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154genetic backgrounds throughout the country. This possibility is of great concern in determining effec-tive chemotherapy and in reducing the risk of exposure to antimicrobial resistance microbes; as it can result in the regional spread of MRSA strains with resistance to multiple antimicrobial agents. This, in turn, could increase the ingestion of multiple types of antimicrobials, subsequently leading to more frequent appearance of drug-resistance microbes. Because MICs have been determined for very few strains of MRSA isolated from patients in Indonesia, it is difficult to determine the proper treatment of each infection. Of the IDSA strains isolated, one, IDSA1, which belongs to the ST239 lineage, was subjected to whole genome sequencing. This may be the first report describing the complete genome sequence of an MRSA strain isolated in Indonesia. Compara-tive genome analyses with the S. aureus strain TW20 showed that both this strain and IDSA1 were of the same ST and SCCmec types. They differed in possession of some mobile genetic elements that affected the presence or absence of some drug-resistance and virulence related deter-minants. Mobile genetic elements may be acquired or lost more rapidly than migration of strains with a specific ST to another geographical region. This hypothesis can be tested by acquiring more infor-mation on the regional molecular epidemiology of MRSA strains. Such a study could contribute to the determination of trends of MRSA strains.Patient Consent for Publication StatementClinical isolates taken during routine clinical microbiology laboratory examination and human carriage swabs were provided voluntarily by patients in Surabaya, Indonesia, in 2015, with all patients providing written informed consent.AcknowledgmentThe authors thank all the members of the Department of Bacteriology of Juntendo Medical School for their support. The authors also thank Dr. Hajime Orita of the Department of Gastroenter-ology and Minimally Invasive Surgery of Juntendo University Hospital and Mr. Yukihiro Sugiyama of JUIC at Juntendo University for their personal support of FS. 1) Kourtis AP, Hatfield K, Baggs J, et al: Vital signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections — United States. MMWR Morbidity and Mortality Weekly Report, 2019; 68: 214- 219. doi:10.15585/mmwr.mm6809e1 2) Tsuzuki S, Matsunaga N, Yahara K, et al: National trend of blood-stream infection attributable deaths caused by Staphylococcus aureus and Escherichia coli in Japan. Journal of Infection and Chemotherapy, 2020; 26: 367- 371. doi:10.1016/j.jiac.2019.10.017 3) Larsen MV, Cosentino S, Rasmussen S, et al: Multilocus sequence typing of total-genome-sequenced bacteria. Journal of Clinical Microbiology, 2012; 50: 1355-1361. doi:10.1128/JCM.06094-11 4) Bartels MD, Petersen A, Worning P, et al: Comparing whole-genome sequencing with Sanger sequencing for spa typing of methicillin-resistant Staphylococcus aureus. Journal of Clinical Microbiology, 2014; 52: 4305-4308. doi:10.1128/JCM.01979-14 5) Katayama Y, Ito T, Hiramatsu K: A new class of genetic element, staphylococcus cassette chromosome mec, encodes methicillin resistance in Staphylococcus aureus. Antimicrobial Agents and Chemotherapy, 2000; 44: 1549-1555. doi: 10.1128/AAC.44.6.1549-1555.2000This work was primarily supported by a Grant-in-aid for special research in subsidies for ordinary expenses of private schools from Promotion and Mutual Aid Corporation for Private Schools of Japan. This work was also supported by grants from the Research Program on Emerging and Re- emerging Infectious Diseases from Japan Agency for Medical Research and Development (Grant number 19fk0108061h0302).All authors contributed to the study conception and design. Strain and DNA manipulation and MIC determination: FS and YM; Funding acquisition: TK and KH; Writing, reviewing and editing the manuscript: FS and TB; In silico genome analyses and preparation and drawing figures: TB, YN and RS. Supervision and project administration: TB. All authors read and approved the final manuscript, except for KH who passed away on the 5th of June, 2020. KH had approved the draft version of this manuscript before passing.The authors declare that they have no conflicts of interest.FundingAuthor contributions Conflicts of interest statementReferences