Global Distribution and Evolution of Panton-Valentine Leukocidin-Positive Methicillin-Susceptible Staphylococcus aureus, 1981-2007

Background. Panton-Valentine leukocidin (PVL)-positive methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus (MSSA and MRSA, respectively) are both associated with severe infections, such as necrotizing pneumonia. The epidemiological profile of PVL-positive community-acquired (CA) MRSA has been extensively studied, but few corresponding data on PVL-positive MSSA are available. Objectives. The objectives of the study were to investigate the global population structure of PVL-positive MSSA, to compare it with that reported for CA-MRSA, and thus to examine the phylogenetic relationship between these pathogens. Methods. We determined the agr types, multilocus sequence types, and toxin gene profiles of 211 PVL-positive MSSA clinical isolates collected in 19 countries throughout the world between 1981 and 2007. Results. The predominant lineages of PVL-positive MSSA were agr3/ST30, agr4/ST121, agr3/ST1, agr2/ST5, and agr3/ST80. Except for agr4/ST121, these lineages are also reported to be prevalent among CA-MRSA. PVL-positive MSSA lineages that are genetically related to CA-MRSA have gradually replaced other lineages (especially agr4/ST121) over the past 2 decades. Within a given sequence type, the toxin gene content of PVL-positive MSSA strains was very similar to that of PVL-positive CA-MRSA. Conclusions. The molecular epidemiological profiles of PVL-positive MSSA and CA-MRSA are dynamically interrelated, with the former appearing to constitute a reservoir for the latter.