Staphylococcus aureus (MRSA) among clinical samples in Tehran-Iran and its correlation with polymorphism of specific accessory gene regulator (agr) groups. Braz J Microbiol 2012; 43(2):779-785.
62. Seidl K, Chen L, Bayer A, Abdel W, Kreiswirth B, Xiong Y. Relationship of agr Expression and Function with Virulence and Vancomycin Treatment Outcomes in Experimental Endocarditis Due to MethicillinResistant Staphylococcus aureus. Cell Microbiool 2011; 55(12):5631-9.
2. Li M, Diep BA, Villaruz AE. Evolution of virulence in epidemic community-associated methicillinresistant Staphylococcus aureus. Proc Natl Acad Sci USA 2009; 106:5883.
3. Appelbaum PC. Microbiology of Antibiotic Resistance in Staphylococcus aureus. Clin Infect Dis 2007; 45(Suppl 3):S165-S170. DOI: 10.1086/519474
4. Chongtrakool P, Ho T, Xue X, Kondo Y, Trakulsomboon S, Tiensasitorn C, et al. Staphylococcal cassette chromosome mec (SCCmec) typing of methicillin-resistant Staphylococcus aureus strains isolated in 11 Asian countries: a proposal for a new nomenclature for SCCmec elements. Antimicrob Agents Chemother 2006; 50:1001-12.
5. Deurenberg RH, Stobberingh EE. The evolution of Staphylococcus aureus. Infect Genet Evol 2008; 8:747-63. http://dx.doi.org/10.1016/j.meegid 2008.07.007
6. Gordon RJ, Lowy FD. Pathogenesis of methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008; 46(Suppl 5):S350-9. http://dx.doi.org/10.1086/533591
7. Ochoa V, Guzmán AR, Caicedo Y. Infección por Staphylococcus aureus meticilino resistente adquirido en la comunidad. Biomédica 2012; 14(2):47.
8. Durand G, Bes M, Meugnier H, Enright M, Forey F, Liassine N, et al. Detection of new methicillinresistant Staphyloccus aureus clones containing the toxic shock syndrome toxin 1 gene, responsible for hospital -and community- acquired infections in France. J Clin Microbiol 2006; 44:847-53.
9. Datta P, Gulati N, Singla N, Vasdeva HR, Bala K, Chander J, et al. Evaluation of various methods for the detection of methicillin-resistant Staphylococcus aureus strains and susceptibility patterns. J Med Microbiol 2011; 60:1613-16.
10. Velasco D, del Mar Tomas M, Cartelle M, Beceiro A, Pérez A, Molina F, et al. Evaluation of different methods for detecting methicillin (oxacillin) resistance in Staphylococcus aureus. J Antimicrob Chemother 2005; 55(3):379-382.
11. Brown DFJ, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner KJ. Wren MWD on behalf of the Joint Working Party of the British Society for Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistan Staphylococcus aureus (MRSA). J Antimicrob Chemother 2005; 56:1000-18.
12. Horna G, Astocondor L, Jacobs J, García C. Phenotypic methods for detection of methicillin-resistant Staphylococcus aureus. Rev Esp Quimioter 2015; 28(2):98-100.
13. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-third Informational Supplement. 2013; M100-S23. CLSI, Wayne, PA, USA.
14. Akcam FZ, Tinaz GB, Kaya O, Tigli A, Ture E, Hosoglu S. Evaluation of methicillin resistance by cefoxitin disk diffusion and PBP2 a latex agglutination test in mecA positive Staphylococcus aureus, and comparison of mecA with femA, femB, femX positivities. Microbiol Res 2009; 164:400-03.
15. Klaus W, Cimbal AK, Lecke C, Kampf G, Rüden H, Vonberg RP. Evaluation of six agglutination tests for Staphylococcus aureus identification depending upon local prevalence of meticillin-resistant S. aureus (MRSA). J Med Microbiol 2006; 55(3):283-290. DOI: 10.1099/jmm.0.46225-0
16. Cherkaoui A, Renzi G, Schrenzel PF. Comparison of four chromogenic media for culture-based screening of methicillin-resistant Staphylococcus aureus. J Med Microbiol 2007; 56(3):500-503.
