Abstract
This study characterized EMRSA-15 isolates obtained from patients in Kuwait hospitals for their genotypic relatedness, antibiotic resistance and carriage of virulence genes using pulsed-field gel electrophoresis (PFGE), coagulase serotyping, SCCmec subtyping, spa typing, multilocus sequence typing and DNA microarray. The isolates were resistant to trimethoprim (75.6%), ciprofloxacin (29.7%), erythromycin and clindamycin (24.3%), tetracycline (19.0%), and gentamicin and kanamycin (21.6%). All 37 isolates belonged to sequence type (ST) 22, coagulase type XI, three PFGE types and eight subtypes, ten spa types including t223 (51.3%), t852 (13.5%), t032 (8.1%), t790 (8.1%), t3107 (5.4%) and one each of t309, t2251, t3935, t5708 and t5983. Twenty-six isolates (70.2%) carried SCCmec IVa, eight isolates carried SCCmec IV and three isolates carried SCCmec IVh. All isolates carried agr1, cap5 and egc gene cluster (seg, sei, selm, seln, selo, and selu). tst (toxic shock syndrome toxin) was detected in 23 isolates. Eight isolates (21.6%) were positive for Panton-Valentine leukocidin (PVL). Genotypic analysis revealed that 62.1% of the isolates comprising ST22-IVa-t223 (51.3%) and ST22-IVa-t309/t2251/t3935/t5708 (10.8%) were CC22-[tst1+] UK EMRSA-15/Middle Eastern variant, 21.6% were CC22-PVL+ EMRSA-15 variant and 16.2% were CC22-UK EMRSA-15/Barnim clone. These results show that the tst1 positive-ST22-IVa-t223 (Middle Eastern variant) and the CC22-PVL+ EMRSA-15 variant were the dominant EMRSA-15 variants in Kuwait hospitals.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) strains continue to be isolated from both healthcare- and communityassociated infections in different parts of the world
Whereas MRSA isolates obtained in the 1960s were usually susceptible to majority of non-β-lactam antibiotics, those isolated in the late 1970s and beyond were multiply resistant to non-β-lactam antibiotics and were described as epidemic MRSA (EMRSA) because of their capacity to spread extensively and cause serious infections among hospitalized patients [1,2]
We investigated EMRSA-15 isolates obtained in Kuwait public hospitals using a combination of molecular typing methods to establish their genetic relatedness to EMRSA-15 isolated in the United Kingdom and other Gulf Cooperative Council (GCC) countries
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) strains continue to be isolated from both healthcare- and communityassociated infections in different parts of the world. The increase in the number of MRSA infections reported worldwide has been accompanied by changes in the characteristics of MRSA strains emerging in different parts of the world [1]. Epidemiologic typing using a combination of phenotypic and genotypic typing methods has contributed to our understanding of changes in the clonal distribution of MRSA isolated in different geographical locations over time. The EMRSA-15 clone was first characterized in England on the basis of phage typing (a weak lysis pattern with phage 75), susceptibility to antimicrobial agents and failure to produce urease [5]. Multilocus sequence typing of the EMRSA-15 strains classified them as multilocus sequence (ST) type 22 (ST22) [7]
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