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PubMed1993

Relationship between slime production, antibiotic sensitivity and the phagetype of coagulase-negative staphylococci.

Three hundred and three strains of coagulase-negative staphylococci (CNS) were collected from the fingers of healthy donors (289) and from blood cultures (14). Twelve different species were identified (5 S. auricularis, 45 S. capitis, 15 S. cohnii, 86 S. epidermidis, 23 S. haemolyticus, 37 S. hominis, 1 S. lentus, 5 S. saprophyticus, 7 S. sciuri, 6 S. simulans, 54 S. xylosus and 19 S. warneri). Amongst these CNS strains, 151 were slime producers, 112 were phage-typable and 188, 133, 126 and 91 were, respectively, resistant to penicillin, teicoplanin, erythromycin and kanamycin. Slime-producing strains were resistant to at least seven antibiotics with a probability of 0.01 < P < 0.05. Non-slime-producing strains were sensitive to all the tested antibiotics with a probability of 0.001 < P < 0.01. There was no direct relationship between antibiotic sensitivity and phage type, although a non-typable strain was more often resistant to seven or more antibiotics than a typable one (0.05 < P < 0.1).

Anti-Bacterial Agents↗

PubMed1993

[Production of glycocalyx by coagulase negative staphylococci isolated from the oral cavity].

The study was aimed at determination whether and how frequently coagulase-negative staphylococci persisting in human oral cavity possess the same feature. The material consisted of 255 strains of coagulase-negative staphylococci isolated from oral cavity of persons of both sexes and in differing age. Glycocalyx production by these strains was tested quantitatively by a colorimetric method. Glycocalyx was produced by 222 out of 225 tested strains (87.1%). For individual genera this frequency was following: epidermidis 164/186, hominis 14/14, warneri 12/13, saprophyticus 7/8, auricularis 4/5, haemolyticus 1/4, simulans 4/4, caseolyticus 2/2, xylosus 0/1 and for unidentified 14/18. Majority of tested strains produced only slight amounts of the glycocalyx. Only 46 out of the -20.7% of active strains (18.0% of all tested strains) produced large amount of glycocalyx. Among these strains, 37 belonged to the genus epidermidis, 6 to hominis and one each to warneri, simulans and auricularis. There was no correlation between amount of glycocalyx produced by individual strains and their number in the oral cavity. These results indicate that production of glycocalyx is a common feature of coagulase-negative staphylococci belonging to different genera and may appear with different intensity. Oral cavity may be a source of strains producing large amounts of glycocalyx and thus potentially pathogenic.

Coagulase↗

PubMed2000

In vitro activity of quinupristin/dalfopristin in comparison with five antibiotics against worldwide clinical isolates of staphylococci.

OBJECTIVE: To evaluate the in vitro activity of quinupristin/dalfopristin (Q/D), a streptogramin combination, in comparison with five antibiotics against worldwide clinical isolates of staphylococci. METHODS: A multicenter in vitro study was performed using the E test during a period of 3 months (April to June) in 1997 on fresh, clinically significant, non repetitive strains of staphylococci from patients hospitalized in 23 different hospitals in 18 countries tested. RESULTS: A total of 2132 staphylococcal isolates including methicillin resistant (MR), methicillin susceptible (MS) S. aureus (1003 MS, 462 MR), S. epidermidis (169 MS, 251 MR), S. haemolyticus (28 MS, 46 MR), S. hominis (28 MS, 16 MR), and coagulase negative staphylococci (86 MS, 43 MR) were analyzed. Q/D was highly active against all species tested. MIC90 (mg/L) ranged from 0.5 to 2 depending on the species. Strains had MIC < or = 1 mg/L in 97.6%. For S. aureus, S. epidermidis, S. hominis and other coagulase-negative staphylococci no differences in MIC90 were observed for MS or MR. One dilution difference was observed for S. haemolyticus, which overall was the less susceptible species. Erythromycin resistance was observed among 57- 87% of MR-strains and was lower among MS-strains (18-56%). Erythromycin resistance had no or little influence on MIC of Q/D. In comparison to vancomycin, Q/D was two to four times more active. CONCLUSIONS: The streptogramin combination Q/D showed an excellent in vitro activity against all staphylococcal species tested regardless of the resistance pattern to other drug classes, particularly resistance to methicillin. Q/D was two to four times more active than vancomycin and MIC values varied from 0.5-2 according to the species. The synergy of Q/D was well conserved in macrolide-resistant strains.

