Methicillin was first introduced in 1959−1960, and, within a year, methicillin-resistant isolates
were reported [45]. Methicillin resistance is conferred by the mecA gene, which encodes a
penicillin-binding protein (PBP2A) with decreased affinity for β-lactam antibiotics. mecA is
part of a mobile genetic element called the “staphylococcal cassette chromosome (SCC)
mec.” SCCmec is flanked by cassette chromosome recombinase genes (ccrA/ccrB or ccrC) that
permit intra- and interspecies horizontal transmission of SCCmec. The initial reservoir of
SCCmec is unclear but may have been a coagulase-negative staphylococcal species [46–48].
A limited number of MRSA lineages has emerged from the transfer of SCCmec into successful
methicillin-susceptible S. aureus (MSSA) clones. Using multilocus sequence typing
(comparing the internal sequences of 7 housekeeping genes), Enright et al. [49] demonstrated
that MRSA clones evolved from 5 different groups of related genotypes or clonal complexes,
each arising from a distinct ancestral genotype. The earliest MRSA isolates evolved from
sequence type (ST) 8-MSSA, which, after a point mutation, evolved into ST250-MSSA. This
MSSA was likely the first recipient of SCCmec (specifically, type I) to yield the first MRSA,
labeled ST250-MRSA-I [49]. As in the work of Enright et al. [49], Crisóstomo et al. [50]
identified probable recipient MSSA strains for early MRSA strains in another collection of
isolates. Select MRSA clones are described in table 2
Methicillin was first introduced in 1959−1960, and, within a year, methicillin-resistant isolates
were reported [45]. Methicillin resistance is conferred by the mecA gene, which encodes a
penicillin-binding protein (PBP2A) with decreased affinity for β-lactam antibiotics. mecA is
part of a mobile genetic element called the “staphylococcal cassette chromosome (SCC)
mec.” SCCmec is flanked by cassette chromosome recombinase genes (ccrA/ccrB or ccrC) that
permit intra- and interspecies horizontal transmission of SCCmec. The initial reservoir of
SCCmec is unclear but may have been a coagulase-negative staphylococcal species [46–48].
A limited number of MRSA lineages has emerged from the transfer of SCCmec into successful
methicillin-susceptible S. aureus (MSSA) clones. Using multilocus sequence typing
(comparing the internal sequences of 7 housekeeping genes), Enright et al. [49] demonstrated
that MRSA clones evolved from 5 different groups of related genotypes or clonal complexes,
each arising from a distinct ancestral genotype. The earliest MRSA isolates evolved from
sequence type (ST) 8-MSSA, which, after a point mutation, evolved into ST250-MSSA. This
MSSA was likely the first recipient of SCCmec (specifically, type I) to yield the first MRSA,
labeled ST250-MRSA-I [49]. As in the work of Enright et al. [49], Crisóstomo et al. [50]
identified probable recipient MSSA strains for early MRSA strains in another collection of
isolates. Select MRSA clones are described in table 2
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