The new RIF-R MRSA isolates were resistant to clindamycin, erythromycin, gentamicin, tobramycin, ciprofloxacin and susceptible to tetracycline. However, molecular

typing showed that the Iberian clone and the new RIF-R MRSA clone had different genetic backgrounds represented by ST-247 and ST-228, respectively, with only a single locus in common. Although both clones carried a SCCmec element type I, PFGE patterns and spa-types were clearly different. All strains with the multi-resistant phenotype described in this work, showing resistance or decreased susceptibility to rifampicin, belonged to ST-228, carried a SCCmec element type I and were spa-type t041. This clone seems to be related to the Southern Germany clone (ST-228, SCCmec type I, spa-type t001 or spa-type t041) reported in Germany in 1997-98 [21, 33]. In the same period, strains of ST-228 and SCCmec click here type I were reported at several hospitals located in seven Italian cities [34], although these isolates also showed resistance to multiple antibiotics, rifampicin resistance was not stated. Recently, strains of ST-228 have spread epidemically in Finland in 2002-2004 and in Hungary in 2003-2004 [35, 36]. Also, ST-228 has been reported in other European countries: Belgium, Slovenia or Switzerland [37]. The first isolate ST-228, SCCmec type I was isolated in our hospital

BLZ945 research buy Interleukin-3 receptor in September 2003, from a patient admitted to the ICU. However, it was not until March 2004 that this clone spread epidemically in our hospital and currently represents one third of all clinical MRSA isolates in our institution. Strains belonging to ST-228 have been reported in other hospitals in Spain since 1996 [9, 29, 38]. However, none of these reports (from Spain or other countries) analysed the decreased susceptibility to rifampicin among representative strains of ST-228. During the 2004-2007 period, we did not find significant changes in the rifampin consumption in our JNJ-26481585 price institution, which was on average 0.5 DDD/100 patients-days

for intravenous and 1.0 DDD/100 patients-days for oral administration. A set of 5 strains resistant to clindamycin, erythromycin, gentamicin, tobramycin, ciprofloxacin, but fully susceptible to rifampicin with MICs of 0.012 mg/L were included in this study. On average, this RIF-S pattern represented 4% of all MRSA isolated between 2004 and 2006, however this resistance phenotype can be traced back to 1999 in our hospital. The RIF-S isolates were classified as ST-228, the same as the RIF-R MRSA. Isolates of ST-228 (MLST, arcc 1, aroe 4, glpf 1, gmk 4, pta 12, tpi 24, and yqi 29) belong to the Clonal Complex 5, as well as isolates of ST-125 (MLST, arcc 1, aroe 4, glpf 1, gmk 4, pta 12, tpi 1, and yqi 54) which was the dominant MRSA clone in Hospital Universitari de Bellvitge from 1996 to 2003.