17. Girgis SA, Howida Gomaa E, Saad NE, Salem MM. A Comparative Study for Detection of Methicillin Resistance Staphylococci by Polymerase Chain Reaction and Phenotypic Methods. Life Sci J 2013; 10(4): 3711-3718.
18. Pramodhini S, Thenmozhivalli PR, Selvi R, Dillirani V, Vasumathi A, Agatha D. Comparison of variousphenotypic methods and mecA based PCR for the detection of MRSA. J Clin Diag Res 2011; 5(7) (Suppl 2):1359-62.
19. Milheirico C, Duarte O, De Lencastre H. Update to the multiplex PCR strategy for assignment of mec element types in Staphylococcus aureus. Antimicrob Agents Chemother 2007; 51(9):3374-3377.
20. McAleese F, Murphy E, Babinchak T, Singh G, Said-Salim B, Kreiswirth B, et al. Use of ribotyping to retrospectively identify methicillin-resistant Staphylococcus aureus isolates from phase 3 clinical trials for tigecycline that are genotypically related to community-associated isolates. Antimicrob Agents Chemother 2005; 49:4521-9.
21. Karakulska J, Pobucewicz A, Nawrotek P, Muszyńska M, Furowicz AJ, Czernomysy-Furowicz D. Molecular typing of Staphylococcus aureus based on PCR-RFLP of coa gene and RAPD analysis. Polish J Vet Sci 2011; 14(2):285-286.
22. Ostojiæ M. Epidemiologic genotyping of methicillin-resistant Staphylococcus aureus (MRSA) by pulsed-field gel electrophoresis (PFGE). Bosn J Basic Med Sci 2008; 8:259-65.
23. He Y, Xie Y, Reed S. Pulsed-field gel electrophoresis typing of Staphylococcus aureus isolates. Methods Mol Biol 2014; 1085:103-11. DOI: 10.1007/978-1-62703-664-1_6
24. Cockfield J D, Pathak S, Edgeworth JD, Lindsay JA. Rapid determination of hospital-acquired meticillinresistant Staphylococcus aureus lineages. J. Med. Microbiol. 2007; 56:614-619.
25. Larsen J, Enright MC, Godoy D, Spratt BG, Larsen AR, Skov RL. Multilocus Sequence Typing Scheme for Staphylococcus aureus: Revision of the gmk Locus. J. Clin. Microbiol. 2012; 50(7):2538-2539. DOI: 10.1128/JCM.00290-12
26. Saunders NA, Holmes A. Multilocus sequence typing (MLST) of Staphylococcus aureus. Methods Mol Biol 2007; 391:71-85.
27. Brakstad OG, Aasbakk K, Maeland JA. Detection of Methicillin-Resistant Staphylococcus aureus Using mecA /nuc Genes and Antibiotic Susceptibility Profile of Malaysian Clinical Isolates. World J Microbiol Biotech 2006; 22(12):1289-1294.
28. Hallin M, Friedrich AW, Struelens MJ. Spa typing for epidemiological surveillance of Staphylococcus aureus. Methods Mol Biol 2009; 551:189-202. DOI: 10.1007/978-1-60327-999-4_15
29. Najar-Pirayeh S, Azimian A, Nejad QB, Kashi M. Prevalence of agr Specificity Groups Among Staphylococcus aureus Isolates From University Hospitals in Tehran. Lab Medicine 2009; 40:27-29. DOI: 10.1309/LMGB9GB82WKDANWF
30. International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC). Classification of staphylococcal cassette chromosome mec (SCCmec): guidelines for reporting novel SCCmec elements. Antimicrob. Agents Chemother 2009; 53(12):4961-4967.
31. Kondo Y, Ito T, Ma X, Watanabe S, Kreiswirth B, Etienne J, et al. Combination of multiplex PCRs for staphylococcal cassette chromosome mec type assignment: Rapid identification system for mec, ccr, and major differences in junkyard regions. Antimicrob Agents Chemother 2007; 51:264-274.
32. Kim YK, Kim JS, Kim HS, Song W, Cho HC, Lee KM. Molecular typing of Staphylococcus aureus isolated from blood on the basis of coagulase gene polymorphism and toxin genes. Korean J Lab Med 2008; 28:286-90.
33. Francois P, Renzi G, Pittet D, Bento M, Lew D, Harbarth S, et al. A novel multiplex real-time PCR assay for rapid typing of major staphylococcal cassette chromosome mec elements. J Clin Microbiol 2004; 42:3309-3312.
