# Patent

## Title
Method for the detection and identification of methicillin-resistant Staphylococcus aureus

## Abstract

The present invention describes novel SCCmec right extremity junction sequences for the detection of methicillin-resistant Staphyloccocus aureus (MRSA). It relates to the use of these DNA sequences for diagnostic purposes.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a continuation of U.S. patent application Ser. No. 10/479,674, to Huletsky, et al., “SEQUENCES FOR DETECTION AND IDENTIFICATION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS,” filed Sep. 7, 2004 which is a National Phase Application of International Patent Application PCT/CA02/00824, filed Jun. 4, 2002, now closed, which claims priority to Canadian Patent Application No. 2,348,042, filed Jun. 4, 2001, now abandoned.


REFERENCE TO SEQUENCE LISTING, TABLE, OR COMPUTER PROGRAM LISTING
The present application is being filed along with duplicate copies of a CD-ROM marked “Copy 1” and “Copy 2” containing a Sequence Listing in electronic format. The duplicate copies of CD-ROM entitled The “Copy 1” and “Copy 2” each contains a file entitled GENOM051C1.txt created on May 2, 2006 which is 200,704 Bytes in size. The information on these duplicate CD-ROMs is incorporated herein by reference in its entirety.
BACKGROUND OF THE INVENTION
Clinical Significance of Staphylococcus Aureus 
The coagulase-positive species Staphylococcus aureus is well documented as a human opportunistic pathogen. Nosocomial infections caused by S. aureus are a major cause of morbidity and mortality. Some of the most common infections caused by S. aureus involve the skin, and they include furuncles or boils, cellulitis, impetigo, and postoperative wound infections at various sites. Some of the more serious infections produced by S. aureus are bacteremia, pneumonia, osteomyelitis, acute endocarditis, myocarditis, pericarditis, cerebritis, meningitis, scalded skin syndrome, and various abcesses. Food poisoning mediated by staphylococcal enterotoxins is another important syndrome associated with S. aureus. Toxic shock syndrome, a community-acquired disease, has also been attributed to infection or colonization with toxigenic S. aureus (Murray et al. Eds, 1999, Manual of Clinical Microbiology, 7th Ed., ASM Press, Washington, D.C.).
Methicillin-resistant S. aureus (MRSA) emerged in the 1980s as a major clinical and epidemiologic problem in hospitals. MRSA are resistant to all β-lactams including penicillins, cephalosporins, carbapenems, and monobactams, which are the most commonly used antibiotics to cure S. aureus infections. MRSA infections can only be treated with more toxic and more costly antibiotics, which are normally used as the last line of defence. Since MRSA can spread easily from patient to patient via personnel, hospitals over the world are confronted with the problem to control MRSA. Consequently, there is a need to develop rapid and simple screening or diagnostic tests for detection and/or identification of MRSA to reduce its dissemination and improve the diagnosis and treatment of infected patients.
Methicillin resistance in S. aureus is unique in that it is due to acquisition of DNA from other coagulase-negative staphylococci (CNS), coding for a surnumerary β-lactam-resistant penicillin-binding protein (PBP), which takes over the biosynthetic functions of the normal PBPs when the cell is exposed to β-lactam antibiotics. S. aureus normally contains four PBPs, of which PBPs 1, 2 and 3 are essential. The low-affinity PBP in MRSA, termed PBP 2a (or PBP2′), is encoded by the choromosomal mecA gene and functions as a β-lactam-resistant transpeptidase. The mecA gene is absent from methicillin-sensitive S. aureus but is widely distributed among other species of staphylococci and is highly conserved (Ubukata et al., 1990, Antimicrob. Agents Chemother. 34:170-172).
By nucleotide sequence determination of the DNA region surrounding the mecA gene from S. aureus strain N315 (isolated in Japan in 1982), Hiramatsu et al. have found that the mecA gene is carried by a novel genetic element, designated staphylococcal cassette chromosome mec (SCCmec), inserted into the chromosome. SCCmec is a mobile genetic element characterized by the presence of terminal inverted and direct repeats, a set of site-specific recombinase genes (ccrA and ccrB), and the mecA gene complex (Ito et al., 1999, Antimicrob. Agents Chemother. 43:1449-1458; Katayama et al., 2000, Antimicrob. Agents Chemother. 44:1549-1555). The element is precisely excised from the chromosome of S. aureus strain N315 and integrates into a specific S. aureus chromosomal site in the same orientation through the function of a unique set of recombinase genes comprising ccrA and ccrB. Two novel genetic elements that shared similar structural features of SCCmec were found by cloning and sequencing the DNA region surrounding the mecA gene from MRSA strains NCTC 10442 (the first MRSA strain isolated in England in 1961) and 85/2082 (a strain from New Zealand isolated in 1985). The three SCCmec have been designated type I (NCTC 10442), type II (N315) and type III (85/2082) based on the year of isolation of the strains (Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-1336) (FIG. 1). Hiramatsu et al. have found that the SCCmec DNAs are integrated at a specific site in the methicillin-sensitive S. aureus (MSSA) chromosome. They characterized the nucleotide sequences of the regions around the left and right boundaries of SCCmec DNA (i.e. attL and attR, respectively) as well as those of the regions around the SCCmec DNA integration site (i.e. attBscc which is the bacterial chromosome attachment site for SCCmec DNA). The attBscc site was located at the 3′ end of a novel open reading frame (ORF), orfX. The orfX potentially encodes a 159-amino acid polypeptide sharing identity with some previously identified polypeptides, but of unknown function (Ito et al., 1999, Antimicrob. Agents Chemother. 43:1449-1458). Recently, a new type of SCCmec (type IV) has been described by both Hiramatsu et al. (Ma et al, 2002, Antimicrob. Agents Chemother. 46:1147-1152) and Oliveira et al. (Oliveira et al, 2001, Microb. Drug Resist. 7:349-360). The sequences of the right extremity of the new type IV SCCmec from S. aureus strains CA05 and 8/6-3P published by Hiramatsu et al. (Ma et al., 2002, Antimicrob. Agents Chemother. 46:1147-1152) were nearly identical over 2000 nucleotides to that of type II SCCmec of S. aureus strain N315 (Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-1336). No sequence at the right extremity of the SCCmec type IV is available from the S. aureus strains HDE288 and PL72 described by Oliveira et al. (Oliveira et al., 2001, Microb. Drug Resist. 7:349-360).
Previous methods used to detect and identify MRSA (Saito et al., 1995, J. Clin. Microbiol. 33:2498-2500; Ubukata et al., 1992, J. Clin. Microbiol. 30:1728-1733; Murakami et al., 1991, J. Clin. Microbiol. 29:2240-2244; Hiramatsu et al., 1992, Microbiol. Immunol. 36:445-453), which are based on the detection of the mecA gene and S. aureus-specific chromosomal sequences, encountered difficulty in discriminating MRSA from methicillin-resistant coagulase-negative staphylococci (CNS) because the mecA gene is widely distributed in both S. aureus and CNS species (Suzuki et al., 1992, Antimicrob. Agents. Chemother. 36:429-434). Hiramatsu et al. (U.S. Pat. No. 6,156,507) have described a PCR assay specific for MRSA by using primers that can specifically hybridize to the right extremities of the 3 types of SCCmec DNAs in combination with a primer specific to the S. aureus chromosome, which corresponds to the nucleotide sequence on the right side of the SCCmec integration site. Since nucleotide sequences surrounding the SCCmec integration site in other staphylococcal species (such as S. epidermidis and S. haemolyticus) are different from those found in S. aureus, this PCR assay was specific for the detection of MRSA. This PCR assay also supplied information for MREP typing (standing for <<mec right extremity polymorphism>>) of SCCmec DNA (Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-1336; Hiramatsu et al., 1996, J. Infect. Chemother. 2:117-129). This typing method takes advantage of the polymorphism at the right extremity of SCCmec DNAs adjacent to the integration site among the three types of SCCmec. Type III has a unique nucleotide sequence while type II has an insertion of 102 nucleotides to the right terminus of SCCmec type I. The MREP typing method described by Hiramatsu et al. (Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-1336; Hiramatsu et al., 1996, J. Infect. Chemother. 2:117-129) defines the SCCmec type I as MREP type i, SCCmec type II as MREP type ii and SCCmec type III as MREP type iii. It should be noted that the MREP typing method cannot differentiate the new SCCmec type IV described by Hiramatsu et al. (Ma et al., 2002, Antimicrob. Agents Chemother. 46:1147-1152) from SCCmec type II because these two SCCmec types exhibit the same nucleotide sequence to the right extremity.
The set of primers described by Hiramatsu et al. as being the optimal primer combination (SEQ ID NOs.: 22, 24, 28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58 and 60, respectively, in the present invention) have been used in the present invention to test by PCR a variety of MRSA and MSSA strains (FIG. 1 and Table 1). Twenty of the 39 MRSA strains tested were not amplified by the Hiramatsu et al. multiplex PCR assay (Tables 2 and 3). Hiramitsu's method indeed was successful in detecting less than 50% of the tested 39 MRSA strains.
This finding demonstrates that some MRSA strains have sequences at the right extremity of SCCmec-chromosome right extremity junction different from those identified by Hiramatsu et al. Consequently, the system developed by Hiramatsu et al. does not allow the detection of all MRSA. The present invention relates to the generation of SCCmec-chromosome right extremity junction sequence data required to detect more MRSA strains in order to improve the Hiramatsu et al. assay. There is a need for developing more ubiquitous primers and probes for the detection of most MRSA strains around the world.
SUMMARY OF THE INVENTION
It is an object of the present invention to provide a specific, ubiquitous and sensitive method using probes and/or amplification primers for determining the presence and/or amount of nucleic acids from all MRSA strains.
Ubiquity of at least 50% amongst the strains representing MRSA strains types IV to X is an objective of this invention.
Therefore, in accordance with the present invention is provided a method to detect the presence of a methicillin-resistant Staphylococcus aureus (MRSA) strain in a sample, the MRSA strain being resistant because of the presence of an SCCmec insert containing a mecA gene, said SCCmec being inserted in bacterial nucleic acids thereby generating a polymorphic right extremity junction (MREJ), the method comprising the step of annealing the nucleic acids of the sample with a plurality of probes and/or primers, characterized by:
the primers and/or probes are specific for MRSA strains and capable of annealing with polymorphic MREJ nucleic acids, the polymorphic MREJ comprising MREJ types i to x; and
the primers and/or probes altogether can anneal with at least four MREJ types selected from MREJ types i to x.
In a specific embodiment, the primers and/or probes are all chosen to anneal under common annealing conditions, and even more specifically, they are placed altogether in the same physical enclosure.
A specific method has been developed using primers and/or probes having at least 10 nucleotides in length and capable of annealing with MREJ types i to iii, defined in any one of SEQ ID NOs: 1, 20, 21, 22, 23, 24, 25, 41, 199; 2, 17, 18, 19, 26, 40, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 185, 186, 197; 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 104, 184, 198 and with one or more of MREJ types iv to ix, having SEQ ID NOs: 42, 43, 44, 45, 46, 51; 47, 48, 49, 50; 171; 165, 166; 167; 168. To be perfectly ubiquitous with the all the sequenced MREJs, the primers and/or probes altogether can anneal with said SEQ ID NOs of MREJ types i to ix.
The following specific primers and/or probes having the following sequences have been designed:
66, 100, 101, 105, 52, 53, 54, 55, 56, 57, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type i
66, 97, 99, 100, 101, 106, 117, 118, 124, 125, 52, 53, 54, 55, 56, 57, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89 for the detection of MREJ type ii
67, 98, 102, 107, 108, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 58, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type iii
79, 77, 145, 146, 147, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 68, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type iv
65, 80, 154, 155, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type v
202, 203, 204, 4, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type vi
112, 113, 114, 119, 120, 121, 122, 123, 150, 151, 153, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type vii
115, 116, 187, 188, 207, 208, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159
59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type viii
109, 148, 149, 205, 206, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 126, 127, 128, 129, 131, 200, 201, 60, 61, 63, 32, 83, 84, 160, 161, 162, 163, 164, 85, 86, 87, 88, 89, for the detection of MREJ type ix.
Amongst these, the following primer pairs having the following sequences are used:
64/66, 64/100, 64/101; 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56, 63/57, for the detection of type i MREJ
64/66, 64/97, 64/99, 64/100, 64/101, 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56, 63/57 for the detection of type ii MREJ
64/67, 64/98, 64/102; 59/58, 60/58, 61/58, 62/58, 63/58 for the detection of type iii MREJ
64/79 for the detection of type iv MREJ
64/80 for the detection of type v MREJ
64/204 for the detection of type vi MREJ
64/112, 64/113 for the detection of type vii MREJ
64/115, 64/116 for the detection of type viii MREJ
64/109 for the detection of type ix MREJ
As well, amongst these, the following probes having the following sequences are used:
SEQ ID NOs: 32, 83, 84, 160, 161, 162, 163, 164 for the detection of MREJ types i to ix.
In the most preferred embodied method, the following primers and/or probes having the following nucleotide sequences are used together. The preferred combinations make use of:
SEQ ID NOs: 64, 66, 84, 163, 164 for the detection of MREJ type i
SEQ ID NOs: 64, 66, 84, 163, 164 for the detection of MREJ type ii
SEQ ID NOs: 64, 67, 84, 163, 164 for the detection of MREJ type iii
SEQ ID NOs: 64, 79, 84, 163, 164 for the detection of MREJ type iv
SEQ ID NOs: 64, 80, 84, 163, 164 for the detection of MREJ type v
SEQ ID NOs: 64, 112, 84, 163, 164 for the detection of MREJ type vii.
All these probes and primers can even be used together in the same physical enclosure.
It is another object of this invention to provide a method for typing a MREJ of a MRSA strain, which comprises the steps of: reproducing the above method with primers and/or probes specific for a determined MREJ type, and detecting an annealed probe or primer as an indication of the presence of a determined MREJ type.
It is further another object of this invention to provide a nucleic acid selected from SEQ ID NOs:
SEQ ID NOs: 42, 43, 44, 45, 46, 51 for sequence of MREJ type iv;
SEQ ID NOs: 47, 48, 49, 50 for sequence of MREJ type v;
SEQ ID NOs: 171 for sequence of MREJ type vi;
SEQ ID NOs: 165, 166 for sequence of MREJ type vii;
SEQ ID NOs: 167 for sequence of MREJ type viii;
SEQ ID NOs: 168 for sequence of MREJ type ix.
Oligonucleotides of at least 10 nucleotides in length which hybridize with any of these nucleic acids and which hybridize with one or more MREJ of types selected from iv to ix are also objects of this invention. Amongst these, primer pairs (or probes) having the following SEQ ID NOs:
64/66, 64/100, 64/101; 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56, 63/57 for the detection of type i MREJ
64/66, 64/97, 64/99, 64/100, 64/101, 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56, 63/57 for the detection of type ii MREJ
64/67, 64/98, 64/102; 59/58, 60/58, 61/58, 62/58, 63/58 for the detection of type iii MREJ
64/79 for the detection of type iv MREJ
64/80 for the detection of type v MREJ
64/204 for the detection of type vi MREJ
64/112, 64/113 for the detection of type vii MREJ
64/115, 64/116 for the detection of type viii MREJ
64/109 for the detection of type ix MREJ,
are also within the scope of this invention.
Further, internal probes having nucleotide sequences defined in any one of SEQ ID NOs: 32, 83, 84, 160, 161, 162, 163, 164, are also within the scope of this invention. Compositions of matter comprising the primers and/or probes annealing or hybridizing with one or more MREJ of types selected from iv to ix as well as with the above nucleic acids, comprising or not primers and/or probes, which hybridize with one or more MREJ of types selected from i to iii, are further objects of this invention. The preferred compositions would comprise the primers having the nucleotide sequences defined in SEQ ID NOs:
64/66, 64/100, 64/101; 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56, 63/57, for the detection of type i MREJ
64/66, 64/97, 64/99, 64/100, 64/101, 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56, 63/57 for the detection of type ii MREJ
64/67, 64/98, 64/102; 59/58, 60/58, 61/58, 62/58, 63/58 for the detection of type iii MREJ
64/79 for the detection of type iv MREJ
64/80 for the detection of type v MREJ
64/204 for the detection of type vi MREJ
64/112, 64/113 for the detection of type vii MREJ
64/115, 64/116 for the detection of type viii MREJ
64/109 for the detection of type ix MREJ,
or probes, which SEQ ID NOs are: 32, 83, 84, 160, 161, 162, 163, 164, or both.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a diagram illustrating the position of the primers developed by Hiramatsu et al. (U.S. Pat. No. 6,156,507) in the SCCmec-chromosome right extremity junction for detection and identification of MRSA.
FIG. 2 is a diagram illustrating the position of the primers selected in the present invention in the SCCmec-orfX right extremity junction for detection and identification of MRSA.
FIG. 3 is a diagram illustrating the position of the primers selected in the present invention to sequence new MREP types.
FIG. 4. Multiple sequence alignment of representatives of nine MREJ types (represented by the reverse complement of nucleotides 2193-2588 of SEQ ID NO: 1, for type i, the reverse complement of nucleotides 1972-2469 of SEQ ID NO: 2 for type ii, the reverse complement of nucleotides 305-797 of SEQ ID NO: 104 for type iii, nucleotides 435-932 of SEQ ID NO: 51 for type iv, nucleotides 427-924 of SEQ ID NO: 50 for type v, nucleotides 451-948 of SEQ ID NO: 171 for type vi, nucleotides 451-947 of SEQ ID NO:165 for type vii, nucleotides 445-935 of SEQ ID NO:167 for type viii, and nucleotides 442-937 of SEQ ID NO: 168 for type ix).