Drug Resistance, Microbial↗

PubMed1991

Platelet aggregation induced by strains of various species of coagulase-negative staphylococci.

Major species of coagulase-negative staphylococci (CNS) were tested for their ability to induce platelet aggregation in rabbit platelet-rich plasma (PRP). Among 11 species of CNS tested, a majority of the strains of 10 species of CNS (S. epidermidis, S. simulans, S. capitis, S. hyicus, S. sciuri, S. cohnii, S. xylosus, S. hominis, S. haemolyticus, S. warneri) caused induction of the platelet aggregation and serotonin release, while S. saprophyticus did not show such activity. The addition of aspirin (10 mM) or quinacrine (1 mM) to PRP resulted in no remarkable effect on the platelet aggregation induced by these strains and it was shown that the platelet aggregation did not require arachidonate pathways. Complement system components were shown to be one of the plasma factors required for platelet aggregation by ten strains of each species of CNS. The bacterial substance participating in the platelet aggregation by ten species of CNS tested was indicated to be heat-stable and trypsin-resistant, while the activity of a strain of S. epidermidis was susceptible to trypsin.

Animals↗

PubMed2005

Predictive factors of outcome following staphylococcal peritonitis in continuous ambulatory peritoneal dialysis.

BACKGROUND AND AIMS: Staphylococcus epidermidis and other coagulase-negative staphylococci (CoNS) are the most common agents of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Episodes caused by Staphylococcus aureus evolve with a high method failure rate while CoNS peritonitis is generally benign. The purpose of this study was to compare episodes of peritonitis caused by CoNS species and S. aureus to evaluate the microbiological and host factors that affect outcome. MATERIAL AND METHODS: Microbiological and clinical data were retrospectively studied from 86 new episodes of peritonitis caused by staphylococci species between January 1996 and December 2000 in a university dialysis center. The influence of microbiological and host factors (age, sex, diabetes, use of vancomycin, exchange system and treatment time on CAPD) was analyzed by logistic regression model. The clinical outcome was classified into two results (resolution and non-resolution). RESULTS: The odds of peritonitis resolution were not influenced by host factors. Oxacillin susceptibility was present in 30 of 35 S. aureus lineages and 22 of 51 CoNS (p = 0.001). There were 32 of 52 (61.5%) episodes caused by oxacillin-susceptible and 20 of 34 (58.8%) by oxacillin-resistant lineages resolved (p = 0.9713). Of the 35 cases caused by S. aureus, 17 (48.6%) resolved and among 51 CoNS episodes 40 (78.4%) resolved. Resolution odds were 7.1 times higher for S. epidermidis than S. aureus (p = 0.0278), while other CoNS had 7.6 times higher odds resolution than S. epidermidis cases (p = 0.052). Episodes caused by S. haemolyticus had similar resolution odds to S. epidermidis (p = 0.859). CONCLUSIONS: S. aureus etiology is an independent factor associated with peritonitis non-resolution in CAPD, while S. epidermidis and S. haemolyticus have a lower resolution rate than other CoNS. Possibly the aggressive nature of these agents, particularly S. aureus, can be explained by their recognized pathogenic factors, more than antibiotic resistance.

Adult↗

PubMed2004

[Microbiological external quality assurance program (MEQAP)--evaluation of results obtained in sanitary epidemiological laboratories in 2002].

The aim of this study was to evaluate reliability of identification and determination of sensitivity to antibiotics and chemotherapeutics of some Gram positive cocci strains in 34 sanitary-epidemiological stations. All laboratories engaged in this study received 3 strains: S. aureus (S. aureus SC+ CF+, resistant to methicillin., or S. aureus SC - CF+, sensitive to methicillin), coagulase-negative staphylococci (S. epidermidis or S. haemolyticus or S. saprophyticus) and Enterococcus sp. (E. faecalis HLAR-positive or E. faecalis HLAR-negative or E. faecium or E. gallinarum). All these strains previously were identified in Department of Bacteriology of National Institute of Hygiene. Of the 68 staphylococci strains tested, 66 isolates were correctly identified. Among the 34 enterococcal strains studied the greatest difficulty in identification was caused by E. gallinarum strain--(8 out of 13 strains were incorrectly recognised). The determination of the sensitivity of the control strains to antibiotics and chemotherapeutic agents, generally was performed correctly in accordance with to the NCCLS and national recommendations. Some incorrect results of the antibiograms were caused by an erroneous interpretation of the zones of inhibition.

