Genetic alterations in methicillin-susceptible Staphylococcus aureus associated with high vancomycin minimum inhibitory concentration

Background: There are many reports on gene mutations observed in methicillin-resistant Staphylococ-cus aureus (MRSA) showing reduced susceptibility to vancomycin. However, there are limited studies on the genetic alterations that contribute to high vancomycin minimum inhibitory concentrations (MICs) in methicillin-susceptible S. aureus (MSSA). This study aimed to compare MSSA strains with high van-comycin MICs with those with low MICs, and to identify specific genetic alterations associated with in-creased vancomycin MICs.Methods: In total, 124 MSSA strains were analysed, with 62 having vancomycin MICs of 1-2 mg/L (MS -HV) and the remaining 62 having MICs < 1 mg/L (MS-LV) as control. Polymerase chain reaction amplifi-cation and sequencing were conducted to identify point mutations and amino acid changes in the vraSR, graRS and walRK operons and rpoB gene. The number of single nucleotide polymorphisms (SNPs) and specific mutations in the indicated gene were compared between the two groups.Results: The MS-HV strains had a significantly higher median number of SNPs in studied genes than the MS-LV strains (5 vs 3; P < 0.0 0 01), with higher frequency of SNPs in the graR and walK genes. The MS -HV strains also displayed a significantly higher prevalence of specific mutations in the graR gene (V135I, I136V and V136I) compared with the MS-LV strains. The odds of having a high vancomycin MIC was 5.54 times higher in strains with a mutation in the graR gene, and 5.32 times higher in strains with a mutation in the walK gene, compared with those without these mutations.Conclusions: Mutations in the graR and walK genes may contribute to reduced vancomycin susceptibility in MSSA. This study gives key insights into the mechanisms underlying this phenomenon.(c) 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.