DETAILED DESCRIPTION OF THE INVENTION
Here is particularly provided a method wherein each of MRSA nucleic acids or a variant or part thereof comprises a selected target region hybridizable with said primers or probes developed to be ubiquitous;
wherein each of said nucleic acids or a variant or part thereof comprises a selected target region hybridizable with said primers or probes;
said method comprising the steps of contacting said sample with said probes or primers and detecting the presence and/or amount of hybridized probes or amplified products as an indication of the presence and/or amount of MRSA.
In the method, sequences from DNA fragments of SCCmec-chromosome right extremity junction, thereafter named MREJ standing for <<mec right extremity junction>> including sequences from SCCmec right extremity and chromosomal DNA to the right of the SCCmec integration site are used as parental sequences from which are derived the primers and/or the probes. MREJ sequences include our proprietary sequences as well as sequences obtained from public databases and from U.S. Pat. No. 6,156,507 and were selected for their capacity to sensitively, specifically, ubiquitously and rapidly detect the targeted MRSA nucleic acids.
Our proprietary DNA fragments and oligonucleotides (primers and probes) are also another object of this invention.
Compositions of matter such as diagnostic kits comprising amplification primers or probes for the detection of MRSA are also objects of the present invention.
In the above methods and kits, probes and primers are not limited to nucleic acids and may include, but are not restricted to, analogs of nucleotides. The diagnostic reagents constituted by the probes and the primers may be present in any suitable form (bound to a solid support, liquid, lyophilized, etc.).
In the above methods and kits, amplification reactions may include but are not restricted to: a) polymerase chain reaction (PCR), b) ligase chain reaction (LCR), c) nucleic acid sequence-based amplification (NASBA), d) self-sustained sequence replication (3SR), e) strand displacement amplification (SDA), f) branched DNA signal amplification (bDNA), g) transcription-mediated amplification (TMA), h) cycling probe technology (CPT), i) nested PCR, j) multiplex PCR, k) solid phase amplification (SPA), l) nuclease dependent signal amplification (NDSA), m) rolling circle amplification technology (RCA), n) Anchored strand displacement amplification, o) Solid-phase (immobilized) rolling circle amplification.
In the above methods and kits, detection of the nucleic acids of target genes may include real-time or post-amplification technologies. These detection technologies can include, but are not limited to fluorescence resonance energy transfer (FRET)-based methods such as adjacent hybridization of probes (including probe-probe and probe-primer methods), TaqMan probe, molecular beacon probe, Scorpion probe, nanoparticle probe and Amplifluor probe. Other detection methods include target gene nucleic acids detection via immunological methods, solid phase hybridization methods on filters, chips or any other solid support. In these systems, the hybridization can be monitored by fluorescence, chemiluminescence, potentiometry, mass spectrometry, plasmon resonance, polarimetry, colorimetry, flow cytometry or scanometry. Nucleotide sequencing, including sequencing by dideoxy termination or sequencing by hybridization (e.g. sequencing using a DNA chip) represents another method to detect and characterize the nucleic acids of target genes.
In a preferred embodiment, a PCR protocol is used for nucleic acid amplification.
A method for detection of a plurality of potential MRSA strains having different MREJ types may be conducted in separate reactions and physical enclosures, one type at the time. Alternatively, it could be conducted simultaneously for different types in separate physical enclosures, or in the same physical enclosures. In the latter scenario a multiplex PCR reaction could be conducted which would require that the oligonucleotides are all capable of annealing with a target region under common conditions. Since many probes or primers are specific for a determined MREJ type, typing a MRSA strain is a possible embodiment. When a mixture of oligonucleotides annealing together with more than one type is used in a single physical enclosure or container, different labels would be used to distinguish one type from another.
We aim at developing a DNA-based test or kit to detect and identify MRSA. Although the sequences from orfX genes and some SCCmec DNA fragments are available from public databases and have been used to develop DNA-based tests for detection of MRSA, new sequence data allowing to improve MRSA detection and identification which are object of the present invention have either never been characterized previously or were known but not shown to be located at the right extremity of SCCmec adjacent to the integration site (Table 4). These novel sequences could not have been predicted nor detected by the MRSA-specific PCR assay developed by Hiramatsu et al. (U.S. Pat. No. 6,156,507). These sequences will allow to improve current DNA-based tests for the diagnosis of MRSA because they allow the design of ubiquitous primers and probes for the detection and identification of more MRSA strains including all the major epidemic clones from around the world.
The diagnostic kits, primers and probes mentioned above can be used to detect and/or identify MRSA, whether said diagnostic kits, primers and probes are used for in vitro or in situ applications. The said samples may include but are not limited to: any clinical sample, any environmental sample, any microbial culture, any microbial colony, any tissue, and any cell line.
It is also an object of the present invention that said diagnostic kits, primers and probes can be used alone or in combination with any other assay suitable to detect and/or identify microorganisms, including but not limited to: any assay based on nucleic acids detection, any immunoassay, any enzymatic assay, any biochemical assay, any lysotypic assay, any serological assay, any differential culture medium, any enrichment culture medium, any selective culture medium, any specific assay medium, any identification culture medium, any enumeration culture medium, any cellular stain, any culture on specific cell lines, and any infectivity assay on animals.
In the methods and kits described herein below, the oligonucleotide probes and amplification primers have been derived from larger sequences (i.e. DNA fragments of at least 100 base pairs). All DNA sequences have been obtained either from our proprietary sequences or from public databases (Tables 5, 6, 7, 8 and 9).
It is clear to the individual skilled in the art that oligonucleotide sequences other than those described in the present invention and which are appropriate for detection and/or identification of MRSA may also be derived from the proprietary fragment sequences or selected public database sequences. For example, the oligonucleotide primers or probes may be shorter but of a length of at least 10 nucleotides or longer than the ones chosen; they may also be selected anywhere else in the proprietary DNA fragments or in the sequences selected from public databases; they may also be variants of the same oligonucleotide. If the target DNA or a variant thereof hybridizes to a given oligonucleotide, or if the target DNA or a variant thereof can be amplified by a given oligonucleotide PCR primer pair, the converse is also true; a given target DNA may hybridize to a variant oligonucleotide probe or be amplified by a variant oligonucleotide PCR primer. Alternatively, the oligonucleotides may be designed from said DNA fragment sequences for use in amplification methods other than PCR. Consequently, the core of this invention is the detection and/or identification of MRSA by targeting genomic DNA sequences which are used as a source of specific and ubiquitous oligonucleotide probes and/or amplification primers. Although the selection and evaluation of oligonucleotides suitable for diagnostic purposes require much effort, it is quite possible for the individual skilled in the art to derive, from the selected DNA fragments, oligonucleotides other than the ones listed in Tables 5, 6, 7, 8 and 9 which are suitable for diagnostic purposes. When a proprietary fragment or a public database sequence is selected for its specificity and ubiquity, it increases the probability that subsets thereof will also be specific and ubiquitous.
The proprietary DNA fragments have been obtained as a repertory of sequences created by amplifying MRSA nucleic acids with new primers. These primers and the repertory of nucleic acids as well as the repertory of nucleotide sequences are further objects of this invention (Tables 4, 5, 6, 7, 8 and 9).
Claims therefore are in accordance with the present invention.
Sequences for Detection and Identification of MRSA
In the description of this invention, the terms <<nucleic acids>> and <<sequences>> might be used interchangeably. However, <<nucleic acids>> are chemical entities while <<sequences>> are the pieces of information encoded by these <<nucleic acids>>. Both nucleic acids and sequences are equivalently valuable sources of information for the matter pertaining to this invention.
Oligonucleotide Primers and Probes Design and Synthesis
As part of the design rules, all oligonucleotides (probes for hybridization and primers for DNA amplification by PCR) were evaluated for their suitability for hybridization or PCR amplification by computer analysis using standard programs (i.e. the GCG Wisconsin package programs, the primer analysis software OligoTM 6 and MFOLD 3.0). The potential suitability of the PCR primer pairs was also evaluated prior to their synthesis by verifying the absence of unwanted features such as long stretches of one nucleotide and a high proportion of G or C residues at the 3′ end (Persing et al., 1993, Diagnostic Molecular Microbiology: Principles and Applications, American Society for Microbiology, Washington, D.C.). Oligonucleotide amplification primers were synthesized using an automated DNA synthesizer (Applied Biosystems). Molecular beacon designs were evaluated using criteria established by Kramer et al. (http://www.molecular-beacons.org).
The oligonucleotide sequence of primers or probes may be derived from either strand of the duplex DNA. The primers or probes may consist of the bases A, G, C, or T or analogs and they may be degenerated at one or more chosen nucleotide position(s) (Nichols et al., 1994, Nature 369:492-493). Primers and probes may also consist of nucleotide analogs such as Locked Nucleic Acids (LNA) (Koskin et al., 1998, Tetrahedron 54:3607-3630), and Peptide Nucleic Acids (PNA) (Egholm et al., 1993, Nature 365:566-568). The primers or probes may be of any suitable length and may be selected anywhere within the DNA sequences from proprietary fragments, or from selected database sequences which are suitable for the detection of MRSA.
Variants for a given target microbial gene are naturally occurring and are attributable to sequence variation within that gene during evolution (Watson et al., 1987, Molecular Biology of the Gene, 4th ed., The Benjamin/Cummings Publishing Company, Menlo Park, Calif.; Lewin, 1989, Genes IV, John Wiley & Sons, New York, N.Y.). For example, different strains of the same microbial species may have a single or more nucleotide variation(s) at the oligonucleotide hybridization site. The person skilled in the art is well aware of the existence of variant nucleic acids and/or sequences for a specific gene and that the frequency of sequence variations depends on the selective pressure during evolution on a given gene product. The detection of a variant sequence for a region between two PCR primers may be demonstrated by sequencing the amplification product. In order to show the presence of sequence variations at the primer hybridization site, one has to amplify a larger DNA target with PCR primers outside that hybridization site. Sequencing of this larger fragment will allow the detection of sequence variation at this primer hybridization site. A similar strategy may be applied to show variations at the hybridization site of a probe. Insofar as the divergence of the target nucleic acids and/or sequences or a part thereof does not affect significantly the sensitivity and/or specificity and/or ubiquity of the amplification primers or probes, variant microbial DNA is under the scope of this invention. Variants of the selected primers or probes may also be used to amplify or hybridize to a variant target DNA.
DNA Amplification
For DNA amplification by the widely used PCR method, primer pairs were derived from our proprietary DNA fragments or from public database sequences.
During DNA amplification by PCR, two oligonucleotide primers binding respectively to each strand of the heat-denatured target DNA from the microbial genome are used to amplify exponentially in vitro the target DNA by successive thermal cycles allowing denaturation of the DNA, annealing of the primers and synthesis of new targets at each cycle (Persing et al, 1993, Diagnostic Molecular Microbiology: Principles and Applications, American Society for Microbiology, Washington, D.C.).
Briefly, the PCR protocols on a standard thermocycler (PTC-200 from MJ Research Inc., Watertown, Mass.) were as follows: Treated standardized bacterial suspensions or genomic DNA prepared from bacterial cultures or clinical specimens were amplified in a 20 μl PCR reaction mixture. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 2.5 mM MgCl2, 0.4 μM of each primer, 200 μM of each of the four dNTPs (Pharmacia Biotech), 3.3 μg/μl bovine serum albumin (BSA) (Sigma-Aldrich Canada Ltd, Oakville, Ontario, Canada) and 0.5 unit of Taq DNA polymerase (Promega Corp., Madison, Wis.) combined with the TaqStartTM antibody (BD Biosciences, Palo Alto, Calif.). The TaqStartTM antibody, which is a neutralizing monoclonal antibody to Taq DNA polymerase, was added to all PCR reactions to enhance the specificity and the sensitivity of the amplifications (Kellogg et al., 1994, Biotechniques 16:1134-1137). The treatment of bacterial cultures or of clinical specimens consists in a rapid protocol to lyse the microbial cells and eliminate or neutralize PCR inhibitors (described in application U.S. 60/306,163). For amplification from purified genomic DNA, the samples were added directly to the PCR amplification mixture. An internal control, derived from sequences not found in the target MREJ sequences or in the human genome, was used to verify the efficiency of the PCR reaction and the absence of significant PCR inhibition.
The number of cycles performed for the PCR assays varies according to the sensitivity level required. For example, the sensitivity level required for microbial detection directly from a clinical specimen is higher than for detection from a microbial culture. Consequently, more sensitive PCR assays having more thermal cycles are probably required for direct detection from clinical specimens.
The person skilled in the art of nucleic acid amplification knows the existence of other rapid amplification procedures such as ligase chain reaction (LCR), reverse transcriptase PCR (RT-PCR), transcription-mediated amplification (TMA), self-sustained sequence replication (3SR), nucleic acid sequence-based amplification (NASBA), strand displacement amplification (SDA), branched DNA (bDNA), cycling probe technology (CPT), solid phase amplification (SPA), rolling circle amplification technology (RCA), solid phase RCA, anchored SDA and nuclease dependent signal amplification (NDSA) (Lee et al., 1997, Nucleic Acid Amplification Technologies: Application to Disease Diagnosis, Eaton Publishing, Boston, Mass.; Persing et al., 1993, Diagnostic Molecular Microbiology: Principles and Applications, American Society for Microbiology, Washington, D.C.; Westin et al., 2000, Nat. Biotechnol. 18:199-204). The scope of this invention is not limited to the use of amplification by PCR, but rather includes the use of any nucleic acid amplification method or any other procedure which may be used to increase the sensitivity and/or the rapidity of nucleic acid-based diagnostic tests. The scope of the present invention also covers the use of any nucleic acids amplification and detection technology including real-time or post-amplification detection technologies, any amplification technology combined with detection, any hybridization nucleic acid chips or array technologies, any amplification chips or combination of amplification and hybridization chip technologies. Detection and identification by any nucleotide sequencing method is also under the scope of the present invention.
Any oligonucleotide derived from the S. aureus MREJ DNA sequences and used with any nucleic acid amplification and/or hybridization technologies are also under the scope of this invention.
Evaluation of the MRSA Detection Method Developed by Hiramatsu et al.
According to Hiramatsu et al. (Ito et al., 1999, Antimicrob. Agents Chemother. 43:1449-1458; Katayama et al., 2000, Antimicrob. Agents Chemother. 44:1549-1555; Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-1336, Ma et al., 2002, Antimicrob. Agents Chemother. 46:1147-1152), four types of SCCmec DNA are found among MRSA strains. They have found that SCCmec DNAs are integrated at a specific site of the MSSA chromosome (named orfX). They developed a MRSA-specific multiplex PCR assay including primers that can hybridize to the right extremity of SCCmec types I, II and III (SEQ ID NOs.: 18, 19, 20, 21, 22, 23, 24 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 52, 53, 54, 55, 56, 57, 58, respectively, in the present invention) as well as primers specific to the S. aureus chromosome to the right of the SCCmec integration site (SEQ ID NO.: 25, 28, 27, 26, 29 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 59, 60, 61, 62, 63, respectively, in the present invention) (Table 1 and FIG. 1). The set of primers described by Hiramatsu et al. as being the optimal primer combination (SEQ ID NOs.: 22, 24 and 28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58 and 60 in the present invention) was used in the present invention to test by PCR a variety of MRSA, MSSA, methicillin-resistant CNS (MRCNS) and methicillin-sensitive CNS (MSCNS) strains (Table 2). A PCR assay performed using a standard thermocycler (PTC-200 from MJ Research Inc.) was used to test the ubiquity, the specificity and the sensitivity of these primers using the following protocol: one μl of a treated standardized bacterial suspension or of a genomic DNA preparation purified from bacteria were amplified in a 20 μl PCR reaction mixture. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2, 0.4 μM of each of the SCCmec- and S. aureus chromosome-specific primers (SEQ ID NOs.: 22, 24 and 28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58 and 60 in the present invention), 200 μM of each of the four dNTPs (Pharmacia Biotech), 3.3 μg/μl BSA (Sigma), and 0.5 U Taq polymerase (Promega) coupled with TaqStartTM Antibody (BD Biosciences).
PCR reactions were then subjected to thermal cycling 3 min at 94° C. followed by 40 cycles of 60 seconds at 95° C. for the denaturation step, 60 seconds at 55° C. for the annealing step, and 60 seconds at 72° C. for the extension step, then followed by a terminal extension of 7 minutes at 72° C. using a standard thermocycler (PTC-200 from MJ Research Inc.). Detection of the PCR products was made by electrophoresis in agarose gels (2%) containing 0.25 μg/ml of ethidium bromide. Twenty of the 39 MRSA strains tested were not amplified with the PCR assay developed by Hiramatsu et al. (Example 1, Tables 2 and 3).