Enterococcus↗

PubMed1998

Clinical relevance of a European collaborative study on comparative susceptibility of gram-positive clinical isolates to teicoplanin and vancomycin.

Seventy laboratories in nine European countries (Belgium, France, Germany, Italy, The Netherlands, Portugal, Spain, Switzerland and the UK) each collected 100 consecutive gram-positive bacterial pathogens during 1995. MICs were determined by a co-ordinating laboratory in each country using an agar incorporation method with Mueller Hinton medium (NCCLS). Quality control was ensured by distribution of five test strains to the co-ordinating laboratories. A total of 7078 isolates was collected: 2885 Staphylococcus aureus, 1706 enterococci, 1480 coagulase-negative staphylococci (CNS), 932 Streptococcus spp. (including 289 strains of S. pneumoniae) and 75 miscellaneous species. Of these, the country coordinators successfully re-tested 6824 isolates. Using NCCLS interpretive criteria, overall 39 isolates (including 28 strains of enterococci) were teicoplanin-resistant (0.57%) and 38 (mostly CNS; 0.56%) were intermediate, whilst 32 isolates (including 30 strains of enterococci) were resistant to vancomycin (0.47%) and 7 (all enterococci; 0.10%) were intermediate. The overall resistance rate was < or = 0.5%. The two glycopeptides were essentially active against the major pathogens encountered in the survey. The only real difference with clinical implications from previously reported susceptibility data is the emergence and spread of resistance in enterococci, particularly in E. faecium. Resistance was highest in SSTI, UTI, bloodstream and GI infections; no resistance was encountered in RTI, gynaecological infections or central nervous system infections. This resistance was also geographically diverse: Resistance to vancomycin in E. faecalis was present only in France, Germany, Italy, Portugal and Spain (Italy and Spain only for teicoplanin), whilst resistance to teicoplanin and vancomycin in E. faecium was present in all countries except Spain. Eight isolates (0.5% of all enterococci) were vancomycin-resistant but teicoplanin-susceptible, exhibiting the vanB phenotype. These were four strains of E. faecalis and four strains of E. faecium. Whilst isolates of S. haemolyticus had higher MIC of teicoplanin than other CNS, and were more susceptible to vancomycin, overall resistance to teicoplanin was low (3.3% in S. haemolyticus; 0.6% in CNS). S. haemolyticus was a relatively rare pathogen, accounting for 6.3% of all CNS isolates, and 1.4% of all gram-positives collected. The results of this survey show that, despite occasional nosocomial problems (e.g. with enterococci and S. haemolyticus), teicoplanin or vancomycin remain adequate therapy for infections caused by gram-positive pathogens in the 1990s.

Anti-Bacterial Agents↗

PubMed1990

Oral ciprofloxacin for treatment of acute bacterial pharyngotonsillitis.

The clinical efficacy and tolerability of ciprofloxacin orally administered at the dosage of 250 mg twice a day was evaluated in 25 patients affected by acute bacterial pharyngotonsillitis. All patients were non-responders to previous conventional antibiotic therapies due to in vitro resistance of the responsible bacteria, or possibly the low antibiotic concentration at the infection site. None of the patients had infections caused by group A beta-haemolyticus streptococcus. Treatment with ciprofloxacin lasted for 5-10 days (mean 6.7). A favorable clinical response was observed in 92% of patients (15 resolutions and 7 improvements) at the end of the therapy and two weeks later (follow-up). One patient was not evaluable because of the unfortunate onset of glossitis that caused the interruption of the treatment. No other side-effects were recorded in the other 24 patients. The bacteriological response was excellent: 83% bacteriological eradication, 13% persistence and super-infection in only one patient (4%). Ciprofloxacin administered orally at low dosages is highly effective in the treatment of bacterial pharyngotonsillitis and is also well tolerated.

Administration, Oral↗

PubMedDate not supplied

Evaluation of the antimicrobial susceptibilities of coagulase-negative staphylococci by E-test.

