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N Engl J Med. 2014 Apr 17;370(16):1524-31. doi: 10.1056/NEJMoa1303359.

Transferable vancomycin resistance in a community-associated MRSA lineage.

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From the Department of Pathology, Division of Microbiology of the Central Laboratory (LIM 03) and Department of Infectious Disease (LIM 54), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (F.R., T.S.R.D.G., A.D., D.B., I.M.H.); Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota (L.D., D.P., S.R., J.R., L.P.C., C.A.A.), and Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Cali (A.H.-R.) - both in Colombia; Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile (J.M.M.); the Department of Internal Medicine, Division of Infectious Diseases (L.D., D.P., T.T.T., J.R., J.M.M., A.H.-R., B.E.M, C.A.A.), and the Department of Microbiology and Molecular Genetics (B.E.M., C.A.A.), University of Texas Medical School at Houston, and the University of Houston College of Pharmacy (T.T.T.) - both in Houston; the Genome Institute, Washington University at St. Louis, St. Louis (A.W., Y.Z., G.M.W.); and Sackler Institute for Comparative Genomics, American Museum of Natural History (A.N., P.J.P.), and Division of Pediatric Infectious Diseases, Columbia University (G.X., P.J.P.) - both in New York.

Erratum in

  • N Engl J Med. 2014 Jun 5;370(23):2253.


We report the case of a patient from Brazil with a bloodstream infection caused by a strain of methicillin-resistant Staphylococcus aureus (MRSA) that was susceptible to vancomycin (designated BR-VSSA) but that acquired the vanA gene cluster during antibiotic therapy and became resistant to vancomycin (designated BR-VRSA). Both strains belong to the sequence type (ST) 8 community-associated genetic lineage that carries the staphylococcal chromosomal cassette mec (SCCmec) type IVa and the S. aureus protein A gene (spa) type t292 and are phylogenetically related to MRSA lineage USA300. A conjugative plasmid of 55,706 bp (pBRZ01) carrying the vanA cluster was identified and readily transferred to other staphylococci. The pBRZ01 plasmid harbors DNA sequences that are typical of the plasmid-associated replication genes rep24 or rep21 described in community-associated MRSA strains from Australia (pWBG745). The presence and dissemination of community-associated MRSA containing vanA could become a serious public health concern.

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