Abstract
BackgroundAs the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is constantly changing globally, determining the prevailing MRSA clones in a local healthcare facility is important for better management of infections. This study investigated clonal composition and distribution of MRSA isolates in Kuwait’s hospitals using a combination of molecular typing methods.Materials and MethodsIn total, 400 non-repeat MRSA isolates were obtained between 1992 and 2010 in 13 public hospitals and were characterized using antibiogram, SCCmec typing, spa typing, and multilocus-sequence typing. Clonal assignment and detection of virulence factors and antibiotic resistance genes were performed by DNA microarray.ResultsThe isolates were resistant to kanamycin (74.2%), erythromycin (69.5%), tetracycline (66.7%), gentamicin (61%), ciprofloxacin, (61%), fusidic acid (53.5%), clindamycin (41.5%), high-level mupirocin resistance (5.2%) and carried aphA3, aacA-aphD, ermA, ermC, mupA, tetK, tetM, fusC and far1. Molecular typing revealed 31 different MRSA clones consisting of ST239-MRSA-III (52.2%), ST22-MRSA-IV (9.2%), ST80-MRSA-IV (7.5%), ST5-MRSA-II/IV/V/VI (6.5%), ST30-MRSA-IV (3.5%), ST241-MRSA-III (2.7%), ST6-MRSA-IV (2.2%), ST36-MRSA-II (2%) and ST772-MRSA-V (1.75%). The isolates differed in the carriage of genes for enterotoxins, Panton–Valentine leukocidin (PVL), toxic shock syndrome toxin (tst-1), arginine catabolic mobile element (ACME) and exfoliative toxins. The number of clones increased from one (ST239-III-t037) in 1992 to 30 in 2010 including ST8-IV-t008 [PVL+] [ACME+] (USA300), ST772-V (Bengal Bay clone) and ST2816 identified for the first time in Kuwait.ConclusionThe study revealed that the MRSA isolates belonged to diverse clones that changed in numbers and diversity overtime. Although ST239-MRSA-III, a healthcare-associated clone remained the dominant MRSA clone overtime, the newly emerged clones consisted mostly of community-associated.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen causing a wide range of infections [1]
The isolates differed in the carriage of genes for enterotoxins, Panton–Valentine leukocidin (PVL), toxic shock syndrome toxin, arginine catabolic mobile element (ACME) and exfoliative toxins
The study revealed that the methicillin-resistant Staphylococcus aureus (MRSA) isolates belonged to diverse clones that changed in numbers and diversity overtime
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen causing a wide range of infections [1]. By using epidemiological typing methods such as multilocus-sequence typing (MLST) and SCCmec typing, it is possible to group MRSA strains into different clones [5, 6] and has contributed to the understanding of MRSA transmission in healthcare facilities. The ST239-III-MRSA is a well-known pathogen that has been associated with healthcare-associated infections It is a pandemic clone which has been widely reported from Asia, Europe, Middle East, South and North America [5]. Using phylogenomic methods to analyze the genome sequence of 193 S. aureus isolates, Holden et al, [14] showed that the current pandemic population of EMRSA-15 descends from a healthcare-associated MRSA epidemic that spread throughout England in the 1980s. As the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is constantly changing globally, determining the prevailing MRSA clones in a local healthcare facility is important for better management of infections. This study investigated clonal composition and distribution of MRSA isolates in Kuwait’s hospitals using a combination of molecular typing methods
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