Coagulase-negative staphylococci (CoNS) have recently emerged as important nosocomial pathogens. In this study, the susceptibility of 53 isolates of CoNS (42 S. epidermidis, 6 S. haemolyticus, 3 S. caprae, 1 S. lugdunensis and 1 S. chromogenes) obtained over a 1 year period at a Brazilian Hospital were tested for vancomycin, teicoplanin, cephalothin, penicillin, oxacillin, and chloramphenicol. The minimal inhibitory concentration (MICs) were determined by the E-test using saturated swabs or the flooding method. No isolates showed resistance to vancomycin, 3 (5.7%) were resistant to teicoplanin, 5 (9.4%) to cephalotin, most of them, (47, 88.6%) were resistant to penicillin, 19 (35.8%) to oxacillin and 27 (50.9%) to chloramphenicol. The study shows that the increased resistance of CoNS can cause serious infections of difficult treatment. The E-test proved to be a convenient and reliable method for MIC determination of CoNS isolates and the qualitative and quantitative results obtained by flooding were much more reproducible than the results obtained using swabs.

Bacterial Proteins↗

PubMedDate not supplied

[Sensitivity to antibiotics in coagulase-negative staphylococci isolated from patients with central venous catheters].

We examined 25 coagulase-negative staphylococci isolated from children, of whom 17 with leukaemia and 8 with terminal renal failure. Strain identification performed by api Staph system revealed the presence of S. epidermidis in 21 children, S. hominis in 3 patients and S. haemolyticus in 1 patient. By diffusion method we examined the activity of penicillin, methicillin, cephalexin, cephtriaxon, lincomycin, erythromycin, vancomycin, co-trimoxasol, gentamicin, amikacin, chloramphenicol, rifampicin and fusidic acid. MICs of seven antibiotics were obtained by agar dilution method. MIC50 and MIC90 were as follows: /ml Methicillin 3.13 mg/ml and 50 mg/ml, lincomycin 100 mg/ml and 100 mg/ml, gentamicin 25 mg/ml and 100 mg/ml, chloramphenicol 6.25 mg/ml and 50 mg/ml, amikacin 1.56 mg/ml and 100 mg/ml, rifampicin 0.09 mg/ml and 12.5 mg/ml, fusidic acid 6.25 mg/ml and 12.5 mg/ml, vancomycin 1.56 mg/ml and 3.13 mg/ml. These data show that the examined strains are highly resistant to numerous antibiotics. Thirty six percent of all strains were resistant to methicillin, 88% to lincomycin, 60% to gentamicin, 52% to chloramphenicol, 24% to amikacin, 52% to rifampicin and 56% to fuscidic acid. All the examined strains were sensitive to vancomycin.

Adolescent↗

PubMed1986

Bactericidal action of nafcillin, vancomycin, and three cephalosporins against nafcillin-susceptible and nafcillin-resistant coagulase-negative staphylococci.

Coagulase-negative staphylococci (S. epidermidis, 43 strains; S. warneri, 16 strains; S. haemolyticus, five strains; and others, four strains) were tested by the agar dilution method for nafcillin susceptibility: 53 were susceptible with a minimal inhibitory concentration (MIC) of less than or equal to 2 micrograms/ml; four were of indeterminate susceptibility, MIC = 4-16 micrograms/ml; and 11 were resistant, MIC greater than or equal to 32 micrograms/ml. The bactericidal activities from 0 to 24 hr for nafcillin, vancomycin, cephalothin, cefazolin, and cefamandole, each at 16 micrograms/ml in broth, were determined for all the isolates. The data indicate that a nafcillin agar dilution susceptibility test result of resistance does not consistently predict lack of killing activity by the cephalosporins. It is likely that each cephalosporin would have to be tested against individual coagulase-negative staphylococci in order to determine a suitable therapeutic or prophylactic cephalosporin, if a cephalosporin were to be used. Vancomycin was bactericidal for all the nafcillin-resistant coagulase-negative organisms tested.

Cefamandole↗

PubMed1984

Staphylococci isolated from abscesses in slaughtered animals: characterization and epidemiological studies.