With a view of establishing a rapid diagnostic test for MRSAs, the present inventors developed new sets of primers specific to the right extremity of SCCmec types I and II (SEQ ID NOs.: 66, 100 and 101) (Annex 1), SCCmec type II (SEQ ID NOs.: 97 and 99), SCCmec type III (SEQ ID NOs.: 67, 98 and 102) and in the S. aureus chromosome to the right of the SCCmec integration site (SEQ ID NOs.: 64, 70, 71, 72, 73, 74, 75 and 76) (Table 5). These primers, amplifying short amplicons (171 to 278 bp), are compatible for use in rapid PCR assays (Table 7). The design of these primers was based on analysis of multiple sequence alignments of orfX and SCCmec sequences described by Hiramatsu et al. (U.S. Pat. No. 6,156,507) or available from GenBank (Table 10, Annex I). These different sets of primers were used to test by PCR a variety of MRSA, MSSA, MRCNS and MSCNS strains. Several amplification primers were developed to detect all three SCCmec types (SEQ ID NOs.: 97 and 99 for SCCmec type II, SEQ ID NOs.: 66, 100 and 101 for SCCmec types I and II and SEQ ID NOs.: 67, 98 and 102 for SCCmec type III). Primers were chosen according to their specificity for MRSA strains, their analytical sensitivity in PCR and the length of the PCR product. A set of two primers was chosen for the SCCmec right extremity region (SEQ ID NO.: 66 specific to SCCmec types I and II; SEQ ID NO.: 67 specific to SCCmec type III). Of the 8 different primers designed to anneal on the S. aureus chromosome to the right of the SCCmec integration site (targeting orfX gene) (SEQ ID NOs.: 64, 70, 71, 72, 73, 74, 75 and 76), only one (SEQ ID.: 64) was found to be specific for MRSA based on testing with a variety of MRSA, MSSA, MRCNS and MSCNS strains (Table 12). Consequently, a PCR assay using the optimal set of primers (SEQ ID NOs.: 64, 66 and 67) which could amplify specifically MRSA strains containing SCCmec types I, II and III was developed (FIG. 2, Annex I). While the PCR assay developed with this novel set of primers was highly sensitive (i.e allowed the detection of 2 to 5 copies of genome for all three SCCmec types) (Table 11), it had the same shortcomings (i.e. lack of ubiquity) of the test developed by Hiramatsu et al. The 20 MRSA strains which were not amplified by the Hiramatsu et al. primers were also not detected by the set of primers comprising SEQ ID NOs.: 64, 66 and 67 (Tables 3 and 12). Clearly, diagnostic tools for achieving at least 50% ubiquity amongst the tested strains are needed.
With a view to establish a more ubiquitous (i.e. ability to detect all or most MRSA strains) detection and identification method for MRSA, we determined the sequence of the MREJ present in these 20 MRSA strains which were not amplified. This research has led to the discovery and identification of seven novel distinct MREJ target sequences which can be used for diagnostic purposes. These seven new MREJ sequences could not have been predicted nor detected with the system described in U.S. Pat. No. 6,156,507 by Hiramatsu et al. Namely, the present invention represents an improved method for the detection and identification of MRSA because it provides a more ubiquitous diagnostic method which allows for the detection of all major epidemic MRSA clones from around the world.
Sequencing of MREJ Nucleotide Sequences from MRSA Strains not Amplifiable with Primers Specific to SCCmec types I, II and III
Since DNA from twenty MRSA strains were not amplified with the set of primers developed by Hiramatsu et al. (SEQ ID NOs.: 22, 24 and 28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58 and 60 in the present invention) (Tables 2 and 3) nor with the set of primers developed in the present invention based on the same three SCCmec types (I, II and III) sequences (SEQ ID NOs.: 64, 66 and 67) (Table 12), the nucleotide sequence of the MREJ was determined for sixteen of these twenty MRSA strains.
Transposase of IS431 is often associated with the insertion of resistance genes within the mec locus. The gene encoding this transposase has been described frequently in one or more copies within the right segment of SCCmec (Oliveira et al., 2000, Antimicrob. Agents Chemother. 44:1906-1910; Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-36). Therefore, in a first attempt to sequence the novel MREJ for 16 of the 20 MRSA strains described in Table 3, a primer was designed in the sequence of the gene coding for the transposase of IS431 (SEQ ID NO.: 68) and combined with an orfX-specific primer to the right of the SCCmec integration site (SEQ ID NO.: 70) (Tables 5 and 8). The strategy used to select these primers is illustrated in FIG. 3.
The MREJ fragments to be sequenced were amplified using the following amplification protocol: one μL of treated cell suspension (or of a purified genomic DNA preparation) was transferred directly into 4 tubes containing 39 μL of a PCR reaction mixture. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2, 1 μM of each of the 2 primers (SEQ ID NOs.: 68 and 70), 200 μM of each of the four dNTPs, 3.3 μg/μl of BSA (Sigma-Aldrich Canada Ltd) and 0.5 unit of Taq DNA polymerase (Promega) coupled with the TaqStartTM Antibody (BD Bisociences). PCR reactions were submitted to cycling using a standard thermocycler (PTC-200 from MJ Research Inc.) as follows: 3 min at 94° C. followed by 40 cycles of 5 sec at 95° C. for the denaturation step, 30 sec at 55° C. for the annealing step and 2 min at 72° C. for the extension step.
Subsequently, the four PCR-amplified mixtures were pooled and 10 μL of the mixture were resolved by electrophoresis in a 1.2% agarose gel containing 0.25 μg/mL of ethidium bromide. The amplicons were then visualized with an Alpha-Imager (Alpha Innotech Corporation, San Leandro, Calif.) by exposing to UV light at 254 nm. Amplicon size was estimated by comparison with a 1 kb molecular weight ladder (Life Technologies, Burlington, Ontario, Canada). The remaining PCR-amplified mixture (150 μL, total) was also resolved by electrophoresis in a 1.2% agarose gel. The amplicons were then visualized by staining with methylene blue (Flores et al., 1992, Biotechniques, 13:203-205). Amplicon size was once again estimated by comparison with a 1 kb molecular weight ladder. Of the sixteen strains selected from the twenty described in Table 3, six were amplified using SEQ ID NOs.: 68 and 70 as primers (CCRI-178, CCRI-8895, CCRI-8903, CCRI-1324, CCRI-1331 and CCRI-9504). For these six MRSA strains, an amplification product of 1.2 kb was obtained. The band corresponding to this specific amplification product was excised from the agarose gel and purified using the QIAquickTM gel extraction kit (QIAGEN Inc., Chatsworth, Calif.). The gel-purified DNA fragment was then used directly in the sequencing protocol. Both strands of the MREJ amplification products were sequenced by the dideoxynucleotide chain termination sequencing method by using an Applied Biosystems automated DNA sequencer (model 377) with their Big DyeTM Terminator Cycle Sequencing Ready Reaction Kit (Applied Biosystems, Foster City, Calif.). The sequencing reactions were performed by using the same primers (SEQ ID NOs.: 68 and 70) and 10 ng/100 bp per reaction of the gel-purified amplicons. Sequencing of MREJ from the six MRSA strains (CCRI-178, CCRI-8895, CCRI-8903, CCRI-1324, CCRI-1331 and CCRI-9504) described in Table 3 yielded SEQ ID NOs.: 42, 43, 44, 45, 46 and 51, respectively (Table 4).
In order to ensure that the determined sequence did not contain errors attributable to the sequencing of PCR artefacts, we have sequenced two preparations of the gel-purified MREJ amplification products originating from two independent PCR amplifications. For most target fragments, the sequences determined for both amplicon preparations were identical. Furthermore, the sequences of both strands were 100% complementary thereby confirming the high accuracy of the determined sequence. The MREJ sequences determined using the above strategy are described in the Sequence Listing and in Table 4.
In order to sequence MREJ in strains for which no amplicon had been obtained using the strategy including primers specific to the transposase gene of IS431 and orfX, another strategy using primers targeting mecA and orfX sequences was used to amplify longer genomic fragments. A new PCR primer targeting mecA (SEQ ID NO.: 69) (Table 8) to be used in combination with the same primer in the orfX sequence (SEQ ID NO.: 70). The strategy used to select these primers is illustrated in FIG. 3.
The following amplification protocol was used: Purified genomic DNA (300 ng) was transferred to a final volume of 50 μl of a PCR reaction mixture. Each PCR reaction contained 1× Herculase buffer (Stratagene, La Jolla, Calif.), 0.8 μM of each of the 2 primers (SEQ ID NOs.: 69 and 70), 0.56 mM of each of the four dNTPs and 5 units of Herculase (Stratagene). PCR reactions were subjected to cycling using a standard thermal cycler (PTC-200 from MJ Research Inc.) as follows: 2 min at 92° C. followed by 35 or 40 cycles of 10 sec at 92° C. for the denaturation step, 30 sec at 55° C. for the annealing step and 30 min at 68° C. for the extension step.
Subsequently, 10 μL of the PCR-amplified mixture were resolved by electrophoresis in a 0.7% agarose gel containing 0.25 μg/mL of ethidium bromide. The amplicons were then visualized as described above. Amplicon size was estimated by comparison with a 1 kb molecular weight ladder (Life Technologies). A reamplification reaction was then performed in 2 to 5 tubes using the same protocol with 3 μl of the first PCR reaction used as test sample for the second amplification. The PCR-reamplified mixtures were pooled and also resolved by electrophoresis in a 0.7% agarose gel. The amplicons were then visualized by staining with methylene blue as described above. An amplification product of approximately 12 kb was obtained using this amplification strategy for all strains tested. The band corresponding to the specific amplification product was excised from the agarose gel and purified as described above. The gel-purified DNA fragment was then used directly in the sequencing protocol as described above. The sequencing reactions were performed by using the same amplification primers (SEQ ID NOs.: 69 and 70) and 425-495 ng of the gel-purified amplicons per reaction. Subsequently, internal sequencing primers (SEQ ID NOs.: 65, 77 and 96) (Table 8) were used to obtain sequence data on both strands for a larger portion of the amplicon. Five of the 20 MRSA strains (CCRI-1331, CCRI-1263, CCRI-1377, CCRI-1311 and CCRI-2025) described in Table 3 were sequenced using this strategy, yielding SEQ ID NOs.: 46, 47, 48, 49 and 50, respectively (Table 4). Sequence within mecA gene was also obtained from the generated amplicons yielding SEQ ID NOs: 27, 28, 29, 30 and 31 from strains CCRI-2025, CCRI-1263, CCRI-1311, CCRI-1331 and CCRI-1377, respectively (Table 4). Longer sequences within the mecA gene and from downstream regions were also obtained for strains CCRI-2025, CCRI-1331, and CCRI-1377 as described below.
In order to obtain longer sequences of the orfX gene, two other strategies using primers targeting mecA and orfX sequences (at the start codon) was used to amplify longer chromosome fragments. A new PCR primer was designed in orfX (SEQ ID NO.: 132) to be used in combination with the same primer in the mecA gene (SEQ ID NO.: 69). The strategy used to select these primers is illustrated in FIG. 3. Eight S. aureus strains were amplified using primers SEQ ID NOs.: 69 and 132 (CCRI-9860, CCRI-9208, CCRI-9504, CCRI-1331, CCRI-9583, CCRI-9681, CCRI-2025 and CCRI-1377). The strategy used to select these primers is illustrated in FIG. 3.
The following amplification protocol was used: Purified genomic DNA (350 to 500 ng) was transferred to a 50 μl PCR reaction mixture. Each PCR reaction contained 1× Herculase buffer (Stratagene), 0.8 μM of each of the set of 2 primers (SEQ ID NOs.: 69 and 132), 0.56 mM of each of the four dNTPs and 7.5 units of Herculase (Stratagene) with 1 mM MgCl2. PCR reactions were subjected to thermocycling as described above.
Subsequently, 5 μL of the PCR-amplified mixture were resolved by electrophoresis in a 0.8% agarose gel containing 0.25 μg/mL of ethidium bromide. The amplicons were then visualized as described above. For one S. aureus strain (CCRI-9583), a reamplification was then performed by using primers SEQ ID NOs.: 96 and 158 (FIG. 3) in 4 tubes, using the same PCR protocol, with 2 μl of the first PCR reaction as test sample for the second amplification. The PCR-reamplified mixtures were pooled and also resolved by electrophoresis in a 0.8% agarose gel. The amplicons were then visualized by staining with methylene blue as described above. A band of approximately 12 to 20 kb was obtained using this amplification strategy depending on the strains tested. The band corresponding to the specific amplification product was excised from the agarose gel and purified using the QIAquickTM gel extraction kit or QIAEX II gel extraction kit (QIAGEN Inc.). Two strains, CCRI-9583 and CCRI-9589, were also amplified with primers SEQ ID NOs.: 132 and 150, generating an amplification product of 1.5 kb. Long amplicons (12-20 kb) were sequenced using 0.6 to 1 μg per reaction, while short amplicons (1.5 kb) were sequenced using 150 ng per reaction. Sequencing reactions were performed using different sets of primers for each S. aureus strain: 1) SEQ ID NOs.: 68, 70, 132, 145, 146, 147, 156, 157 and 158 for strain CCRI-9504; 2) SEQ ID NOs.: 70, 132, 154 and 155 for strain CCRI-2025; 3) SEQ ID NOs.: 70, 132, 148, 149, 158 and 159 for strain CCRI-9681; 4) SEQ ID NOs.: 70, 132, 187, and 188 for strain CCRI-9860; 5) SEQ ID NOs: 70, 132, 150 and 159 for strain CCRI-9589, 6) SEQ ID NOs.: 114, 123, 132, 150 and 158 for strain CCRI-9583; 7) SEQ ID NOs: 70, 132, 154 and 155 for strain CCRI-1377, 8) SEQ ID NOs.: 70, 132, 158 and 159 for strain CCRI-9208; 9) SEQ ID NOs: 68, 70, 132, 145, 146, 147 and 158 for strain CCRI-1331; and 10) SEQ ID NOs.: 126 and 127 for strain CCRI-9770.
In one strain (CCRI-9770), the orfX and orfSA0022 genes were shown to be totally or partially deleted based on amplification using primers specific to these genes (SEQ ID NOs: 132 and 159 and SEQ ID NOs.: 128 and 129, respectively) (Table 8). Subsequently, a new PCR primer was designed in orfSA0021 (SEQ ID NO.: 126) to be used in combination with the same primer in the mecA gene (SEQ ID NO.: 69). An amplification product of 4.5 kb was obtained with this primer set. Amplification, purification of amplicons and sequencing of amplicons were performed as described above.
To obtain the sequence of the SSCmec region containing mecA for ten of the 20 MRSA strains described in Table 3 (CCRI-9504, CCRI-2025, CCRI-9208, CCRI-1331, CCRI-9681, CCRI-9860, CCRI-9770, CCRI-9589, CCRI-9583 and CCRI-1377), the primer described above designed in mecA (SEQ ID NO.: 69) was used in combination with a primer designed in the downstream region of mecA (SEQ ID NO.: 118) (Table 8). An amplification product of 2 kb was obtained for all the strains tested. For one strain, CCRI-9583, a re-amplification with primers SEQ ID NOs.: 96 and 118 was performed with the amplicon generated with primers SEQ ID NOs.: 69 and 132 described above. The amplification, re-amplification, purification of amplicons and sequencing reactions were performed as described above. Sequencing reactions were performed with amplicons generated with SEQ ID NOs.: 69 and 132 described above or SEQ ID NOs.: 69 and 118. Different sets of sequencing primers were used for each S. aureus strain: 1) SEQ ID NOs.: 69, 96, 117, 118, 120, 151, 152 for strains CCRI-9504, CCRI-2025, CCRI-1331, CCRI-9770 and CCRI-1377; 2) SEQ ID NOs.: 69, 96, 118 and 120 for strains CCRI-9208, CCRI-9681 and CCRI-9589; 3) SEQ ID NOs.: 69, 96, 117, 118, 120 and 152 for strain CCRI-9860; and 4) SEQ ID NOs.: 96, 117, 118, 119, 120, 151 and 152 for strain CCRI-9583.
The sequences obtained for 16 of the 20 strains non-amplifiable by the Hiramatsu assay (Table 4) were then compared to the sequences available from public databases. In all cases, portions of the sequence had an identity close to 100% to publicly available sequences for orfX (SEQ ID NOs.: 42-51, 165-168 and 171) or mecA and downstream region (SEQ ID NOs.: 27-31, 189-193, 195, 197-199 and 225). However, while the orfX portion of the fragments (SEQ ID NOs.: 42-51, 165-168 and 171) shared nearly 100% identity with the orfX gene of MSSA strain NCTC 8325 described by Hiramatsu et al. (SEQ ID NO.: 3), the DNA sequence within the right extremity of SCCmec itself was shown to be very different from those of types I, II, III and IV described by Hiramatsu et al. (Table 13, FIG. 4). Six different novel sequence types were obtained.
It should be noted that Hiramatsu et al. demonstrated that SCCmec type I could be associated with MREP type i, SCCmec types II and IV are associated with MREP type ii, and SCCmec type III is associated with MREP type iii. Our MREJ sequencing data from various MRSA strains led to the discovery of 6 novel MREP types designated types iv, v, vi, vii, viii, and ix. The MREJ comprising distinct MREP types were named according to the MREP numbering scheme. Hence, MREP type i is comprised within MREJ type i, MREP type ii is comprised within MREJ type ii and so on up to MREP type ix.
The sequences within the right extremity of SCCmec obtained from strains CCRI-178, CCRI-8895, CCRI-8903, CCRI-1324, CCRI-1331 and CCRI-9504 (SEQ ID NOs.: 42, 43, 44, 45, 46 and 51) were nearly identical to each other and exhibited nearly 100% identity with IS431 (GenBank accession numbers AF422691, ABO37671, AF411934). However, our sequence data revealed for the first time the location of this IS431 sequence at the right extremity of SCCmec adjacent to the integration site. Therefore, as the sequences at the right extremity of SCCmec from these 6 MRSA strains were different from those of SCCmec type I from strain NCTC 10442, SCCmec type II from strain N315, SCCmec type III from strain 85/2082 and SCCmec type IV from strains CA05 and 8/6-3P described by Hiramatsu et al. (Ito et al., 2001, Antimicrob. Agents Chemother. 45:1323-1336; Ma et al., 2002, Antimicrob. Agents Chemother. 46:1147-1152), these new sequences were designated as MREP type iv (SEQ ID NOs.: 42-46 and 51). A BLAST search with the SCCmec portion of MREP type iv sequences produced significant alignments with sequences coding for portions of a variety of known transposases. For example, when compared to Genbank accession no. AB037671, MREP type iv from SEQ ID NO. 51 shared 98% identity with the putative transposase of IS431 and its downstream region; two gaps of 7 nucleotides each were also present in the alignment.
Sequences obtained from strains CCRI-1263, CCRI-1377, CCRI-1311 and CCRI-2025 (SEQ ID NOs.: 47-50) were nearly identical to each other and different from all three SCCmec types and MREP type iv and, consequently, were designated as MREP type v. When compared with Genbank sequences using BLAST, MREP type v sequences did not share any significant homology with any published sequence, except for the first 28 nucleotides. That short stretch corresponded to the last 11 coding nucleotides of orfX, followed by the 17 nucleotides downstream, including the right inverted repeat (IR-R) of SCCmec.
