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Firoozeh F, Omidi M, Saffari M, Sedaghat H, Zibaei M. Molecular analysis of methicillin-resistant Staphylococcus aureus isolates from four teaching hospitals in Iran: the emergence of novel MRSA clones. Antimicrob Resist Infect Control 2020; 9:112. [PMID: 32680563 PMCID: PMC7367364 DOI: 10.1186/s13756-020-00777-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background The global spread of methicillin-resistant Staphylococcus aureus (MRSA) infections necessitates the use of validated methods for the identification and typing of this bacterium. This study aimed to determine the distribution of main molecular types of MRSA strain circulating among hospitalized patients in teaching hospitals in Isfahan and Kashan. Methods A total of 146 Staphylococcus aureus strains were isolated from patients in four teaching hospitals in Isfahan and Kashan during June 2017 to September 2018. The antimicrobial resistance patterns of Staphylococcus aureus strains were performed by disc diffusion method. The MRSA strains were identified phenotypically and confirmed by PCR assay. The prevalence of microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) genes among MRSA strains was evaluated by multiplex PCR. The genotypes of MRSA strains were determined by multilocus sequence typing and SCCmec typing. Results Of 146 Staphylococcus aureus isolates, 24 (16.4%) isolates were identified as MRSA strains. According to antimicrobial susceptibility testing the highest resistance rates were seen for tetracycline, erythromycin, ciprofloxacin and gentamicin. All of Staphylococcus aureus isolates were susceptible to vancomycin whereas 3 (2.1%) isolates were resistant to linezolid. Three different SCCmec types were obtained among MRSA strains including 16 (66.7%) SCCmec type V, 3 (12.5%) SCCmec type III and 5 (20.8%) SCCmec type II. Of 24 MRSA isolates 20 (83.3%) carried MSCRAMMs genes including eno (70.8%), fib (54.1%), cna (25.0%), fnbB (16.6%), ebps 5 (20.8%), and the fnbA, bbp and clfA genes were not detected in any MRSA isolate. MLST analysis revealed 11 sequence types among MRSA isolates as follows: ST239, ST291, ST22, ST861, ST889, ST8, ST59, ST343, ST772, ST6 and ST1465. Also seven MLST-based clonal complexes (CCs) were identified among MRSA strains including: CC8, CC7, CC398, CC59, CC22, CC1 and CC5. Conclusions A relatively high diversity was found in MRSA genotypes in Kashan and Isfahan hospitals, and seven clonal complexes were identified. Pandemic MRSA clones including CC8 and CC22 were the most prevalent clones and the novel ST types including ST1465, ST861, ST 889 and ST772 are reported for the first time in Iran in the present study. In addition the high prevalence of MSCRAMMs genes in MRSA isolates demonstrates the high potential of these strains for pathogenicity.
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Affiliation(s)
- Farzaneh Firoozeh
- Department of Microbiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran. .,Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran. .,Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Mitra Omidi
- Department of Microbiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
| | - Mahmood Saffari
- Department of Microbiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Sedaghat
- Department of Microbiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Zibaei
- Evidence-based Phytotherapy & Complementary Medicine Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Madzgalla S, Syed MA, Khan MA, Rehman SS, Müller E, Reissig A, Ehricht R, Monecke S. Molecular characterization of Staphylococcus aureus isolates causing skin and soft tissue infections in patients from Malakand, Pakistan. Eur J Clin Microbiol Infect Dis 2016; 35:1541-7. [PMID: 27262852 DOI: 10.1007/s10096-016-2695-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/24/2016] [Indexed: 11/24/2022]
Abstract
Comparatively few studies have been published describing Staphylococcus aureus/MRSA epidemiology in Central Asia including Pakistan. Here, we report the genotyping of Staphylococcus aureus strains (that include both methicillin-susceptible and methicillin-resistant Staphylococcus aureus) from community- and hospital-acquired skin and soft-tissue infections in a tertiary care hospital in the Malakand district of the Khyber Pakhtunkhwa Province of Pakistan. Forty-five isolates of Staphylococcus aureus were characterized by microarray hybridization. Twenty isolates (44 %) were MRSA, whereas 22 (49 %) were PVL-positive. Fourteen isolates (31 %) harboured both mecA and PVL genes. The dominant clones were CC121-MSSA (n = 15, 33 %) and the PVL-positive "Bengal Bay Clone" (ST772-MRSA-V; n = 13, 29 %). The PVL-positive CC8-MRSA-IV strain "USA300" was found once. The pandemic ST239-MRSA-III strain was absent, although it has previously been observed in Pakistan. These observations require a re-assessment of schemes for initial antibiotic therapy to cover MRSA and they emphasise the need for a rapid and non-molecular test for PVL.
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Affiliation(s)
- S Madzgalla
- Alere Technologies GmbH, Jena, Germany.,InfectoGnostics Research Campus, Jena, Germany
| | - M A Syed
- Infectious Diseases Research Group, Department of Microbiology, University of Haripur, Haripur, Pakistan
| | - M A Khan
- Infectious Diseases Research Group, Department of Microbiology, University of Haripur, Haripur, Pakistan
| | - S S Rehman
- Infectious Diseases Research Group, Department of Microbiology, University of Haripur, Haripur, Pakistan
| | - E Müller
- Alere Technologies GmbH, Jena, Germany.,InfectoGnostics Research Campus, Jena, Germany
| | - A Reissig
- Alere Technologies GmbH, Jena, Germany.,InfectoGnostics Research Campus, Jena, Germany
| | - R Ehricht
- Alere Technologies GmbH, Jena, Germany.,InfectoGnostics Research Campus, Jena, Germany
| | - S Monecke
- Alere Technologies GmbH, Jena, Germany. .,Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Dresden, Germany. .,InfectoGnostics Research Campus, Jena, Germany.