A total of 71 strains of Gram positive, catalase positive cocci were isolated from 112 abscesses observed during inspection of slaughtered animals (sheep, cattle, pigs and goats). On the basis of lysostaphin sensitivity, all strains were identified as staphylococci. However, 4 of them did not ferment glucose anaerobically. Classification at the species level was accomplished by complete characterization of the strains. Amongst the 35 coagulase positive isolates, 30 were classified as S. aureus, 2 as S. intermedius and 3 could not be classified. Of the 36 coagulase negative cultures, 1 was classed as S. hyicus subsp. hyicus, 3 as S. simulans, 2 as S. haemolyticus, 5 as S. hominis, 3 as S. epidermidis, 2 as S. capitis, 3 as S. warneri, 4 as S. xylosus, 1 as S. cohnii and 1 as S. saprophyticus. The remaining 11 strains could not be classified. Seventeen of the 30 S. aureus strains belonged to biotype C, 7 were classified as intermediate (shared properties of biotypes A and C), 3 as similar to bitype C, 1 as similar to biotype A and 2 could not be biotyped. Twelve of the 16 biotype C strains showed characteristic properties of ovine S. aureus. The number of strains lysed by phages of human and bovine origin was 11 and 18, respectively. As many as 25 strains (23 S. aureus and 2 coagulase positive, unclassified cultures) produced enterotoxins. The enterotoxins produced were: C (14 strains), D (2 strains), A (1 strain), E (1 strain), A + C (1 strain) and A + D (6 strains). A good correlation between the type of enterotoxin produced, biotype and phage type was observed.

Abattoirs↗

PubMed2005

Species-level identification of staphylococcal isolates by real-time PCR and melt curve analysis.

A real-time PCR assay was developed to identify common staphylococcal species. A single set of consensus primers was designed to amplify a portion of the 16S rRNA gene, and a pair of fluorescence resonance energy transfer probes was used to identify species based on the unique melt properties of the probes resulting from sequence variations in the amplicons from each species. Nine common staphylococcal strains (S. aureus, S. capitis, S. epidermidis, S. haemolyticus, S. hominis, S. lugdunensis, S. schleiferi, S. simulans, and S. warneri) were used for assay development. The species-specific melting profiles were validated by correctly identifying 36 of 37 coagulase-negative staphylococcal (CoNS) isolates identified by ribotyping. In a study of clinical isolates, the PCR/melt curve approach correctly identified 56/56 S. aureus isolates identified by coagulase/protein A latex agglutination. Fifty-four CoNS clinical isolates characterized using the API Staph assay were studied, with the PCR/melt curve approach yielding matching identifications for 32/54 (59%). The API Staph assay was unable to identify 18 CoNS isolates, and differing results were obtained for 4 isolates. Sequencing of the 22 discrepant or unidentified CoNS samples revealed that the PCR/melt curve results were correct for all but one isolate. Thus, PCR/melt curve analysis achieved a nearly 100% accuracy and performed better than biochemical testing. Performance of the PCR/melt curve approach requires less than 2 h after colony selection. This method thus provides a rapid and accurate approach to the identification of staphylococcal species in the clinical laboratory.

Bacterial Typing Techniques↗

PubMed1994

[Method of DNA extraction and mecA, femA and PBP2' in multi-drug resistant bacterial strains].

Recently, it has become more important to establish rapid and reliable methods for identifying bacterial species and their drug resistances because of the high incidence of nosocomial infection caused by multi-drug resistant bacteria. At first, several enzymes were tested to evaluate the efficacy of DNA extraction. N-acetylmuramidase, lysozyme and achromopeptidase were most effective to extract DNA from E. faecalis, E. faecium and S. aureus, respectively. After achromopeptidase extraction, the mecA gene was amplified by polymerase chain reaction (PCR) in clinically isolated MRSA (95 strains), MSSA (66), MRSE (methicillin-resistant S. epidermidis, 37), MSSE (methicillin-sensitive S. epidermidis, 1), S haemolyticus(5), S.hominis(1) and others (Enterococcus, Pseudomonas, and Streptococcus, total 45). PCR products were analyzed by agarose gel electrophoresis. The positive rates were 95% (MRSA), 1.5% (MSSA), and 97% (MRSE). The mecA gene was also positive in 2/2 of methicillin-resistant S.haemolyticus and 2/3 of methicillin-sensitive S.haemolyticus and 1/1 of methicillin-resistant S.hominis. The mecA gene was not detected in 45 non-Staphylococcal strains. MecA and femA gene by PCR and PBP 2' by IRMA were further detected in newly isolated MRSA (20 strains), MSSA(20), MRSE(14), MSSE(1) and S.simulans(2). Complete correlation between MPIPC susceptibility and mecA were found. The femA gene was positive in 39/40 of S. aureus, and 0/14 of S.epidermidis, 2/3 of S.simulans. PBP2' were positive in 20/20 of MRSA, 0/20 of MSSA, 14/14 of MRSE, 0/1 of MSSE, 1/1 of methicillin-resistant S.simulans, and 0/2 of methicillin-sensitive S.simulans. In conclusion, diagnoses of MRSA by simultaneous detection of mecA and femA gene as well as PBP2' are similarly useful because of their specificity and rapidity.