Sequence obtained from strain CCRI-9208 was also different from all three SCCmec types and MREP types iv and v and, consequently, was designated as MREP type vi (SEQ ID NO.: 171). Upon a BLAST search, MREP type vi was shown to be unique, exhibiting no significant homology to any published sequence.
Sequences obtained from strains CCRI-9583 and CCRI-9589 were also different from all three SCCmec types and MREP types iv to vi and were therefore designated as MREP type vii (SEQ ID NOs.: 165 and 166). Upon a BLAST search, MREP type vii was also shown to be unique, exhibiting no significant homology to any published sequence.
Sequence obtained from strain CCRI-9860 was also different from all three SCCmec types and MREP types iv to vii and was therefore designated as MREP type viii (SEQ ID NO.: 167). Sequence obtained from strain CCRI-9681 was also different from all three SCCmec types and MREP types iv to viii and was therefore designated as MREP type ix (SEQ ID NO.: 168). BLAST searches with the SCCmec portion of MREP types viii and ix sequences yielded significant alignments, but only for the first  ̃150 nucleotides of each MREP type. For example, the beginning of the MREP type viii sequence had 88% identity with a portion of Genbank accession no. AB063173, but no significant homology with any published sequence was found for the rest of the sequence. In the same manner, the first  ̃150 nucleotides of MREP type ix had 97% identity with the same portion of AB063173, with the rest of the sequence being unique. The short homologous portion of MREP types viii and ix corresponds in AB063173 to the last 14 coding nucleotides of orfX, the IR-R of SCCmec, and a portion of orfCM009. Although sharing resemblances, MREP types viii and ix are very different from one another; as shown in Table 13, there is only 55.2% identity between both types for the first 500 nucleotides of the SCCmec portion.
Finally, we did not obtain any sequence within SSCmec from strain CCRI-9770. However, as described in the section “Sequencing of MREJ nucleotide sequences from MRSA strains not amplifiable with primers specific to SCCmec types I, II and III”, this strain has apparently a partial or total deletion of the orfX and orfSA0022 genes in the chromosomal DNA to the right of the SCCmec integration site and this would represent a new right extremity junction. We therefore designated this novel sequence as MREP type x (SEQ ID NO.: 172). Future sequencing should reveal whether this so called MREJ type x contains a novel MREP type x or if the lack of amplification is indeed caused by variation in the chromosomal part of the MREJ.
The sequences of the first 500-nucleotide portion of the right extremity of all SCCmec obtained in the present invention were compared to those of SCCmec types I, II and III using GCG programs Pileup and Gap. Table 13 depicts the identities at the nucleotide level between SCCmec right extremities of the six novel sequences with those of SCCmec types I, II and III using the GCG program Gap. While SCCmec types I and II showed nearly 79.2% identity (differing only by a 102 bp insertion present in SCCmec type II) (FIGS. 1, 2 and 4), all other MREP types showed identities varying from 40.9 to 57.1%. This explains why the right extremities of the novel MREP types iv to ix disclosed in the present invention could not have been predicted nor detected with the system described by Hiramatsu et al.
Four strains (CCRI-1312, CCRI-1325, CCRI-9773 and CCRI-9774) described in Table 3 were not sequenced but rather characterized using PCR primers. Strains CCRI-1312 and CCRI-1325 were shown to contain MREP type v using specific amplification primers described in Examples 4, 5 and 6 while strains CCRI-9773 and CCRI-9774 were shown to contain MREP type vii using specific amplification primers described in Example 7.
To obtain the complete sequence of the SCCmec present in the MRSA strains described in the present invention, primers targeting the S. aureus chromosome to the left (upstream of the mecA gene) of the SCCmec integration site were developed. Based on available public database sequences, 5 different primers were designed (SEQ ID NOs.: 85-89) (Table 9). These primers can be used in combination with S. aureus chromosome-specific primers in order to sequence the entire SCCmec or, alternatively, used in combination with a mecA-specific primer (SEQ ID NO.: 81) in order to sequence the left extremity junction of SCCmec. We have also developed several primers specific to known SCCmec sequences spread along the locus in order to obtain the complete sequence of SCCmec (Table 9). These primers will allow to assign a SCCmec type to the MRSA strains described in the present invention.
Selection of Amplification Primers from SCCmec/orfX Sequences
The MREJ sequences determined by the inventors or selected from public databases were used to select PCR primers for detection and identification of MRSA. The strategy used to select these PCR primers was based on the analysis of multiple sequence alignments of various MREJ sequences.
Upon analysis of the six new MREP types iv to ix sequence data described above, primers specific to each new MREP type sequence (SEQ ID NOs.: 79, 80, 109, 112, 113, 115, 116 and 204) were designed (FIG. 2, Table 5, Examples 3, 4, 5, 6, 7 and 8). Primers specific to MREP types iv, v and vii (SEQ ID NOs.: 79, 80 and 112) were used in multiplex with the three primers to detect SCCmec types I, II and III (SEQ ID NOs: 64, 66 and 67) and the primer specific to the S. aureus orfX (SEQ ID NO. 64) (Examples 3, 4, 5, 6 and 7). Primers specific to MREP types vi, viii and ix (SEQ ID NOs.: 204, 115, 116 and 109) were also designed and tested against their specific target (Example 8).
Detection of Amplification Products
Classically, the detection of PCR amplification products is performed by standard ethidium bromide-stained agarose gel electrophoresis as described above. It is however clear that other methods for the detection of specific amplification products, which may be faster and more practical for routine diagnosis, may be used. Examples of such methods are described in co-pending patent application WO01/23604 A2.
Amplicon detection may also be performed by solid support or liquid hybridization using species-specific internal DNA probes hybridizing to an amplification product. Such probes may be generated from any sequence from our repertory and designed to specifically hybridize to DNA amplification products which are objects of the present invention. Alternatively, amplicons can be characterized by sequencing. See co-pending patent application WO01/23604 A2 for examples of detection and sequencing methods.
In order to improve nucleic acid amplification efficiency, the composition of the reaction mixture may be modified (Chakrabarti and Schutt, 2002, Biotechniques, 32:866-874; Al-Soud and Radstrom, 2002, J. Clin. Microbiol., 38:4463-4470; Al-Soud and Radstrom, 1998, Appl. Environ. Microbiol., 64:3748-3753; Wilson, 1997, Appl. Environ. Microbiol., 63:3741-3751). Such modifications of the amplification reaction mixture include the use of various polymerases or the addition of nucleic acid amplification facilitators such as betaine, BSA, sulfoxides, protein gp32, detergents, cations, tetramethylamonium chloride and others.
In a preferred embodiment, real-time detection of PCR amplification was monitored using molecular beacon probes in a SMART CYCLER® apparatus (Cepheid, Sunnyvale, Calif.). A multiplex PCR assay containing primers specific to MREP types i to v and orfX of S. aureus (SEQ ID NOs.: 64, 66, 67, 79 and 80), a molecular beacon probe specific to the orfX sequence (SEQ ID NO. 84, see Annex II and FIG. 2) and an internal control to monitor PCR inhibition was developed. The internal control contains sequences complementary to MREP type iv- and orfX-specific primers (SEQ ID NOs. 79 and and 64). The assay also contains a molecular beacon probe labeled with tetrachloro-6-carboxyfluorescein (TET) specific to sequence within DNA fragment generated during amplification of the internal control. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 3.45 mM MgCl2, 0.8 μM of each of the MREP-specific primers (SEQ ID NOs.: 66 and 67) and orfX-specific primer (SEQ ID NO.: 64), 0.4 μM of each of the MREP-specific primers (SEQ ID NOs.: 79 and 80), 80 copies of the internal control, 0.2 μM of the TET-labeled molecular beacon probe specific to the internal control, 0.2 μM of the molecular beacon probe (SEQ ID NO.: 84) labeled with 6-carboxyfluorescein (FAM), 330 μM of each of the four dNTPs (Pharmacia Biotech), 3.45 μg/μl of BSA (Sigma), and 0.875 U Taq polymerase (Promega) coupled with TaqStartTM Antibody (BD Biosciences). The PCR amplification on the SMART CYCLER® was performed as follows: 3 min. at 95° C. for initial denaturation, then forty-eight cycles of three steps consisting of 5 seconds at 95° C. for the denaturation step, 15 seconds at 60° C. for the annealing step and 15 seconds at 72° C. for the extension step. Sensitivity tests performed by using purified genomic DNA from one MRSA strain of each MREP type (i to v) showed a detection limit of 2 to 10 genome copies (Example 5). None of the 26 MRCNS or 10 MSCNS tested were positive with this multiplex assay. The eight MRSA strains (CCRI-9208, CCRI-9770, CCRI-9681, CCRI-9860, CCRI-9583, CCRI-9773, CCRI-9774, CCRI-9589) which harbor the new MREP types vi, viii, ix and x sequences described in the present invention remained undetectable (Example 5).
In a preferred embodiment, detection of MRSA using the real-time multiplex PCR assay on the SMART CYCLER® apparatus (Cepheid, Sunnyvale, Calif.) directly from clinical specimens was evaluated. A total of 142 nasal swabs were collected during a MRSA hospital surveillance program at the Montreal General Hospital (Montreal, Quebec, Canada). The swab samples were tested at the Centre de Recherche en Infectiologie de l'Université Laval within 24 hours of collection. Upon receipt, the swabs were plated onto mannitol agar and then the nasal material from the same swab was prepared with a simple and rapid specimen preparation protocol described in patent application number U.S. 60/306,163. Classical identification of MRSA was performed by standard culture methods.
The PCR assay detected 33 of the 34 samples positive for MRSA based on the culture method. As compared to culture, the PCR assay detected 8 additional MRSA positive specimens for a sensitivity of 97.1% and a specificity of 92.6% (Example 6). This multiplex PCR assay represents a rapid and powerful method for the specific detection of MRSA carriers directly from nasal specimens and can be used with any types of clinical specimens such as wounds, blood or blood culture, CSF, etc.
In a preferred embodiment, a multiplex PCR assay containing primers specific to MREP types i, ii, iii, iv, v and vi and orfX of S. aureus (SEQ ID NOs.: 66, 67, 79, 80 and 112), and three molecular beacons probes specific to orfX sequence which allowed detection of the two sequence polymorphisms identified in this region of the orfX sequence was developed. Four of the strains which were not detected with the multiplex assay for the detection of MREP types i to v were now detected with this multiplex assay while the four MRSA strains (CCRI-9208, CCRI-9770, CCRI-9681, CCRI-9860) which harbor the MREP types vi, viii, ix and x described in the present invention remained undetectable (Example 7). Primers specific to MREP types vi, viii and ix (SEQ ID NOs.: 204, 115, 116 and 109) were also designed and were shown to detect their specific target strains (Example 8). While the primers and probes derived from the teaching of Hiramatsu et al., permitted the detection of only 48.7% (19 strains out of 39) of the MRSA strains of Table 2, the primers and probes derived from the present invention enable the detection of 97.4% of the strains (38 strains out of 39) (see examples 7 and 8). Therefore it can be said that our assay has a ubiquity superior to 50% for the MRSA strains listed in Table 2.
Specificity, Ubiquity and Sensitivity Tests for Oligonucleotide Primers and Probes
The specificity of oligonucleotide primers and probes was tested by amplification of DNA or by hybridization with staphylococcal species. All of the staphylococcal species tested were likely to be pathogens associated with infections or potential contaminants which can be isolated from clinical specimens. Each target DNA could be released from microbial cells using standard chemical and/or physical treatments to lyse the cells (Sambrook et al., 1989, Molecular Cloning: A Laboratory Manual, 2nd ed., Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y.) or alternatively, genomic DNA purified with the GNOMETM DNA kit (Qbiogene, Carlsbad, Calif.) was used. Subsequently, the DNA was subjected to amplification with the set of primers. Specific primers or probes hybridized only to the target DNA.
Oligonucleotides primers found to amplify specifically DNA from the target MRSA were subsequently tested for their ubiquity by amplification (i.e. ubiquitous primers amplified efficiently most or all isolates of MRSA). Finally, the analytical sensitivity of the PCR assays was determined by using 10-fold or 2-fold dilutions of purified genomic DNA from the targeted microorganisms. For most assays, sensitivity levels in the range of 2-10 genome copies were obtained. The specificity, ubiquity and analytical sensitivity of the PCR assays were tested either directly with bacterial cultures or with purified bacterial genomic DNA.
Molecular beacon probes were tested using the SMART CYCLER® platform as described above. A molecular beacon probe was considered specific only when it hybridized solely to DNA amplified from the MREJ of S. aureus. Molecular beacon probes found to be specific were subsequently tested for their ubiquity (i.e. ubiquitous probes detected efficiently most or all isolates of the MRSA) by hybridization to bacterial DNAs from various MRSA strains.
Bacterial Strains
The reference strains used to build proprietary SCCmec-chromosome right extremity junction sequence data subrepertories, as well as to test the amplification and hybridization assays, were obtained from (i) the American Type Culture Collection (ATCC), (ii) the Laboratoire de santé publique du Québec (LSPQ) (Ste-Anne de Bellevue, Québec, Canada), (iii) the Centers for Disease Control and Prevention (CDC) (Atlanta, Ga.), (iv) the Institut Pasteur (Paris, France), and V) the Harmony Collection (London, United Kingdom) (Table 14). Clinical isolates of MRSA, MSSA, MRCNS and MSCNS from various geographical areas were also used in this invention (Table 15). The identity of our MRSA strains was confirmed by phenotypic testing and reconfirmed by PCR analysis using S. aureus-specific primers and mecA-specific primers (SEQ ID NOs.: 69 and 81) (Martineau et al., 2000, Antimicrob. Agents Chemother. 44:231-238).
For sake of clarity, below is a list of the Examples, Tables, Figures and Annexes of this invention.
DESCRIPTION OF THE EXAMPLES
Example 1:
Primers developed by Hiramatsu et al. can only detect MRSA strains belonging to MREP types i, ii, and iii while missing prevalent novel MREP types.
Example 2:
Detection and identification of MRSA using primers specific to MREP types i, ii and iii sequences developed in the present invention.
Example 3:
Development of a multiplex PCR assay on a standard thermocycler for detection and identification of MRSA based on MREP types i, ii, iii, iv and v sequences.
Example 4:
Development of a real-time multiplex PCR assay on the SMART CYCLER® for detection and identification of MRSA based on MREP types i, ii, iii, iv and v sequences.
Example 5:
Development of a real-time multiplex PCR assay on the SMART CYCLER® for detection and identification of MRSA based on MREP types i, ii, iii, iv and v sequences and including an internal control.
Example 6:
Detection of MRSA using the real-time multiplex assay on the SMART CYCLER® based on MREP types i, ii, iii, iv and v sequences for the detection of MRSA directly from clinical specimens.
Example 7:
Development of a real-time multiplex PCR assay on the SMART CYCLER® for detection and identification of MRSA based on MREP types i, ii, iii, iv, v, vi and vii sequences.
Example 8:
Development of real-time PCR assays on the SMART CYCLER® for detection and identification of MRSA based on MREP types vi, viii and ix.
DESCRIPTION OF THE TABLES
Table 1 provides information about all PCR primers developed by Hiramatsu et al. in U.S. Pat. No. 6,156,507.
Table 2 is a compilation of results (ubiquity and specificity) for the detection of SCCmec-orfX right extremity junction using primers described by Hiramatsu et al. in U.S. Pat. No. 6,156,507 on a standard thermocycler.
Table 3 is a list of MRSA strains not amplifiable using primers targeting types I, II and III of SCCmec-orfX right extremity junction sequences.
Table 4 is a list of novel sequences revealed in the present invention.
Table 5 provides information about all primers developed in the present invention.
Table 6 is a list of molecular beacon probes developed in the present invention.
Table 7 shows amplicon sizes of the different primer pairs described by Hiramatsu et al. in U.S. Pat. No. 6,156,507 or developed in the present invention.
Table 8 provides information about primers developed in the present invention to sequence the SCCmec-chromosome right extremity junction.
Table 9 provides information about primers developed in the present invention to obtain sequence of the complete SCCmec.
Table 10 is a list of the sequences available from public databases (GenBank, genome projects or U.S. Pat. No. 6,156,507) used in the present invention to design primers and probes.
Table 11 gives analytical sensitivity of the PCR assay developed in the present invention using primers targeting types I, II and III of SCCmec-orfX right extremity junction sequences and performed using a standard thermocycler.
Table 12 is a compilation of results (ubiquity and specificity) for the detection of MRSA using primers developed in the present invention which target types I, II and III of SCCmec-orfX right extremity junction sequences and performed using a standard thermocycler.
Table 13 shows a comparison of sequence identities between the first 500 nucleotides of SCCmec right extremities between 9 types of MREP.
Table 14 provides information about the reference strains of MRSA, MSSA, MRCNS and MSCNS used to validate the PCR assays developed in the present invention.
Table 15 provides information about the origin of clinical strains of MRSA, MSSA, MRCNS and MSCNS used to validate the PCR assays described in the present invention.
Table 16 depicts the analytical sensitivity of the PCR assay developed in the present invention using primers targeting 5 types of MREP sequences and performed on a standard thermocycler.
Table 17 is a compilation of results (ubiquity and specificity) for the PCR assay developed in the present invention using primers targeting 5 types of MREP sequences and performed on a standard thermocycler.
Table 18 depicts the analytical sensitivity of the PCR assay developed in the present invention using the SMART CYCLER® platform for the detection of 5 types of MREP.
Table 19 is a compilation of results (ubiquity and specificity) for the PCR assay developed in the present invention using primers and a molecular beacon probe targeting 5 types of MREP sequences and performed on the SMART CYCLER® platform.
Table 20 depicts the analytical sensitivity of the PCR assay developed in the present invention using the SMART CYCLER® platform for the detection of 6 MREP types.