34. Chlebowicz MA, van Dijl JM, Buist G. Considerations for the Distinction of ccrC-Containing Staphylococcal Cassette Chromosome mec Elements. Antimicrob Agents Chemother 2011; 55:1823-1824.
35. Oliveira DC, Milheirico C, De Lencastre H. Redefining a structural variant of staphylococcal cassette chromosome mec, SCCmec type VI. Antimicrob Agents Chemother 2006; 50:3457-3459.
36. Li S, Skov RL, Han X, Larsen AR, Larsen J, et al. Novel types of staphylococcal cassette chromosome mec elements identified in clonal complex 398 Methicillin-Resistant Staphylococcus aureus Strains. Antimicrob Agents Chemother 2011; 55:3046-3050.
37. Nübel U, Roumagnac P, Feldkamp M, Song JH, Ko KS, Huang YC, et al. Frequent emergence and limited geographic dispersal of methicillin-resistant Staphylococcus aureus. Proc Natl Acad Sci 2008; 105(37):14130-14135.
38. Sola C, Cortes P, Saka HA, Vindel A, Bocco JL. Evolution and molecular characterization of methicillinresistant Staphylococcus aureus epidemic and sporadic clones in Cordoba, Argentina. J Clin Microbiol 2006; 44:192-200.
39. Guzmán-Blanco M, Mejía C, Istúriz R, Álvarez C, Bavestrello L, Gotuzzo E, et al. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Latin America. Int J Antimicrob Agents 2009; 34(4):304-8.
40. Mejía C, Zurita J, Guzmán-Blanco M. Epidemiology and surveillance of methicillin-resistant Staphylococcus aureus in Latin America. Braz J Infect Dis 2010; 14(Suppl 2):S79-S86.
41. Mayor L, Ortellado J, Menacho C, Lird G, Courtier C, Gardon C, et al. Molecular characterization of methicillin-resistant Staphylococcus aureus isolates collected in Asunción, Paraguay. J Clin Microbiol 2007; 45(7):2298-300.
42. Rodríguez-Noriega E, Seas C, Guzmán-Blanco M, Mejía C, Álvarez C, Bavestrello L, et al. Evolution of methicillin-resistant Staphylococcus aureus clones in Latin America. Int J Infect Dis 2010; 14:e560-e566.
43. Echániz-Aviles G, Velázquez-Meza ME, Aires-de-Sousa M, Moríin-Otero R, Rodríguez-Noriega E, Carnalla-Barajas N, et al. Molecular characterisation of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone in a Mexican hospital (1999-2003). Clin Microbiol Infect 2006; 12:22-28.
44. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298:1763-1771.
45. Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, et al. Complete genome sequence of USA300, an epidemic clone of community-acquired methicillin-resistant Staphylococcus aureus. Lancet 2006; 367:731-9.
46. Highlander SK, Hultén KG, Qin X, Jiang H, Yerrapragada S, Mason EO, et al. Subtle genetic differences enhance virulence of methicillin resistant and susceptible Staphylococcus aureus. BMC Microbiol 2007; 7:99.
47. Seybold U, Kourbatova EV, Johnson JG, Halvosa SJ, Wang YF, King MD, et al. Emergence of communityassociated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006; 42:647-56. [PMID: 16447110].
48. Wang J-T, Fang C-T, Chen Y-C, Wu C-L, Chen M-L, Chang S-C. Staphylococcal Cassette Chromosome mec in MRSA, Taiwan. Emerg Infect Dis 2007; 13(3):494-497. DOI: 10.3201/eid1303.060247
49. Tietz A, Frei R, Widmer AF. Transatlantic spread of the USA300 clone of MRSA. N Engl J Med 2005; 353:532-3.
50. Chambers HF, Deleo FR. Waves of resistance: Staphycococcus aureus in the antibiotic era. Nat Rev Microbiol 2009; 7:629-41. http://dx.doi.org/10.1038/nrmicro2200
51. Noriega L, González P, Hormazábal J, Pinto C, Canals M, Munita J, et al. Staphylococcus aureus comunitario resistente a cloxacilina. Comunicación de los primeros cinco casos descritos en Chile. Rev Med Chil 2008; 136: 885-91.
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