Bacterial Proteins↗

PubMed1990

Comparative post-antibiotic effect of five antibiotics against ten aerobic gram-positive cocci.

The post-antibiotic effect (PAE) is the persistent suppression of bacterial growth after a short antibiotic exposure. It is well documented with a variety of antibiotics and micro-organisms and may have important therapeutic implications. The authors have evaluated the PAE produced by teicoplanin, fucidin, gentamicin, rifampicin and ciprofloxacin against a total of ten Gram-positive organisms (S. aureus (2), MRSA (2), S. epidermis (2) S. haemolyticus (2) and E. faecalis (2)). All the organisms were clinical isolates with variable sensitivity patterns confirmed by disc and MIC testing. MICs were performed by the broth dilution method using a final inoculum of 10 x 5 cfu/ml. The PAE was estimated by adding 5 x MIC of each antibiotic to a log phase of growth of approximately 10 x 7 cfu/ml, and incubating at 37 degrees C for 1 h. Antibiotic was removed by 1000-fold dilution in nutrient broth, and total viable counts were carried out hourly by the Miles and Misra method for a further 9 h. All the antibiotics tested showed a PAE against the organisms tested, except for fucidin and ciprofloxacin against the enterococci. Overall, teicoplanin showed a maximum PAE of 5 h against MSRA and a minimum of 0.6 h against E. faecalis. Gentamicin, rifampicin and ciprofloxacin also showed a variable range. Fucidin showed the least PAE against the ten organisms, ranging from 0-1.3 h, except for S. epidermidis (FUC-R) which had a PAE of up to 4.5 h. The duration of PAE of each antibiotic/organism combination varied and was associated with the sensitivity pattern of the organism.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

PubMed2001

[The HVR genotypes and their relationship with the resistance of methicillin-resistant staphylococci].

OBJECTIVE: To investigate the HVR-PCR genotype of methicillin-resistant Staphylococci in local hospitals and compare it with the antibiograms, with aview to selecting effective antibacterial agents, moreover, to discuss preliminarily its role in molecular epidemiology. METHODS: The minimal inhibitory concentrations(MICs) of 86 MRSA, 10 MRSE(Mc'S. epidemidis), 5 MSSE(Mc'S. epidemidis), 8 MRSH(Mc'S. haemolyticus) and 5 MSSH(Mc'S. haemolyticus) clinical isolates collected from 4 local hospitals were tested by serial two-fold agar dilution method; their DNA were extracted by moved basic lytic method, whose polymerase chain reaction(PCR) products amplified, based on the size of mec-associated hypervariable region(HVR) were analyzed by PAG vertical and agarose gel electrophoresis. RESULTS: MRSA, MRSE and MRSH were grouped into 4, 3 and 2 HVR genotypes respectively according to the size of the PCR products. The PCR products amplified from 9 of 10 MRSE isolates were the same as the products amplified from MRSA isolates. MRSA strains in this study were mainly HVR genotypes A and D, which accounted for 52.32% and 39.53%; Genotypes B and C were the most multi-drug resistant, but genotype D was multi-sensitive. The I genotype of MRSE was multi-drug resistant, but its genotype III was multi-drug sensitive. The genotype a of MRSH was more resistant than genotype b. CONCLUSION: These results suggest that HVR-PCR genotype method is an easy and fast method for epidemiological investigation of nosocomial infections caused by MRSA, and it is helpful for clinical selection of antibacterial agents. This method can compare the mec determinants of MRSA and Mc'CNSt isolates and hence to search for the origin of the mec determinant.

Complementarity Determining Regions↗