K. Trzcinski et al., Expression of resistance to tetracyclines in strains of methicillin-resistant Staphylococcus aureus, J ANTIMICRO, 45(6), 2000, pp. 763-770
A diverse collection of methicillin-resistant Staphylococcus aureus (MRSA)
isolates resistant to tetracycline was screened by PCR for the presence of
the resistance determinants tetK, tetL, tetM or tetO. Twenty-four of 66 iso
lates had tetM alone, 21 had tetK alone and 21 had both tetK and tetM (tetK
M). All isolates were tetL- and tetO-negative. MICs of tetracycline, doxycy
cline and minocycline were evaluated for all isolates with or without prein
cubation in the presence of subinhibitory concentrations of tetracycline or
minocycline. All isolates with one or more tetracycline resistance determi
nants were resistant to tetracycline 8 mg/L without induction of resistance
. Some MRSA isolates of each of these three genotypes showed an unexpected
lack of resistance to tetracyclines when the disc diffusion or agar dilutio
n method was applied to uninduced cells. Resistance to tetracycline and dox
ycycline was greater (two- to four-fold) in tetK cells preincubated with te
tracycline (tetK MRSA isolates were susceptible to minocycline less than or
equal to 0.25 mg/L under all conditions tested). For isolates with tetM al
one, preincubation with tetracycline or minocycline gave up to a four-fold
increase in the level of resistance to doxycycline and minocycline. Inducti
on of doxycycline and minocycline resistance was clearly observed for tetKM
Isolates when cells were preincubated with minocycline. This study suggest
s that, despite the results of susceptibility testing, all tetracycline-res
istant S. aureus isolates should be treated as resistant to doxycycline, an
d all tetM-positive isolates should be treated as resistant to all tetracyc
lines. A double disc diffusion method has been developed to identify induci
ble resistance to minocycline and to distinguish between tetK, tetM and tet
KM isolates.