Exotoxin gene backgrounds in bloodstream and wound Staphylococcus aureus isolates from geriatric patients attending a long-term care Spanish hospital

The exotoxin gene content was established for 62 Staphylococcus aureus isolates causing bloodstream (n=31) and wound (n=31) infections in geriatric patients attending a long-term care Spanish hospital from 1996 to 2006. Content was determined based on PCR screening of genes encoding five haemolysins, three exfoliatins, three leukotoxins and 21 pyrogenic toxin superantigens (PTSAgs), in addition to markers of genomic (vSa beta) and pathogenicity (SaPls) islands. Exotoxin genes were abundant in both bloodstream (11-23 genes) and wound (8-19 genes) isolates, and they were arranged in 55 combinations with only two represented in both groups. All isolates were positive for genes encoding haemolysins (hl; 3-5) and PTSAgs (tst, se and sel; 5-14), whereas exfoliatin (et) and leukotoxin (luk) genes appeared in 98.4 and 51.6% of isolates, respectively. The hlg, lukPV, tst, sec and selu genes were found significantly more frequently in bloodstream than in wound isolates, whereas hlg-variant, sea, seb, see and selk-selq were more frequent in wound isolates (P<0.05). Distinctive exotoxin gene combinations could potentially be associated with specific mobile genetic elements, including genomic islands [lukED, egc1 (seg, seln, sei, selm, selo) and egc2 (seg, seln, selu, sei, selm, selo)]; pathogenicity islands (etd, seb, sec, sell, selq, selk and tst); bacteriophages (eta, lukPV, sea, selp, selk, selq and see); and plasmids (sed, selj, ser, ses and set). The abundance of exotoxin genes and variety of arrangements shown by S. aureus from geriatric patients could play a role in the adaptation of the pathogen.