Table 21 is a compilation of results (ubiquity and specificity) for the PCR assay developed in the present invention using primers and a molecular beacon probe targeting 6 types of MREP sequences and performed on the SMART CYCLER® platform.
FIGURE LEGENDS
FIG. 1. Schematic organization of types I, II and III SCCmec-orfX right extremity junctions and localization of the primers (SEQ ID NOs: 52-63) described by Hiramatsu et al. for the detection and identification of MRSA. Amplicon sizes are depicted in Table 7.
FIG. 2. Schematic organization of MREP types i, ii, iii, iv, v, vi, vii, viii and ix and localization of the primers and molecular beacon targeting all MREP types (SEQ ID NOs. 20, 64, 66, 67, 79, 80, 84, 112, 115, 116, 84, 163 and 164) which were developed in the present invention. Amplicon sizes are depicted in Table 7.
FIG. 3. Schematic organization of the SCCmec-chromosome right extremity junctions and localization of the primers (SEQ ID NOs. 65, 68, 69, 70, 77, 96, 118, 126, 132, 150 and 158) developed in the present invention for the sequencing of MREP types iv, v, vi, vii, viii, ix and x.
FIG. 4. Multiple sequence alignment of representatives of nine MREP types (represented by portions of SEQ ID NOs.: 1, 2, 104, 51, 50, 171, 165, 167 and 168 for types i, ii, iii, iv, v, vi, vii, viii and ix, respectively).
DESCRIPTION OF THE ANNEXES
The Annexes show the strategies used for the selection of primers and internal probes:
Annex I illustrates the strategy for the selection of primers from SCCmec and or orfX sequences specific for SCCmec types I and II.
Annex II illustrates the strategy for the selection of specific molecular beacon probes for the real-time detection of SCCmec-orfX right extremity junctions.
As shown in these Annexes, the selected amplification primers may contain inosines and/or base ambiguities. Inosine is a nucleotide analog able to specifically bind to any of the four nucleotides A, C, G or T. Alternatively, degenerated oligonucleotides which consist of an oligonucleotide mix having two or more of the four nucleotides A, C, G or T at the site of mismatches were used. The inclusion of inosine and/or of degeneracies in the amplification primers allows mismatch tolerance thereby permitting the amplification of a wider array of target nucleotide sequences (Dieffenbach and Dveksler, 1995, PCR Primer: A Laboratory Manual, Cold Spring Harbor Laboratory Press, Plainview, N.Y.).
EXAMPLES
Example 1
Primers Developed by Hiramatsu et al. Can Only Detect MRSA Strains Belonging to MREP Types i, ii, and iii while Missing Prevalent Novel MREP Types.
As shown in FIG. 1, Hiramatsu et al. have developed various primers that can specifically hybridize to the right extremities of types I, II and III SCCmec DNAs. They combined these primers with primers specific to the S. aureus chromosome region located to the right of the SCCmec integration site for the detection of MRSA. The primer set (SEQ ID NOs.: 22, 24 and 28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58 and 60 in the present invention) was shown by Hiramatsu et al. to be the most specific and ubiquitous for detection of MRSA. This set of primers gives amplification products of 1.5 kb for SCCmec type I, 1.6 kb for SCCmec type II and 1.0 kb for SCCmec type III (Table 7). The ubiquity and specificity of this multiplex PCR assay was tested on 39 MRSA strains, 41 MSSA strains, 9 MRCNS strains and 11 MSCNS strains (Table 2). One μL of a treated standardized bacterial suspension or of a bacterial genomic DNA preparation purified from bacteria were amplified in a 20 μl PCR reaction mixture. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2, 0.4 μM of each of the SCCmec- and orfX-specific primers (SEQ ID NOs.: 56, 58 and 60), 200 μM of each of the four dNTPs (Pharmacia Biotech), 3.3 μg/μl of BSA (Sigma), and 0.5 U Taq polymerase (Promega) coupled with TaqStartTM Antibody (BD Biosciences).
PCR reactions were then subjected to thermal cycling: 3 min at 94° C. followed by 40 cycles of 60 seconds at 95° C. for the denaturation step, 60 seconds at 55° C. for the annealing step, and 60 seconds at 72° C. for the extension step, then followed by a terminal extension of 7 minutes at 72° C. using a standard thermocycler (PTC-200 from MJ Research Inc.). Detection of the PCR products was made by electrophoresis in agarose gels (2%) containing 0.25 μg/ml of ethidium bromide.
None of the MRCNS or MSCNS strains tested were detected with the set of primers detecting SCCmec types I, II and III. Twenty of the 39 MRSA strains tested were not detected with this multiplex PCR assay (Tables 2 and 3). One of these undetected MRSA strains corresponds to the highly epidemic MRSA Portuguese clone (strain CCRI-9504; De Lencastre et al., 1994. Eur. J. Clin. Microbiol. Infect. Dis. 13:64-73) and another corresponds to the highly epidemic MRSA Canadian clone CMRSA1 (strain CCRI-9589; Simor et al. CCDR 1999, 25-12, June 15). These data demonstrate that the primer set developed by Hiramatsu et al. (SEQ ID NOs.: 22, 24 and 28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58 and 60 in the present invention) is not ubiquitous for the detection of MRSA and suggest that some MRSA strains have sequences at the SCCmec right extremity junction which are different from those identified by Hiramatsu et al. other types of SCCmec sequences or other sequences at the right extremity of SCCmec (MREP type) are found in MRSA. A limitation of this assay is the non-specific detection of 13 MSSA strains (Table 2).
Example 2
Detection and Identification of MRSA using Primers Specific to MREP Types i, ii and iii Sequences Developed in the Present Invention.
Based on analysis of multiple sequence alignments of orfX and SCCmec sequences described by Hiramatsu et al. or available from GenBank, a set of primers (SEQ ID NOs: 64, 66, 67) capable of amplifying short segments of types I, II and III of SCCmec-orfX right extremity junctions from MRSA strains and discriminating from MRCNS (Annex I and FIG. 2) were designed. The chosen set of primers gives amplification products of 176 bp for SCCmec type I, 278 pb for SCCmec type II and 223 bp for SCCmec type III and allows rapid PCR amplification. These primers were used in multiplex PCR to test their ubiquity and specificity using 208 MRSA strains, 252 MSSA strains, 41 MRCNS strains and 21 MRCNS strains (Table 12). The PCR amplification and detection was performed as described in Example 1. PCR reactions were then subjected to thermal cycling (3 minutes at 94° C. followed by 30 or 40 cycles of 1 second at 95° C. for the denaturation step and 30 seconds at 60° C. for the annealing-extension step, and then followed by a terminal extension of 2 minutes at 72° C.) using a standard thermocycler (PTC-200 from MJ Research Inc.). Detection of the PCR products was made as described in Example 1.
None of the MRCNS or MSCNS strains tested were detected with this set of primers (Table 12). However, the twenty MRSA strains which were not detected with the primer set developed by Hiramatsu et al. (SEQ ID NOs: 56, 58 and 60) were also not detected with the primers developed in the present invention (Tables 3 and 12). These data also demonstrate that some MRSA strains have sequences at the SCCmec-chromosome right extremity junction which are different from those identified by Hiramatsu et al. Again, as observed with the Hiramatsu primers, 13 MSSA strains were also detected non-specifically (Table 12). The clinical significance of this finding remains to be established since these apparent MSSA strains could be the result of a recent deletion in the mec locus (Deplano et al., 2000, J. Antimicrob. Chemotherapy, 46:617-619; Inglis et al., 1990, J. Gen. Microbiol., 136:2231-2239; Inglis et al., 1993, J. Infect. Dis., 167:323-328; Lawrence et al. 1996, J. Hosp. Infect., 33:49-53; Wada et al., 1991, Biochem. Biophys. Res. Comm., 176:1319-1326).
Example 3
Development of a Multiplex PCR Assay on a Standard Thermocycler for Detection and Identification of MRSA Based on MREP Types i, ii, iii, iv and v Sequences.
Upon analysis of two of the new MREP types iv and v sequence data described in the present invention, two new primers (SEQ ID NOs.: 79 and 80) were designed and used in multiplex with the three primers SEQ ID NOs.: 64, 66 and 67 described in Example 2. PCR amplification and detection of the PCR products was performed as described in Example 2. Sensitivity tests performed by using ten-fold or two-fold dilutions of purified genomic DNA from various MRSA strains of each MREP type showed a detection limit of 5 to 10 genome copies (Table 16). Specificity tests were performed using 0.1 ng of purified genomic DNA or 1 μl of a standardized bacterial suspension. All MRCNS or MSCNS strains tested were negative with this multiplex assay (Table 17). Twelve of the 20 MRSA strains which were not detected with the multiplex PCR described in Examples 1 and 2 were now detected with this multiplex assay. Again, as observed with the Hiramatsu primers, 13 MSSA strains were also detected non-specifically (Table 12). The eight MRSA strains (CCRI-9208, CCRI-9583, CCRI-9773, CCRI-9774, CCRI-9589, CCRI-9860, CCRI-9681, CCRI-9770) and which harbor the new MREP types vi, vii, viii, ix and x sequences described in the present invention remained undetectable.
Example 4
Development of a Real-Time Multiplex PCR Assay on the SMART CYCLER® for Detection and Identification of MRSA Based on MREP Types i, ii, iii, iv and v Sequences.
The multiplex PCR assay described in Example 3 containing primers (SEQ ID NOs.: 64, 66, 67, 79 and 80) was adapted to the SMART CYCLER® platform (Cepheid). A molecular beacon probe specific to the orfX sequence was developed (SEQ ID NO. 84, see Annex II). Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 3.5 mM MgCl2, 0.4 μM of each of the SCCmec- and orfX-specific primers (SEQ ID NOs.: 64, 66, 67, 79 and 80), 0.2 μM of the FAM-labeled molecular beacon probe (SEQ ID NO.: 84), 200 μM of each of the four dNTPs, 3.3 μg/μl of BSA, and 0.5 U Taq polymerase coupled with TaqStartTM Antibody. The PCR amplification on the SMART CYCLER® was performed as follows: 3 min. at 94° C. for initial denaturation, then forty-five cycles of three steps consisting of 5 seconds at 95° C. for the denaturation step, 15 seconds at 59° C. for the annealing step and 10 seconds at 72° C. for the extension step. Fluorescence detection was performed at the end of each annealing step. Sensitivity tests performed by using purified genomic DNA from several MRSA strains of each MREP type showed a detection limit of 2 to 10 genome copies (Table 18). None of the MRCNS or MSCNS were positive with this multiplex assay (Table 19). Again, as observed with the Hiramatsu primers, 13 MSSA strains were also detected non-specifically. Twelve of the twenty MRSA strains which were not detected with the multiplex PCR described in Examples 1 and 2 were detected by this multiplex assay. As described in Example 3, the eight MRSA strains which harbor the new MREP types vi, vii, viii, ix and x sequences described in the present invention remained undetectable.
Example 5
Development of a Real-Time Multiplex PCR Assay on the SMART CYLCER® for Detection and Identification of MRSA Based on MREP Types i, ii, iii, iv and v Sequences Including an Internal Control.
The multiplex PCR assay described in Example 4 containing primers specific to MREP types i to v and orfX of S. aureus (SEQ ID NOs.: 64, 66, 67, 79 and 80) and a molecular beacon probe specific to the orfX sequence (SEQ ID NO. 84, see Annex II) was optimized to include an internal control to monitor PCR inhibition. This internal control contains sequences complementary to MREP type iv- and orfX-specific primers (SEQ ID NOs. 79 and and 64). The assay also contains a TET-labeled molecular beacon probe specific to sequence within the amplicon generated by amplification of the internal control. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 3.45 mM MgCl2, 0.8 μM of each of the MREP-specific primers (SEQ ID NOs.: 66 and 67) and or orfX-specific primer (SEQ ID NO.: 64), 0.4 μM of each of the MREP-specific primers (SEQ ID NOs.: 79 and 80), 80 copies of the internal control, 0.2 μM of the TET-labeled molecular beacon probe specific to the internal control, 0.2 μM of the FAM-labeled molecular beacon probe (SEQ ID NO.: 84), 330 μM of each of the four dNTPs (Pharmacia Biotech), 3.45 μg/μl of BSA (Sigma), and 0.875 U Taq polymerase (Promega) coupled with TaqStartTM Antibody (BD Biosciences). The PCR amplification on the SMART CYCLER® was performed as follows: 3 min. at 95° C. for initial denaturation, then forty-eight cycles of three steps consisting of 5 seconds at 95° C. for the denaturation step, 15 seconds at 60° C. for the annealing step and 15 seconds at 72° C. for the extension step. Sensitivity tests performed by using purified genomic DNA from one MRSA strain of each MREP type (i to v) showed a detection limit of 2 to 10 genome copies. None of the 26 MRCNS or 10 MSCNS were positive with this multiplex assay. Again, as observed with the Hiramatsu primers, 13 MSSA strains were also detected non-specifically. As described in Examples 3 and 4, the eight MRSA strains which harbor the new MREP types vi to x sequences described in the present invention remained undetectable.
Example 6
Detection of MRSA using the Real-Time Multiplex Assay on the SMART CYLCER® Based on MREP Types i, ii, iii iv and v Sequences Directly from Clinical Specimens.
The assay described in Example 5 was adapted for detection directly from clinical specimens. A total of 142 nasal swabs collected during a MRSA hospital surveillance program at the Montreal General Hospital (Montreal, Quebec, Canada) were tested. The swab samples were tested at the Centre de Recherche en Infectiologie de l'Université Laval within 24 hours of collection. Upon receipt, the swabs were plated onto mannitol agar and then the nasal material from the same swab was prepared with a simple and rapid specimen preparation protocol described in patent application number U.S. 60/306,163. Classical identification of MRSA was performed by standard culture methods.
The PCR assay described in Example 5 detected 33 of the 34 samples positive for MRSA based on the culture method. As compared to culture, the PCR assay detected 8 additional MRSA positive specimens for a sensitivity of 97.1% and a specificity of 92.6%. This multiplex PCR assay represents a rapid and powerful method for the specific detection of MRSA carriers directly from nasal specimens and can be used with any type of clinical specimens such as wounds, blood or blood culture, CSF, etc.
Example 7
Development of a Real-Time Multiplex PCR Assay on the SMART CYCLER® for Detection and Identification of MRSA Based on MREP Types i, ii iii, iv, v and vii Sequences.
Upon analysis of the new MREP type vii sequence data described in the present invention (SEQ ID NOs.: 165 and 166), two new primers (SEQ ID NOs.: 112 and 113) were designed and tested in multiplex with the three primers SEQ ID NOs.: 64, 66 and 67 described in Example 2. Primer SEQ ID NO.: 112 was selected for use in the multiplex based on its sensitivity. Three molecular beacon probes specific to the orfX sequence which allowed detection of two sequence polymorphisms identified in this region of the orfX sequence, based on analysis of SEQ ID NOs.: 173-186, were also used in the multiplex (SEQ ID NOs.: 84, 163 and 164). Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 3.45 mM MgCl2, 0.8 μM of each of the SCCmec-specific primers (SEQ ID NOs.: 66 and 67) and orfX-specific primer (SEQ ID NO.: 64), 0.4 μM of each of the SCCmec-specific primers (SEQ ID NOs.: 79 and 80), 0.2 μM of the FAM-labeled molecular beacon probe (SEQ ID NO.: 84), 330 μM of each of the four dNTPs (Pharmacia Biotech), 3.45 μg/μl of BSA (Sigma), and 0.875 U of Taq polymerase (Promega) coupled with TaqStartTM Antibody (BD Biosciences). The PCR amplification on the SMART CYCLER® was performed as follows: 3 min. at 95° C. for initial denaturation, then forty-eight cycles of three steps consisting of 5 seconds at 95° C. for the denaturation step, 15 seconds at 60° C. for the annealing step and 15 seconds at 72° C. for the extension step. The detection of fluorescence was done at the end of each annealing step. Sensitivity tests performed by using purified genomic DNA from several MRSA strains of each MREP type showed a detection limit of 2 genome copies (Table 20). None of the 26 MRCNS or 8 MSCNS were positive with this multiplex assay. Again, as observed with the Hiramatsu primers, 13 MSSA strains were also detected non-specifically (Table 21). Four of the strains which were not detected with the multiplex assay for the detection of MREP types i to v were now detected with this multiplex assay while the four MRSA strains (CCRI-9208, CCRI-9770, CCRI-9681, CCRI-9860) which harbor the MREP types vi, viii, ix and x described in the present invention remained undetectable.
Example 8
Development of Real-Time PCR Assays on the SMART CYCLER® for Detection and Identification of MRSA Based on MREP Types vi, viii, ix.
Upon analysis of the new MREP types vi, viii and ix sequence data described in the present invention, one new primers specific to MREP type vi (SEQ ID NO.: 201), one primer specific to MREP type viii (SEQ ID NO.: 115), a primer specific to MREP type ix (SEQ ID NO.: 109) and a primer specific to both MREP types viii and ix (SEQ ID NO.: 116) were designed. Each PCR primer was used in combination with the orfX-specific primer (SEQ ID NO.: 64) and tested against its specific target strain. Each PCR reaction contained 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 3.45 mM MgCl2, 0.4 μM of each of the SCCmec- and orfX-specific primers, 200 μM of each of the four dNTPs, 3.4 μg/μl of BSA, and 0.875 U Taq polymerase coupled with TaqStartTM Antibody. The PCR amplification was performed as described en Example 7. Sensitivity tests performed by using genomic DNA purified from their respective MRSA target strains showed that the best primer pair combination was SEQ ID NOs.: 64 and 115 for the detection of MREP types viii and ix simultaneously. These new SCCmec-specific primers may be used in multiplex with primers specific to MREP types i, ii, ii, iv, v and vii (SEQ ID NOs.: 64, 66, 67, 79 and 80) described in previous examples to provide a more ubiquitous MRSA assay.
In conclusion, we have improved the ubiquity of detection of MRSA strains. New MREJ types iv to x have been identified. Amongst strains representative of these new types, Hiramitsu's primers and/or probes succeeded in detecting less than 50% thereof. We have therefore amply passed the bar of at least 50% ubiquity, since our primers and probes were designed to detect 100% of the strains tested as representatives of MREJ types iv to ix. Therefore, although ubiquity depends on the pool of strains and representatives that are under analysis, we know now that close to 100% ubiquity is an attainable goal, when using the sequences of the right junctions (MREJ) to derive probes and primers dealing with polymorphism in this region. Depending on how many unknown types of MREJ exist, we have a margin of maneuver going from 50% (higher than Hiramatsu's primers for the tested strains) to 100% if we sequence all the existing MREJs to derive properly the present diagnostic tools and methods, following the above teachings.
This invention has been described herein above, and it is readily apparent that modifications can be made thereto without departing from the spirit of this invention. These modifications are under the scope of this invention, as defined in the appended claims.







