Abstract
Background:Community acquired methicillin resistant staphylococcus aureus (CA-MRSA) is emerging in hospitals, worldwide. Method: In Suez Canal University Hospitals(SCUH), we documented causing hospital acquired- (HA-) sepsis, by polymerase chain reaction (PCR) amplification of major virulence determinant genes, namely: Panton-Valentine leukocidin pvl, accessory regulator I and III, and staphylococcal cassette chromosome mec genes IV and V. Antibiograms were determined by disk diffusion and minimum inhibitory concentration (MIC). Results: Methicillin resistant staphylococcus aureus was detected in 90 hospital acquired infections (HAIs), including bacteremia, pneumonia, osteomyelitis, soft tissue infections, and meningitis. Pvl gene, characterizing CA-MRSA, was detected in 24/90 MRSA strains (26.7%). Pvl+ve strains were subtyped into SCCmec gene type II (8.3%), type IV (75%), type V (8.3%), and 8.3% were non-typeable. They showed only agr group I (62.5%), and III (37.5%). Co-trimoxazole resistance was detected in 41.6% of CA-MRSA. Only 12.5% of strains were susceptible to all non-beta-lactam drugs. There was no statistical correlation between SCCmec or agr groups, and co-trimoxazole resistance in CA-MRSA; nor between SCCmec types and agr groups. Conclusion: Community aquired-MRSA is emerging in all wards of SCU hospitals, causing HAI, mostly soft tissue infections. The classical antibiogram of is no longer prevailing. Diagnosis of should rely upon detection of pvl gene, rather that clinical and antibiogram-profiles. The name CA-MRSA is no longer satisfactory to describe such strains in hospital settings; instead, Pvl +ve MRSA is more accurate and reliable term to use.
Highlights
The emergence of CA-MRSA has changed the clinical and molecular epidemiology of S. aureus infections during the past twenty years [1]
A third type of human MRSA infection is known as livestock-associated MRSA (LA-MRSA), first isolated in 2003, and was found to be transmitted from a reservoir of clonal complex (CC) 398 lineage isolated from pigs and cattle
Pvl gene characterizing CA-MRSA- was detected in 24/90 MRSA strains (26.7%) (Figure 2); of which 13 strains (54%) were isolated from skin and soft tissue infections (Table 1)
Summary
The emergence of CA-MRSA has changed the clinical and molecular epidemiology of S. aureus infections during the past twenty years [1]. Community acquired methicillin resistant staphylococcus aureus (CAMRSA) is emerging in hospitals, worldwide. Results: Methicillin resistant staphylococcus aureus was detected in 90 hospital acquired infections (HAIs), including bacteremia, pneumonia, osteomyelitis, soft tissue infections, and meningitis. Pvl gene, characterizing CA-MRSA, was detected in 24/90 MRSA strains (26.7%). Pvl+ve strains were subtyped into SCCmec gene type II (8.3%), type IV (75%), type V (8.3%), and 8.3% were non-typeable. They showed only agr group I (62.5%), and III (37.5%). Conclusion: Community aquired-MRSA is emerging in all wards of SCU hospitals, causing HAI, mostly soft tissue infections. Diagnosis of CA-MRSA should rely upon detection of pvl gene, rather that clinical and antibiogram-profiles. The name "CAMRSA" is no longer satisfactory to describe such strains in hospital settings; instead, Pvl +ve MRSA is more accurate and reliable term to use
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