Table 1 S. aureus isolates with and without different types of rearrangement in the spa -gene in community and inpatient samples: formerly non-typeable isolates Group Community1 Hospital2   Isolates Individuals Isolates Individuals   no. % no. % no. % no. % Total 3,905 100% 442 100% 2,205 100% 1,273 100% Pure without deletions/insertions or with hidden deletions3 3647 93.4% 334 75.6% 2055 93.2% 1150 90.3% Mixed with or without deletions and/or rearrangements4 258 6.6% 108 24.4% 150 6.8% 123 9.7% Formerly non-typeable:

i.e. pure with rearrangements affecting standard spa-typing 72 1.8% (from total) 8 1.8% (from total) 14 0.6% (from total) Bioactive Compound Library research buy 9 0.7% (from total)     27.9% (from 12 picks)   7.4% (from12 picks)   9.3% (from 12 picks) SN-38   7.3% (from 12 picks) 1 – nasal swabs collected from individuals recruited in 5 GP practices in Oxfordshire. 2 – nasal swabs from individuals admitted to the adult ITU, Gerontology and Trauma wards of the Oxford University Hospitals NHS Trust. 3 – indicates where all samples from an individual were pure using our spa-typing protocol (i.e.

were without deletions/insertions or only with hidden deletions) versus any sample did not fall into this category. 4 –subjected to 12 single colony picks, i.e. 12 sub-colonies analysed from each sample. The proportion of S. aureus strains with ‘hidden’ deletions in the IgG-binging region of the spa-gene that do not affect spa-typing was estimated using spaT3-F/1517R primers on a random subset of previously typed samples. These hidden spa-gene deletions were

found in 11% (6-19%) of S. aureus strains from 11% (6-19%) of individuals (Table 2). Table 2 S. aureus isolates with and without different types of rearrangement in the spa -gene in community and inpatient samples: isolates with hidden deletions Group Isolates Individuals   no. % no. % Total strains without deletions/insertions or with only hidden deletions investigated 99 100% 97 100% Hidden deletions found 11 11% 11 11% Note: Hidden deletions Methamphetamine were found in 16% (5/32) of S. aureus strains from 16% (5/31) individuals in the community and in 9% (6/67) strains from 9% (6/66) hospital in patients with bacteraemia (p = 0.33); pooled data are therefore presented. Thus up to 13% of S. aureus carriers could, at some point, be colonized with a strain that has deletions/insertions in the IgG-binding region of the spa-gene, 2% carrying Rigosertib nmr completely ‘non-typeable’ strains. Spa-gene rearrangements lead mixed S. aureus colonization in humans to be underestimated The staged spa-typing protocol allowed us to detect the simultaneous presence of two or more strains in 11% of S. aureus carriers. However, the presence of deletions that affect spa-typing in one or more strains within the mixture complicates the typing process and leads to underestimation of the prevalence of multiple colonization and number of strains involved.