TABLE 1







PCR amplification primers reported by Hiramatsu et al.


in U.S. Pat. No. 6,156,507 found in the sequence listing










SEQ ID NO.:





(present


SEQ ID NO.:


invention)
Target
Positiona,b
(U.S. Pat. No. 6,156,507)





52
MREP types i and ii
 480
18


53
MREP types i and ii
 758
19


54
MREP types i and ii
 927
20


55
MREP types i and ii
1154
21


56
MREP types i and ii
1755
22


57
MREP types i and ii
2302
23


58
MREP type iii
  295c
24


59
orfX
1664
25


60
orfSA0022d
3267
28


61
orfSA0022d
3585
27


62
orfX
1389
26


63
orfSA0022d
2957
29





aPosition refers to nucleotide position of the 5′ end of primer.


bNumbering for SEQ ID NOs.: 52-57 refers to SEQ ID NO.: 2; numbering for SEQ ID NO.: 58 refers to SEQ ID NO.: 4; numbering for SEQ ID NOs.: 59-63 refers to SEQ ID NO.: 3.


cPrimer is reverse-complement of target sequence.


dorfSA0022 refers to the open reading frame designation from GenBank accession number AP003129 (SEQ ID NO.: 231).













TABLE 2







Specificity and ubiquity tests performed on a standard


thermocycler using the optimal set of primers described


by Hiramatsu et al. (SEQ ID NOs.: 22, 24 and 28 in


U.S. Pat. No. 6,156,507 corresponding to SEQ ID NOs.: 56, 58


and 60, respectively, in the present invention) for the


detection of MRSA










PCR results for SCCmec -




orfX right extremity junction












Strains
Positive (%)
Negative (%)
















MRSA - 39 strains
19
(48.7)
20
(51.2)



MSSA - 41 strains
13
(31.7)
28
(68.3)



MRCNS - 9 strains*
0
(0%)
9
(100%)



MSCNS - 11 strains*
0
(0%)
11
(100%)










*Details regarding CNS strains:








MRCNS:
S. caprae (1)



S. cohni cohnii (1)



S. epidermidis (1)



S. haemolyticus (2)



S. hominis (1)



S. sciuri 1)



S. simulans (1)



S. warneri (1)


MSCNS:
S. cohni cohnii (1)



S. epidermidis (1)



S. equorum (1)



S. gallinarum (1)



S. haemolyticus (1)



S. lentus (1)



S. lugdunensis (1)



S. saccharolyticus (1)



S. saprophyticus (2)



S. xylosus (1)
















TABLE 3







Origin of MRSA strains not amplifiable using primers


developed by Hiramatsu et al. (SEQ ID NOs.: 22, 24 and


28 in U.S. Pat. No. 6,156,507 corresponding to SEQ ID


NOs.: 56, 58 and 60, respectively, in the present


invention) as well as primers developed in the present


invention targeting MREP types i, ii and iii (SEQ ID


NOs.: 64, 66 and 67)










Staphylococcus aureus




strain designation:












Original
CCRIa
Origin






ATCC BAA-40b
CCRI-9504
Portugal



ATCC 33592
CCRI-178
USA



R991282
CCRI-2025
Québec, Canada



 4508
CCRI-9208
Québec, Canada



19121
CCRI-8895
Denmark



Z109
CCRI-8903
Denmark



45302
CCRI-1263
Ontario, Canada



R655
CCRI-1324
Québec, Canada



MA 50428
CCRI-1311
Québec, Canada



MA 50609
CCRI-1312
Québec, Canada



MA 51363
CCRI-1331
Québec, Canada



MA 51561
CCRI-1325
Québec, Canada



14A0116
CCRI-9681
Poland



23 (CCUG 41787)
CCRI-9860
Sweden



SE26-1
CCRI-9770
Ontario, Canada



SE1-1
CCRI-9583
Ontario, Canada



ID-61880c
CCRI-9589
Ontario, Canada



SE47-1
CCRI-9773
Ontario, Canada



SE49-1
CCRI-9774
Ontario, Canada



39795-2
CCRI-1377
Québec, Canada





aCCRI stands for “Collection of the Centre de Recherche en Infectiologie”.


bPortuguese clone.


cCanadian clone EMRSA1.













TABLE 4





Staphylococcus aureus MREJ nucleotide sequences


revealed in the present invention

















SEQ
Staphylococcus aureus



ID
strain designation:











NO.
Original
CCRIa
Genetic Target





27
R991282
CCRI-2025
mecA


 


28
45302
CCRI-1263
mecA


 


29
MA 50428
CCRI-1311
mecA


 


30
MA 51363
CCRI-1331
mecA


 


31
39795-2
CCRI-1377
mecA and 1.5 kb





of downstream





 region


 


42
ATCC 33592
CCRI-178
MREP type iv


 


43
19121
CCRI-8895
MREP type iv


 


44
Z109
CCRI-8903
MREP type iv


 


45
R655
CCRI-1324
MREP type iv


 


46
MA 51363
CCRI-1331
MREP type iv


 


47
45302
CCRI-1263
MREP type v


 


48
39795-2
CCRI-1377
MREP type v


 


49
MA 50428
CCRI-1311
MREP type v


 


50
R991282
CCRI-2025
MREP type V


 


51
ATCC BAA-40
CCRI-9504
MREP type iv


 


165
SE1-1
CCRI-9583
MREP type vii


 


166
ID-61880
CCRI-9589
MREP type vii


 


167
23 (CCUG 41787)
CCRI-9860
MREP type viii


 


168
14A016
CCRI-9681
MREP type ix


 


171
4508
CCRI-9208
MREP type vi


 


172
SE26-1
CCRI-9770
orfSA0021b and





75 bp of 





orfSA0022b


 


173
26 (98/10618)
CCRI-9864
MREP type ii


 


174
27 (98/26821)
CCRI-9865
MREP type ii


 


175
28 (24344)
CCRI-9866
MREP type ii


 


176
12 (62305)
CCRI-9867
MREP type ii


 


177
22 (90/14719)
CCRI-9868
MREP type ii


 


178
23 (98/14719)
CCRI-9869
MREP type ii


 


179
32 (97599)
CCRI-9871
MREP type ii


 


180
33 (97S100)
CCRI-9872
MREP type ii


 


181
38 (825/96)
CCRI-9873
MREP type ii


 


182
39 (842/96)
CCRI-9874
MREP type ii


 


183
43 (N8-892/99)
CCRI-9875
MREP type ii


 


184
46 (9805-0137)
CCRI-9876
MREP type iii


 


185
1
CCRI-9882
MREP type ii


 


186
29
CCRI-9885
MREP type ii


 


189
SE1-1
CCRI-9583
mecA and 2.2 kb 





of downstream 





region, including 





IS431mec


 


190
ATCC BAA-40
CCRI-9504
mecA and 1.5 kb 





of downstream 





region


 


191
4508
CCRI-9208
mecA and 0.9 kb 





of downstream 





region


 


192
ID-61880
CCRI-9589
mecA and 0.9 kb 





of downstream





region


 


193
14A016
CCRI-9681
mecA and 0.9 kb 





of downstream 





region


 


195
SE26-1
CCRI-9770
mecA and 1.5 kb 





of downstream 





region, including 





IS431mec


 


197
ATCC 43300
CCRI-175
MREP type ii


 


198
R522
CCRI-1262
MREP type iii


 


199
13370
CCRI-8894
MREP type i


 


219
ATCC BAA-40
CCRI-9504
tetK












SEQ
Staphylococcus aureus



ID
strain designation:











NO.
Original
CCRIb
Genetic Targeta





220
MA 51363
CCRI-1331
mecA and 1.5 kb of





downstream region


 


221
39795-2
CCRI-1377
IS431mec and 0.6 kb





of upstream region


 


222
R991282
CCRI-2025
mecA and 1.5 kb of





downstream region


 


223
R991282
CCRI-2025
IS431mec and 0.6 kb





of upstream region


 


224
23 (CCUG
CCRI-9860
mecA and 1.5 kb of



41787)

downstream region


 


225
23 (CCUG
CCRI-9860
IS431mec and 0.6 kb



41787)

of upstream region


 


233
14A016
CCRI-9681
MREP type ix





aCCRI stands for “Collection of the Centre de Recherche en Infectiologie”.


borfSA0021 and orfSA0022 refer to the open reading frame designation from GenBank accession number AP003129 (SEQ ID NO.: 231).













TABLE 5







PCR primers developed in the present invention










Originating DNA











SEQ ID NO.
Target
Positiona
SEQ ID NO.













64
orfX
1720
3


70
orfX
1796
3


71
orfX
1712
3


72
orfX
1749
3


73
orfX
1758
3


74
orfX
1794
3


75
orfX
1797
3


76
orfX
1798
3


66
MREP types i and ii
2327
2


100
MREP types i and ii
2323
2


101
MREP types i and ii
2314
2


97
MREP type ii
2434
2


99
MREP type ii
2434
2


67
MREP type iii
  207b
4


98
MREP type iii
  147b
4


102
MREP type iii
  251b
4


79
MREP type iv
  74b
43


80
MREP type v
  50b
47


109
MREP type ix
  652b
168


204
MREP type vi
  642b
171


112
MREP type vii
  503b
165


113
MREP type vii
  551b
165


115
MREP type viii
  514b
167


116
MREP type viii
  601b
167





aPosition refers to nucleotide position of 5′ end of primer.


bPrimer is reverse-complement of target sequence.













TABLE 6







Molecular beacon probes developed in the present


invention









SEQ ID NO.
Target
Position












32
orfX
 86a


83
orfX
 86a


84
orfX
 34a,b


160
orfX
 55a,b


161
orfX
 34a,b


162
orfX
114a


163
orfX
 34a,b


164
orfX
 34a,b





aPosition refers to nucleotide position of the 5′ end of the molecular beacon's loop on SEQ ID NO.: 3.


bSequence of molecular beacon's loop is reverse-complement of SEQ ID NO.: 3.













TABLE 7







Length of amplicons obtained with the diferent primer


pairs which are objects of the present invention









SEQ ID




NO.
Targetd
Amplicon lengtha





59/52b
orfX/MREP type i and ii
2079 (type i); 2181 (type ii)


59/53b
orfx/MREP type i and ii
1801 (type i); 1903 (type ii)


59/54b
orfX/MREP type i and ii
1632 (type i); 1734 (type ii)


59/55b
orfX/MREP type i and ii
1405 (type i); 1507 (type ii)


59/56b
orfX/MREP type i and ii
 804 (type i); 906 (type ii)


59/57b
orfX/MREP type i and ii
 257 (type i); 359 (type ii)


60/52b
orfSA0022/MREP type i and ii
2794 (type i); 2896 (type ii)


60/53b
orfSA0022/MREP type i and ii
2516 (type i); 2618 (type ii)


60/54b
orfSA0022/MREP type i and ii
2347 (type i); 2449 (type ii)


60/55b
orfSA0022/MREP type i and ii
2120 (type i); 2222 (type ii)


60/56b
orfSA0022/MREP type i and ii
1519 (type i); 1621 (type ii)


60/57b
orfSA0022/MREP type i and ii
 972 (type i); 1074 (type ii)


61/52b
orfSA0022/MREP type i and ii
2476 (type i); 2578 (type ii)


61/53b
orfSA0022/MREP type i and ii
2198 (type i); 2300 (type ii)


61/54b
orfSA0022/MREP type i and ii
2029 (type i); 2131 (type ii)


61/55b
orfSA0022/MREP type i and ii
1802 (type i); 1904 (type ii)


61/56b
orfSA0022/MREP type i and ii
1201 (type i); 1303 (type ii)


61/57b
orfSA0022/MREP type i and ii
 654 (type i); 756(type ii)


62/52b
orfX/MREP type i and ii
2354 (type i); 2456 (type ii)


62/53b
orfX/MREP type i and ii
2076 (type i); 2178 (type ii)


62/54b
orfX/MREP type i and ii
1907 (type i); 2009 (type ii)


62/55b
orfX/MREP type i and ii
1680 (type i); 1782 (type ii)


62/56b
orfX/MREP type i and ii
1079 (type i); 1181 (type ii)


62/57b
orfX/MREP type i and ii
 532 (type i); 634 (type ii)


63/52b
orfSA0022/MREP type i and ii
3104 (type i); 3206 (type ii)


63/53b
orfSA0022/MREP type i and ii
2826 (type i); 2928 (type ii)


63/54b
orfSA0022/MREP type i and ii
2657 (type i); 2759 (type ii)


63/55b
orfSA0022/MREP type i and ii
2430 (type i); 2532 (type ii)


63/56b
orfSA0022/MREP type i and ii
1829 (type i); 1931 (type ii)


63/57b
orfSA0022/MREP type i and ii
1282 (type i); 1384 (type ii)


59/58b
orfX/MREP type iii
 361


60/58b
orfSA0022/MREP type iii
1076


61/58b
orfSA0022/MREP type iii
 758


62/58b
orfX/MREP type iii
 656


63/58b
orfSA0022/MREP type iii
1386


70/66 
orfX/MREP type i and ii
 100 (type i); 202 (type ii)


70/67 
orfX/MREP type iii
 147 (type iii)


64/66c
orfX/MREP type i and ii
 176 (type i); 278 (type ii)


64/67c
orfX/MREP type iii
 223


64/79c
orfX/MREP type iv
 215


64/80c
orfX/MREP type v
 196


64/97c
orfX/MREP type ii
 171


64/98c
orfX/MREP type iii
 163


64/99c
orfX/MREP type ii
 171


 64/100c
orfX/MREP types i and ii
 180 (type i); 282 (type ii)


 64/101c
orfX/MREP types i and ii
 189 (type i); 291 (type ii)


 64/102c
orfX/MREP type iii
 263


 64/109c
orfX/MREP type ix
 369


 64/204c
orfX/MREP type vi
 348


 64/112c
orfX/MREP type vii
 214


 64/113c
orfX/MREP type vii
 263


 64/115c
orfX/MREP type viii
 227


 64/116c
orfX/MREP type viii
 318





aAmplicon length is given in base pairs for MREP types amplified by the set of primers.


bSet of primers described by Hiramatsu et al. in U.S. Pat. 6,156,507.


cSet of primers developed in the present invention.


dorfSA0022 refers to the open reading frame designation from GenBank accession number AP003129 (SEQ ID NO.: 231).













TABLE 8







Other primers developed in the present invention









Originating DNA










SEQ ID NO.
Target
Positiona
SEQ ID NO.













77
MREP type iv
 993
43


65
MREP type v
 636
47


70
orfX
1796
3


68
IS431
 626
92


69
mecA
1059
78


96
mecA
1949
78


81
mecA
1206
78


114
MREP type vii
  629b
165


117
MREP type ii
 856
194


118
MREP type ii
  974b
194


119
MREP type vii
  404
189


120
MREP type vii
  477b
189


123
MREP type vii
 551
165


124
MREP type ii
 584
170


125
MREP type ii
  689b
170


126
orfSA0021
 336
231


127
orfSA0021
 563
231


128
orfSA0022d
2993
231


129
orfSA0022d
 3467b
231


132
orfX
3700
231


145
MREP type iv
 988
51


146
MREP type iv
1386
51


147
MREP type iv
  891b
51


148
MREP type ix
 664
168


149
MREP type ix
  849b
168


150
MREP type vii
 1117b
165


151
MREP type vii
1473
189


152
IS431mec
 1592b
189


154
MREP type v
  996b
50


155
MREP type v
 935
50


156
tetK from plasmid pT181
 1169b
228


157
tetK from plasmid pT181
 136
228


158
orfX
 2714b
2


159
orfX
2539
2


187
MREP type viii
  967b
167


188
MREP type viii
 851
167





aPosition refers to nucleotide position of the 5′ end of primer.


bPrimer is reverse-complement of target sequence.













