Comparison of DNA sequencing of the protein A gene polymorphic region withother molecular typing techniques for typing two epidemiologically diversecollections of methicillin-resistant Staphylococcus aureus

The aim of this study was to compare the recently developed typing approach for methicillin-resistant Staphylococcus aureus (MRSA) based on the DNA se quencing of the protein A gene polymorphic region (spaA typing) with a comb ination of three well-established molecular typing techniques: ClaI-mecA vi cinity polymorphisms, ClaI-Tn554 insertion patterns, and SmaI pulsed-field gel electrophoresis (PFGE) profiles. In order to evaluate the applicability of this typing technique in different types of studies, two groups of MRSA clinical isolates were analyzed: a collection of 185 MRSA isolates circula ting in Hungary recovered from 17 hospitals in seven cities during a 3-year period (1994 through 1996), and a selection of 53 MRSA strains isolated in a single hospital in Hungary between 1997 and 1998. The 238 MRSA clinical strains from Hungary were first classified in clonal types (defined as ClaI -mecA::ClaI-Tn554::SmaI-PFGE patterns), and 65 of the 238 strains, represen ting major MRSA clones and some sporadic clones, were further analyzed by s paA typing. Our results showed that the lineages most recently introduced i n the hospital setting showed little variability in spaA types, whereas the MRSA clones circulating for a longer period of time and spread among sever al hospitals showed a higher degree of variability. The implementation of t he spaA typing method was straightforward, and the results obtained were re producible, unambiguous, and easily interpreted. This method seems to be ad equate for outbreak investigations but should be complemented with other te chniques in long-term surveillance or in studies comparing distant clonal l ineages.