All MRSA isolates were genotyped by multiple-locus variable number of tandem repeat analysis (MLVA) by the Dutch National Reference Center (RIVM, Bilthoven, the Netherlands) [30] (link). MLVA is known for its higher discriminatory power for LA-MRSA strains as compared to either multilocus sequence typing (MLST) or pulsed-field gel electrophoresis (PFGE) [30] (link). The MLVA profiles were clustered using a categorical clustering coefficient (unweighted-pair group method using arithmetic averages, UPGMA) and a minimum spanning tree was constructed to display the relationships between the various MLVA complexes (MC) and MRSA sources. For this study, we incorporated phiSa3 into the MLVA scheme. Furthermore, tetM was determined by use of DNA microarray (Identibac S. aureus Genotyping, Alere).
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