TABLE 9







Amplification and/or sequencing primers developed in


the present invention









Originating DNA










SEQ ID NO.
Target
Positiona
SEQ ID NO.













85
S. aureus chromosome
  197b
35


86
S. aureus chromosome
  198b
37


87
S. aureus chromosome
  197b
38


88
S. aureus chromosome
 1265b
39


89
S. aureus chromosome
1892
3


103
orfX
1386
3


105
MREP type i
2335
2


106
MREP type ii
2437
2


107
MREP type iii
  153b
4


108
MREP type iii
  153b
4


121
MREP type vii
1150
165


122
MREP type vii
 1241b
165


130
orfX
 4029b
231


131
region between orfSA0022 and
3588
231



orfSA0023d




133
merB from plasmid pI258
 262
226


134
merB from plasmid pI258
  539b
226


135
merR from plasmid pI258
 564
226


136
merR from plasmid pI258
 444
227


137
merR from plasmid pI258
 529
227


138
merR from plasmid pI258
  530b
227


139
rep from plasmid pUB110
 796
230


140
rep from plasmid pUB110
  761b
230


141
rep from plasmid pUB110
 600
230


142
aadD from plasmid pUB110
 1320b
229


143
aadD from plasmid pUB110
 759
229


144
aadD from plasmid pUB110
 646
229


153
MREP type vii
1030
165


200
orfSA0022d
  871c
231


201
orfSA0022d
1006
231


202
MREP type vi
 648
171


203
MREP type vi
  883b
171


205
MREP type ix
1180
168


206
MREP type ix
 1311b
233


207
MREP type viii
1337
167


208
MREP type viii
 1441b
167


209
ccrA
 184
232


210
ccrA
 385
232


211
ccrA
  643b
232


212
ccrA
 1282b
232


213
ccrB
1388
232


214
ccrB
1601
232


215
ccrB
 2139b
232


216
ccrB
 2199b
232


217
ccrB
 2847b
232


218
ccrB
 2946b
232





aPosition refers to nucleotide position of the 5′ end of primer.


bPrimer is reverse-complement of target sequence.


cPrimer contains two mismatches.


dorfSA0022 and orfSA0023 refer to the open reading frame designation from GenBank accession number AP003129 (SEQ ID NO.: 231).













TABLE 10







Origin of the nucleic acids and/or sequences available


from public databases found in the sequence listing












Staphylococcal





SEQ ID NO.
strain
Source
Accession number
Genetic Targeta,b














1
NCTC 10442
Database
AB033763
SCCmec type I MREJ


2
N315
Database
D86934
SCCmec type II MREJ


3
NCTC 8325
Database
AB014440
MSSA chromosome


4
86/560
Database
AB013471
SCCmec type III MREJ


5
86/961
Database
AB013472
SCCmec type III MREJ


6
85/3907
Database
AB013473
SCCmec type III MREJ


7
86/2652
Database
AB013474
SCCmec type III MREJ


8
86/1340
Database
AB013475
SCCmec type III MREJ


9
86/1762
Database
AB013476
SCCmec type III MREJ


10
86/2082
Database
AB013477
SCCmec type III MREJ


11
85/2111
Database
AB013478
SCCmec type III MREJ


12
85/5495
Database
AB013479
SCCmec type III MREJ


13
85/1836
Database
AB013480
SCCmec type III MREJ


14
85/2147
Database
AB013481
SCCmec type III MREJ


15
85/3619
Database
AB013482
SCCmec type III MREJ


16
85/3566
Database
AB013483
SCCmec type III MREJ


17
85/2232
Database
AB014402
SCCmec type II MREJ


18
85/2235
Database
AB014403
SCCmec type II MREJ


19
MR108
Database
AB014404
SCCmec type II MREJ


20
85/9302
Database
AB014430
SCCmec type I MREJ


21
85/9580
Database
AB014431
SCCmec type I MREJ


22
85/1940
Database
AB014432
SCCmec type I MREJ


23
85/6219
Database
AB014433
SCCmec type I MREJ


24
64/4176
Database
AB014434
SCCmec type I MREJ


25
64/3846
Database
AB014435
SCCmec type I MREJ


26
HUC19
Database
AF181950
SCCmec type II MREJ


33
G3
U.S. Pat. No. 6,156,507
SEQ ID NO.: 15
S. epidermidis






SCCmec type II MREJ


34
SH 518
U.S. Pat. No. 6,156,507
SEQ ID NO.: 16
S. haemolyticus






SCCmec type II MREJ


35
ATCC 25923
U.S. Pat. No. 6,156,507
SEQ ID NO.: 9
S. aureus chromosome


36
STP23
U.S. Pat. No. 6,156,507
SEQ ID NO.: 10
S. aureus chromosome


37
STP43
U.S. Pat. No. 6,156,507
SEQ ID NO.: 12
S. aureus chromosome


38
STP53
U.S. Pat. No. 6,156,507
SEQ ID NO.: 13
S. aureus chromosome


39
476
Genome projectc

S. aureus chromosome


40
252
Genome projectc

SCCmec type II MREJ


41
COL
Genome projectd

SCCmec type I MREJ


78
NCTC 8325
Database
X52593
mecA


82
NCTC 10442
Database
AB033763
mecA


90
N315
Database
D86934
mecA


91
85/2082
Database
AB037671
mecA


92
NCTC 10442
Database
AB033763
IS431


93
N315
Database
D86934
IS431


94
HUC19
Database
AF181950
IS431


95
NCTC 8325
Database
X53818
IS431


104
85/2082
Database
AB037671
SCCmec type III MREJ


226
unknown
Database
L29436
merB on plasmid pI258


227
unknown
Database
L29436
merR on plasmid pI258


228
unknown
Database
S67449
tetK on plasmid pT181


229
HUC19
Database
AF181950
aadD on plasmid pUB110


230
HUC19
Database
AF181950
rep on plasmid pUB110


231
N315
Database
AP003129
orfSA0021, orfSA0022,






orfSA0023


232
85/2082
Database
AB037671
ccrA/ccrB





aMREJ refers to mec right extremity junction and includes sequences from SCCmec-right extremity and chromosomal DNA to the right of SCCmec integration site.


bUnless otherwise specified, all sequences were obtained from S. aureus strains.


cSanger Institute genome project (http://www.sanger.ac.uk).


dTIGR genome project (http://www.tigr.org).













TABLE 11







Analytical sensitivity of the MRSA-specific PCR assay


targeting MREP types i, ii and iii on a standard


thermocycler using the set of primers developed in the


present invention (SEQ ID NOs.: 64, 66 and 67)








Strain designation:
Detection limit









Original
CCRIa (MREP type)
(number of genome copies)





13370
CCRI-8894 (I)
5


ATCC 43300
CCRI-175 (II)
2


35290
CCRI-1262 (III)
2





aCCRI stands for “Collection of the Centre de Recherche en Infectiologie”.













TABLE 12







Specificity and ubiquity tests performed on a standard


thermocycler using the set of primers targeting MREP


types i, ii and iii developed in the present invention


(SEQ ID NOs.: 64, 66 and 67) for the detection of MRSA










PCR results for MREJ












Strains
Positive (%)
Negative (%)







MRSA - 208 strains
188 (90.4)
20 (9.6) 



MSSA - 252 strains
13 (5.2)
239 (94.8) 



MRCNS - 41 strains*
0
42 (100)



MSCNS - 21 strains*
0
21 (100)











*Details regarding CNS strains:








MRCNS
S. caprae (2)



S. cohni cohnii (3)



S. cohni urealyticum (4)



S. epidermidis (8)



S. haemolyticus (9)



S. hominis (4)



S. sciuri (4)



S. sciuri sciuri (1)



S. simulans (3)



S. warneri (3)


MSCNS
S. cohni cohnii (1)



S. epidermidis (3)



S. equorum (2)



S. felis (1)



S. gallinarum (1)



S. haemolyticus (1)



S. hominis (1)



S. lentus (1)



S. lugdunensis (1)



S. saccharolyticus (1)



S. saprophyticus (5)



S. simulans (1)



S. warneri (1)



S. xylosus (1)













TABLE 13







Percentage of sequence identity for the first 500


nucleotides of SCCmec right extremities between


all 9 types of MREPa,b
















MREP











type
i
ii
iii
iv
v
vi
vii
viii
ix





i
—
79.2
42.8
42.8
41.2
44.4
44.6
42.3
42.1


ii


43.9
47.5
44.7
41.7
45.0
52.0
57.1


iii



46.8
44.5
42.9
45.0
42.8
45.2


iv




45.8
41.4
44.3
48.0
41.3


v





45.4
43.7
47.5
44.3


vi






45.1
41.1
47.2


vii







42.8
40.9


viii








55.2


ix








—





a“First 500 nucleotides” refers to the 500 nucleotides within the SCCmec right extremity, starting from the integration site of SCCmec in the Staphylococcus aureus chromosome as shown on FIG. 4.


bSequences were extracted from SEQ ID NOs.: 1, 2, 104, 51, 50, 171, 165, 167, and 168 for types i to ix, respectively.













TABLE 14





Reference strains used to test sensitivity and/or


specificity and/or ubiquity of the MRSA-specific PCR


assays targeting MREJ sequences

















Staphylococcal species
Strains
Sourcea





MRSA (n = 45)
33591
ATCC



33592
ATCC



33593
ATCC



BAA-38
ATCC



BAA-39
ATCC



BAA-40
ATCC



BAA-41
ATCC



BAA-42
ATCC



BAA-43
ATCC



BAA-44
ATCC



F182
CDC



23 (CCUG 41787)
HARMONY Collection



ID-61880 (EMRSA1)
LSPQ



MA 8628
LSPQ



MA 50558
LSPQ



MA 50428
LSPQ



MA 50609
LSPQ



MA 50884
LSPQ



MA 50892
LSPQ



MA 50934
LSPQ



MA 51015
LSPQ



MA 51056
LSPQ



MA 51085
LSPQ



MA 51172
LSPQ



MA 51222
LSPQ



MA 51363
LSPQ



MA 51561
LSPQ



MA 52034
LSPQ



MA 52306
LSPQ



MA 51520
LSPQ



MA 51363
LSPQ



98/10618
HARMONY Collection



98/26821
HARMONY Collection



24344
HARMONY Collection



62305
HARMONY Collection



90/10685
HARMONY Collection



98/14719
HARMONY Collection



97S99
HARMONY Collection



97S100
HARMONY Collection



825/96
HARMONY Collection



842/96
HARMONY Collection



N8-890/99
HARMONY Collection



9805-01937
HARMONY Collection



1
Kreiswirth-1



29
Kreiswirth-1


MRCNS (n = 4)
29060
ATCC



35983
ATCC



35984
ATCC



2514
LSPQ





Staphylococcal species
Strains
Source





MSSA (n = 28)
MA 52263
LSPQ



6538
ATCC



13301
ATCC



25923
ATCC



27660
ATCC



29213
ATCC



29247
ATCC



29737
ATCC



RN 11
CDC



RN 3944
CDC



RN 2442
CDC



7605060113
CDC



BM 4611
Institut Pasteur



BM 3093
Institut Pasteur



3511
LSPQ



MA 5091
LSPQ



MA 8849
LSPQ



MA 8871
LSPQ



MA 50607
LSPQ



MA 50612
LSPQ



MA 50848
LSPQ



MA 51237
LSPQ



MA 51351
LSPQ



MA 52303
LSPQ



MA 51828
LSPQ



MA 51891
LSPQ



MA 51504
LSPQ



MA 52535
LSPQ



MA 52783
LSPQ


MSCNS (n = 17)
12228
ATCC



14953
ATCC



14990
ATCC



15305
ATCC



27836
ATCC



27848
ATCC



29070
ATCC



29970
ATCC



29974
ATCC



35539
ATCC



35552
ATCC



35844
ATCC



35982
ATCC



43809
ATCC



43867
ATCC



43958
ATCC



49168
ATCC





aATCC stands for “American Type Culture Collection”. LSPQ stands for “Laboratoire de Santé Publique du Québec”. CDC stands for “Center for Disease Control and Prevention”.













TABLE 15







Clinical isolates used to test the sensitivity and/or


specificity and/or ubiquity of the MRSA-specific PCR


assays targeting MREJ sequences











Staphylococcal species
Number of strains
Source















MRSA (n = 177)
150
Canada




10
China




10
Denmark




9
Argentina




1
Egypt




1
Sweden




1
Poland




3
Japan




1
France



MSSA (n = 224)
208
Canada




10
China




4
Japan




1
USA




1
Argentina



MRCNS (n = 38)
32
Canada




3
China




1
France




1
Argentina




1
USA



MSCNS (n = 17)
14
UK




3
Canada

















TABLE 16







Analytical sensitivity of tests performed on a


standard thermocycler using the set of primers


targeting MREP types i, ii, iii, iv and v (SEQ ID


NOs.: 64, 66, 67, 79 and 80) developed in the present


invention for the detection and identification of MRSA








Staphylococcus aureus



strain designation:
Detection limit









Original
CCRIa (MREP type)
(number of genome copies)












13370
CCRI-8894 (i)
10


ATCC 43300
CCRI-175 (ii)
5


 9191
CCRI-2086 (ii)
10


35290
CCRI-1262 (iii)
5


 352
CCRI-1266 (iii)
10


19121
CCRI-8895 (iv)
5


ATCC 33592
CCRI-178 (iv)
5


MA 50428
CCRI-1311 (v)
5


R991282
CCRI-2025 (v)
5





aCCRI stands for “Collection of the Centre de Recherche en Infectiologie”.













TABLE 17







Specificity and ubiquity tests performed on a standard


thermocycler using the set of primers targeting MREP


types i, ii, iii, iv and v (SEQ ID NO.: 64, 66, 67, 79


and 80) developed in the present invention for the


detection and identification of MRSA










PCR results for SCCmec -




orfX right extremity



junction











Strains
Positive (%)
Negative (%)







MRSA - 35 strainsa
27 (77.1)
 8 (22.9)



MSSA - 44 strains
13 (29.5)
31 (70.5)



MRCNS - 9 strains*
0
 9 (100)



MSCNS - 10 strains*
0
10 (100) 











aMRSA strains include the 20 strains listed in Table 3.


*Details regarding CNS strains:








MRCNS
S. caprae (1)



S. cohni cohnii (1)



S. epidermidis (1)



S. haemolyticus (2)



S. hominis (1)



S. sciuri (1)



S. simulans (1)



S. warneri (1)


MSCNS
S. cohni (1)



S. epidermidis (1)



S. equorum (1)



S. haemolyticus (1)



S. lentus (1)



S. lugdunensis (1)



S. saccharolyticus (1)



S. saprophyticus (2)



S. xylosus (1)













TABLE 18







Analytical sensitivity of tests performed on the SMART


CYCLER ® thermocycler using the set of primers targeting


MREP types i, ii, iii, iv and v (SEQ ID NOs.: 64, 66,


67, 79 and 80) and molecular beacon probe (SEQ ID NO.:


84) developed in the present invention for the


detection and identification of MRSA








Staphylococcus aureus



strain designation:
Detection limit









Original
CCRIa(MREP type)
(number of genome copies)












13370
CCRI-8894 (i)
2


ATCC 43300
CCRI-175 (ii)
2


 9191
CCRI-2086 (ii)
10


35290
CCRI-1262 (iii)
2


 352
CCRI-1266 (iii)
10


ATCC 33592
CCRI-178 (iv)
2


MA 51363
CCRI-1331(iv)
5


19121
CCRI-8895 (iv)
10


Z109
CCRI-8903 (iv)
5


45302
CCRI-1263 (v)
10


MA 50428
CCRI-1311 (v)
5


MA 50609
CCRI-1312 (v)
5


MA 51651
CCRI-1325 (v)
10


39795-2
CCRI-1377 (v)
10


R991282
CCRI-2025 (v)
2





aCCRI stands for “Collection of the Centre de Recherche en Infectiologie”.













TABLE 19







Specificity and ubiquity tests performed on the SMART


CYCLER ® thermocycler using the set of primers targeting


MREP types i, ii, iii, iv and v (SEQ ID NO.: 64, 66,


67, 79 and 80) and molecular beacon probe (SEQ ID NO.:


84) developed in the present invention for the


detection of MRSA










PCR results for MREJ












Strains
Positive (%)
Negative (%)







MRSA - 29 strainsa
21 (72.4)
  8 (27.6)



MSSA - 35 strains
13 (37.1)
 22 (62.9)



MRCNS - 14 strains
0
14 (100)



MSCNS - 10 strains
0
10 (100)











aMRSA strains include the 20 strains listed in Table 3.


Details regarding CNS strains:








MRCNS
S. epidermidis (1)



S. haemolyticus (5)



S. simulans (5)



S. warneri (3)


MSCNS
S. cohni cohnii (1)



S. epidermidis (1)



S. gallinarum (1)



S. haemolyticus (1)



S. lentus (1)



S. lugdunensis (1)



S. saccharolyticus (1)



S. saprophyticus (2)



S. xylosus (1)













TABLE 20







Analytical sensitivity of tests performed on the SMART


CYCLER ® thermocycler using the set of primers targeting


MREP types i, ii, iii, iv, v and vii (SEQ ID NOs.: 64,


66, 67, 79 and 80) and molecular beacon probe (SEQ ID


NO.: 84) developed in the present invention for the


detection and identification of MRSA








Staphylococcus aureus



strain designation:
Detection limit









Original
CCRIa(MREP type)
(number of genome copies)





13370
CCRI-8894 (i)
2


ATCC 43300
CCRI-175 (ii)
2


35290
CCRI-1262 (iii)
2


ATCC 33592
CCRI-178 (iv)
2


R991282
CCRI-2025 (v)
2


SE-41-1
CCRI-9771 (vii)
2





aCCRI stands for “Collection of the Centre de Recherche en Infectiologie”.













TABLE 21







Specificity and ubiquity tests performed on the SMART


CYCLER ® thermocycler using the set of primers targeting


MREP types i, ii, iii, iv, vi and vii (SEQ ID NOs.: 64,


66, 67, 79 and 80) and molecular beacon probe (SEQ ID


NO.: 84) developed in the present invention for the


detection and identification of MRSA









PCR results for MREJ











Strains
Positive (%)
Negative (%)







MRSA - 23 strainsa
  19 (82.6)
 4 (17.4)



MSSA - 25 strains
13 (52)
12 (48)



MRCNS - 26 strains
0
26 (100)



MSCNS - 8 strains
0
 8 (100)











aMRSA strains include the 20 strains listed in Table 3.


Details regarding CNS strains:








MRCNS
S. capitis (2)



S. caprae (1)



S. cohnii (1)



S. epidermidis (9)



S. haemolyticus (5)



S. hominis (2)



S. saprophyticus (1)



S. sciuri (2)



S. simulans (1)



S. warneri (2)


MSCNS
S. cohni cohnii (1)



S. epidermidis (1)



S. haemolyticus (1)



S. lugdunensis (1)



S. saccharolyticus (1)



S. saprophyticus (2)



S. xylosus (1)
















Annex I:


Strategy for the selection of specific amplification


primers for types i and ii MREP











Derived
SEQ 
 



from
ID 
                                      












SEQ ID NO:
NO:
                  Types i and ii MREP                                  
 orfX  


















2324 
2358
 2607 











 2
234
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



 1
235
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



17a
236
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



18a
237
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



19a
238
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



20a
239
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



21a
240
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



22a
241
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



23a
242
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



24a
243
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



25a
244
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGQCC GTTTGATCCG CC


 



26 
245
TAT GTCAAAAATC ATGAACCTCA TTACTTATGA TA...CCT TGTGCAGGCC GTTTGATCCG CC


 



33c
246
                                          CtT gGTGtAaaCC aTTgGAgCCa CC


 



34c
247
                                          CCT caTGCAatCC aTTTGATC


 


Selected sequence



for type i MREP



and ii primer










(SEQ ID No: 66)
248
    GTCAAAAATC ATGAACCTCA TTACTTATG


 


Selected sequence



for orfX primerb



(SEQ ID NO: 64)
249
                                              TGTGCAGGCC GTTTGATCC





The sequence positions refer to SEQ ID NO: 2.


Nucleotides in capitals are identical to the selected sequences or match those sequences.


Mismatches are indicated by lower-case letters. Dots indicate gaps in the displayed sequences.


aThese sequences are the reverse-complements of SEQ ID NOs.: 17-25.


bThis sequence is the reverse-complement of the selected primer.


cSEQ ID NOs.: 33 and 34 were obtained from CNS species.













ANNEX II







Strategy for the selection of a specific molecular


beacon probe for the real-time detection of MREJ










SEQ
orfX


SEQ ID NO:
ID NO:
327                                 371












165
250
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


180
251
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


181
252
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


182
253
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


183
254
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


184
255
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


186
256
ACAAG GACGT CTTACAACGC AGTAACTAtG CACTA


 


174
257
ACAAG GACGT CTTACAACGt AGTAACTACG CACTA


 


175
258
ACAAG GACGT CTTACAACGt AGTAACTACG CACTA


 


178
259
ACAAG GACGT CTTACAACGt AGTAACTACG CACTA


 


176
260
ACAAG GACGT CTTACAACGt AGTAACTACG CACTA


 


173
261
ACAAG GACGT CTTACAACGt AGTAACTACG CACTA


 


177
262
ACAAG GACGT CTTACAACGt AGTAACTACG CACTA


 


169
263
ACAAG GACGT CTTACAACGC AGTAACTACG CACTA


 


199
264
ACAAG GACGT CTTACAACGC AGTAACTACG CACTA


 


 33a,b
265
ACcAa GACGT CTTACAACGC AGcAACTAtG CACTA


 


 34a,b
266
AtgAG GACGT CTTACAACGC AGcAACTACG CACTt


 


Selected




sequence for




orfX molecular




beacon probes




(SEQ ID NO: 163)c
267
      GACGT CTTACAACGC AGTAACTAtG


 


(SEQ ID NO: 164)c
268
      GACGT CTTACAACGt AGTAACTACG


 


(SEQ ID NO: 84)c
269
      GACGT CTTACAACGC AGcAACTACG





Nucleotide discrepancies between the orfX sequences and SEQ ID NO.: 84 are shown in lower-case. Other entries in the sequence listing also present similar variations. The stem of the molecular beacon probes are not shown for sake of clarity. The sequence positions refer to SEQ ID NO.: 165.


aThese sequences are the reverse-complements of SEQ ID NOs.: 33 and 34.


bSEQ ID NOs.: 33 and 34 were obtained from CNS species.


cThe sequences presented are the reverse-complement of the selected molecular beacon probes.

## Claims

1. A method to detect the presence of an MREJ type vii methicillin-resistant Staphylococcus aureus (MRSA) strain comprising:
a.) performing an amplification reaction comprising contacting a sample to be analyzed for the presence of said MREJ type vii MRSA strain with a first amplification primer and a second amplification primer to generate a first amplicon if said MREJ type vii MRSA strain is present in said sample, said MREJ type vii MRSA strain including a staphylococcal cassette chromosome mec (SCCmec) element containing a mecA gene inserted into chromosomal DNA, said chromosomal DNA being orfX, thereby generating a polymorphic right extremity junction (MREJ) type vii sequence that comprises sequences from both the SCCmec element right extremity and orfX adjoining said right extremity;
wherein said first primer is at least 10 nucleotides in length and specifically hybridizes at least under conditions of 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2 at 55° C. with an SCCmec element right extremity of an MREJ nucleic acid type vii sequence selected from the group consisting of: SEQ ID NO: 165, SEQ ID NO: 166, and the complements thereof,
wherein said second primer is at least 10 nucleotides in length and specifically hybridizes at least under conditions of 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2 at 55° C. with orfX,
wherein said first amplicon generated if said MREJ type vii MRSA strain is present in said sample comprises polymorphic right extremity junction (MREJ) type vii sequence and orfX sequence, including the junction of the two, and is indicative of the presence of MREJ type vii MRSA strain in said sample; and

b.) detecting said first amplicon if present.

2. The method of claim 1, wherein said first amplification primer that specifically hybridizes with said SCCmec element right extremity of an MREJ type vii sequence comprises at least 10 consecutive residues of SEQ ID NO:112, or the complement thereof.

3. The method of claim 1, wherein said first amplification primer that specifically hybridizes with said SCCmec element right extremity of an MREJ type vii sequence comprises at least 10 consecutive residues of SEQ ID NO: 113, or the complement thereof.

4. The method of claim 2, wherein said second amplification primer comprises at least ten consecutive residues of SEQ ID NO: 64 or the complement thereof.

5. The method of claim 3, wherein said second amplification primer comprises at least ten consecutive residues of SEQ ID NO: 64 or the complement thereof.

6. The method of claim 1, wherein said amplification reaction comprises PCR.

7. The method of claim 1, wherein said method comprises the use of at least one first or second amplification primer and/or a probe comprising a nucleic acid sequence or complement thereof selected from the group consisting of SEQ ID NOs: 112, 113, 114, 119, 120, 121, 122, 123, 150, 151, 153, 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 32, 83, 84, 160, 161, 162, 163, and 164 for the detection of MREJ type vii.

8. The method of claim 1, wherein said second and first amplification primers are a primer pair consisting of SEQ ID NOs: 64 and 112 or SEQ ID NOs: 64 and 113, or the complements thereof.

9. The method of claim 8, further comprising the use of at least one probe having a sequence selected from the group consisting of SEQ ID NOs: 32, 83, 84, 160, 161, 162, 163, 164, and the complements thereof.

10. The method of claim 1, wherein said method comprises the use of at least one first or second amplification primer and/or a probe comprising a nucleic acid sequence or complement thereof selected from the group consisting of: SEQ ID NOs: 64, 112, 113, 84, 163, and 164, for the detection of MREJ type vii.

11. The method of claim 1, further comprising detecting the presence of at least one further methicillin-resistant Staphylococcus aureus (MRSA) strain in said sample, said at least one further MRSA strain including an SCCmec element containing a mecA gene inserted into chromosomal DNA, thereby generating a polymorphic right extremity junction (MREJ) type i, ii, iii, iv, v, vi, viii or ix nucleic acid sequence that comprises sequences from both the SCCmec element right extremity and chromosomal DNA adjoining said right extremity, wherein said method further comprises contacting said sample with at least one additional primer to generate a second amplicon if said at least one further MREJ type i, ii, iii, iv, v, vi, viii or ix MRSA strain is present in said sample,
wherein said at least one additional primer is at least 10 nucleotides in length and specifically hybridizes at least under conditions of 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2 at 55° C. with said polymorphic sequences from the SCCmec element right extremity of said at least one of MREJ type i, ii, iii, iv, v, vi, viii and ix nucleic acid sequences, or complements thereof, selected from the group consisting of:
a) SEQ ID NOs: 1, 20-25, and 41 for MREJ type i;
b) SEQ ID NOs: 2, 17-19, 26, 40, 173-183, 185, 186 and 197 for MREJ type ii;
c) SEQ ID NOs: 4-16, 104, 184 and 198 for MREJ type iii;
d) SEQ ID NOs: 42-46 and 51 for MREJ type iv;
e) SEQ ID NOs: 47-50 for MREJ type v;
f) SEQ ID NO: 171 for MREJ type vi;
g) SEQ ID NO: 167 for MREJ type viii; and
h) SEQ ID NO: 168 for MREJ type ix,

wherein said second amplicon generated if said at least one further MREJ type i, ii, iii, iv, v, vi, viii or ix MRSA strain is present in said sample comprises polymorphic right extremity junction (MREJ) type i, ii, iii, iv, v, vi, viii or ix sequence and orfX sequence, including the junction of the two, and is indicative of the presence of said at least one further MREJ type i, ii, iii, iv, v, vi, viii or ix MRSA strain in said sample; and
detecting said second amplicon if present.

12. The method of claim 11, wherein said at least one additional primer comprises at least one primer selected from the following SEQ ID NOs or complements thereof: 66, 100, 101, 105, 52, 53, 54, 55, 56, 57, 97, 99, 106, 117, 118, 124, 125, 58, 67, 98, 102, 107, 108, 79, 77, 145, 146, 147, 65, 80, 154, 155, 202, 203, 204, 115, 116, 187, 188, 207, 208, 109, 148, 149, 205, and 206.

13. The method of claim 12, further comprising use of at least one second amplification primer and/or a probe selected from the following SEQ ID NOs or complements thereof: 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 32, 83, 84, 160, 161, 162, 163, and 164.

14. The method of claim 11, further comprising the use of at least one primer pair selected from the following SEQ ID NOs, or the complements thereof:
a) 64/66, 64/100, 64/101, 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56 and 63/57, for the detection of type i MREJ;
b) 64/66, 64/97, 64/99, 64/100, 64/101, 59/52, 59/53, 59/54, 59/55, 59/56, 59/57, 60/52, 60/53, 60/54, 60/55, 60/56, 60/57, 61/52, 61/53, 61/54, 61/55, 61/56, 61/57, 62/52, 62/53, 62/54, 62/55, 62/56, 62/57, 63/52, 63/53, 63/54, 63/55, 63/56 and 63/57, for the detection of type ii MREJ;
c) 64/67, 64/98, 64/102, 59/58, 60/58, 61/58, 62/58 and 63/58, for the detection of type iii MREJ;
d) 64/79, for the detection of type iv MREJ;
e) 64/80, for the detection of type v MREJ;
f) 64/204, for the detection of type vi MREJ;
g) 64/115 and 64/116, for the detection of type viii MREJ; and
h) 64/109, for the detection of type ix MREJ.

15. The method of claim 14, comprising the use of at least one probe having a sequence, or the complement thereof, selected from the group consisting of: SEQ ID NOs: 32, 83, 84, 160, 161, 162, 163 and 164.

16. The method of claim 11, comprising the use of primers and probes having the following nucleotide sequences, or the complements thereof:
a) SEQ ID NOs: 64, 66, and at least one of 84, 163, 164 for the detection of MREJ type i or ii;
b) SEQ ID NOs: 64, 67, and at least one of 84, 163, 164 for the detection of MREJ type iii;
c) SEQ ID NOs: 64, 79, and at least one of 84, 163, 164 for the detection of MREJ type iv; and
d) SEQ ID NOs: 64, 80, and at least one of 84, 163, 164 for the detection of MREJ type v.

17. The method of claim 11, wherein multiple primers and/or probes are used together in the same physical enclosure.

18. The method of claim 11, further comprising distinctively detecting each amplicon if present as an indication of the presence of said MREJ type vii and said at least one further MREJ type selected from MREJ types i, ii, iii, iv, v, vi, viii and ix, wherein the presence or absence of an amplicon produced by a primer is indicative of the presence or absence, respectively, of the corresponding MREJ type MRSA.

19. The method of claim 11, wherein a plurality of primers and/or probes all chosen to hybridize under the same hybridization conditions are used.

20. The method of claim 1, comprising detecting the presence or absence of at least three further MRSA strains in said sample, said at least three further MRSA strain including an SCCmec element containing a mecA gene inserted into chromosomal DNA, thereby generating a polymorphic right extremity junction (MREJ) type i, ii, iii, iv, v, vi, viii or ix nucleic acid sequence that comprises sequences from both the SCCmec element right extremity and chromosomal DNA adjoining said right extremity, wherein said method further comprises contacting said sample with at least three additional primers to generate a second, third or fourth amplicon if said at least three further MREJ type i, ii, iii, iv, v, vi, viii or ix MRSA strains are present in said sample,
wherein said at least three additional primers are at least 10 nucleotides in length and each specifically hybridizes under conditions of 50 mM KCl, 10 mM Tris-HCl (pH 9.0), 0.1% Triton X-100, 2.5 mM MgCl2 at 55° C. with said polymorphic sequences from the SCCmec element right extremity of one of said at least three further MRSA strains of MREJ type i-vi, and viii-ix nucleic acid sequences, or complements thereof, selected from the group consisting of:
a) SEQ ID NOs: 1, 20-25, and 41 for MREJ type i;
b) SEQ ID NOs: 2, 17-19, 26, 40, 173-183, 185, 186 and 197 for MREJ type ii;
c) SEQ ID NOs: 4-16, 104, 184 and 198 for MREJ type iii;
d) SEQ ID NOs: 42-46 and 51 for MREJ type iv;
e) SEQ ID NOs: 47-50 for MREJ type v;
f) SEQ ID NO: 171 for MREJ type vi;
g) SEQ ID NO: 167 for MREJ type viii; and
h) SEQ ID NO: 168 for MREJ type ix

wherein said second, third and fourth amplicon generated if said at least three further MREJ type i, ii, iii, iv, v, vi, viii or ix MRSA strains are present in said sample comprises polymorphic right extremity junction (MREJ) type i, ii, iii, iv, v, vi, viii or ix sequence and orfX sequence, including the junction of the two, and said second, third and fourth amplicons are indicative of the presence of said at least three further MREJ type i, ii, iii, iv, v, vi, viii or ix MRSA strains in said sample; and
detecting the presence or absence of each amplicon distinctively,
wherein the presence or absence of an amplicon produced by a primer is indicative of the presence or absence, respectively, of the corresponding MREJ type MRSA, thereby determining the presence or absence in a sample of at least four MREJ types of MRSA, one of which is MREJ type vii.

21. The method of claim 20, for determining the presence or absence of MREJ type vii, type i, type ii, and type iii.

22. The method of claim 20, for determining the presence or absence of MREJ type vii, type i, type ii, type iii and type iv.

23. The method of claim 20, for determining the presence or absence of MREJ type vii, type i, type ii, type iii, type iv, type v, type vi, type viii and type ix.

24. The method of claim 20, for determining the presence or absence of MREJ type vii, type i, type ii, type iii, type iv and type vi.

25. The method of claim 1, wherein said method comprises the use of at least one second amplification primer and/or a probe specific for the S. aureus chromosome comprising a sequence, or the complement thereof, selected from the group consisting of SEQ ID NOs: 32, 59, 62, 70-76, 83, 84, 103, 130, 132, and 160-164.

26. The method of claim 11, wherein multiplex PCR is used.

27. The method of claim 1, comprising the use of at least one probe having a sequence, or the complement thereof, selected from the group consisting of SEQ ID NOs: 84, 163 and 164.

28. The method of claim 1, wherein said method comprises the use of at least one first amplification primer comprising a nucleic acid sequence or complement thereof selected from the group consisting of SEQ ID NOs: 112, 113, 114, 119, 120, 121, 122, 123, 150, 151, and 153, for the detection of MREJ type vii.

29. The method of claim 28, wherein said method further comprises the use of at least one second amplification primer and/or probe comprising a nucleic acid sequence or complement thereof selected from the group consisting of SEQ ID NOs: 64, 71, 72, 73, 74, 75, 76, 70, 103, 130, 132, 158, 159, 59, 62, 32, 83, 84, 160, 161, 162, 163, and 164.