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Recombinations in staphylococcal cassette chromosome mec elements compromise the molecular detection of methicillin resistance in Staphylococcus aureus. PLoS One 2014; 9:e101419. [PMID: 24972080 PMCID: PMC4074205 DOI: 10.1371/journal.pone.0101419] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 06/06/2014] [Indexed: 01/31/2023] Open
Abstract
Clinical laboratories are increasingly using molecular tests for methicillin-resistant Staphylococcus aureus (MRSA) screening. However, primers have to be targeted to a variable chromosomal region, the staphylococcal cassette chromosome mec (SCCmec). We initially screened 726 MRSA isolates from a single UK hospital trust by recombinase polymerase amplification (RPA), a novel, isothermal alternative to PCR. Undetected isolates were further characterised using multilocus sequence, spa typing and whole genome sequencing. 96% of our tested phenotypically MRSA isolates contained one of the six orfX-SCCmec junctions our RPA test and commercially available molecular tests target. However 30 isolates could not be detected. Sequencing of 24 of these isolates demonstrated recombinations within the SCCmec element with novel insertions that interfered with the RPA, preventing identification as MRSA. This result suggests that clinical laboratories cannot rely solely upon molecular assays to reliably detect all methicillin-resistance. The presence of significant recombinations in the SCCmec element, where the majority of assays target their primers, suggests that there will continue to be isolates that escape identification. We caution that dependence on amplification-based molecular assays will continue to result in failure to diagnose a small proportion (∼4%) of MRSA isolates, unless the true level of SCCmec natural diversity is determined by whole genome sequencing of a large collection of MRSA isolates.
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Sun DD, Ma XX, Hu J, Tian Y, Pang L, Shang H, Cui LZ. Epidemiological and molecular characterization of community and hospital acquired Staphylococcus aureus strains prevailing in Shenyang, Northeastern China. Braz J Infect Dis 2013; 17:682-90. [PMID: 23916451 PMCID: PMC9427354 DOI: 10.1016/j.bjid.2013.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 11/17/2022] Open
Abstract
In order to obtain adequate information for the treatment of methicillin resistant Staphylococcus aureus (MRSA) infections, it is crucial to identify trends in epidemiological and antimicrobial resistance patterns of local S. aureus strains. Community and hospital acquired S. aureus isolates (n = 202) were characterized using staphylococcal cassette chromosome mec (SCCmec) typing, pulse field gel electrophoresis (PFGE) analysis, spa typing and minimal inhibitory concentration (MIC) determination. The prevalence of the Panton-Valentine leukocidine (pvl) and several antibiotic resistance genes among the isolates were also detected by PCR. All of the S. aureus isolates were susceptible to vancomycin, daptomycin and linezolid. Three hospital isolates were resistant to teicoplanin while 14 showed intermediate resistance to teicoplanin. The resistance patterns of community-acquired MRSA (CA-MRSA) isolates to other antimicrobials were similar to those of hospital-acquired MRSA (HA-MRSA) isolates except for clindamycin and gentamicin. There was excellent correlation between phenotypes and genotypes in the determination of S. aureus resistance to erythromycin, gentamicin, and tetracycline. The SCCmec type II and SCCmec type IV were the predominant types detected in hospital and community isolates, respectively. The most frequently encountered spa types were t002 and t030 both in HA- and CA-MRSA isolates. Pulsotype A was the most predominant pulsotype identified among the isolates tested, followed by pulsotype B. Seventy-two hospital isolates (19 HA-MRSA and 53 HA-MSSA) and 10 CA-MRSA were positive for the pvl gene. This study shows that the combination of susceptibility testing and various molecular methods has provided useful information on the antibiotic resistance and molecular diversity of S. aureus in a specific region of China. The high proportion of pvl positive MSSA and MRSA isolates observed in this study indicates that adequate measures are needed to curtail the spread of those MRSA and MSSA clones prevailing both in hospital and the community.
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Affiliation(s)
- Dan Dan Sun
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
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Genome analysis of Staphylococcus aureus ST291, a double locus variant of ST398, reveals a distinct genetic lineage. PLoS One 2013; 8:e63008. [PMID: 23704886 PMCID: PMC3660392 DOI: 10.1371/journal.pone.0063008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/27/2013] [Indexed: 12/04/2022] Open
Abstract
Staphylococcus aureus ST291 has been reported as a homologue recombinant double locus variant of the livestock associated S. aureus ST398. However, whole genome sequencing show that ST291 is a unique genetic lineage with highly variable content within its accessory genome compared to both human and livestock associated genome sequenced CC398s.
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Abstract
BACKGROUND Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is increasing in incidence and manifests as skin and soft tissue infections including furuncles. The majority of studies have focused on the epidemiology of single furuncles and not recurrent disease. There is a lack of data concerning the incidence of furunculosis outside the U.S.A. OBJECTIVES This report reviews the literature of recurrent furunculosis and the impact of CA-MRSA on the disease. METHODS Article citations were searched within PubMed. Search terms used were 'furunculosis', 'recurrent furunculosis', 'skin abscess' and 'recurrent boils'. Articles were discarded if they did not refer to furunculosis secondary to S. aureus. RESULTS A total of 1515 articles were initially retrieved with the term 'furunculosis', 77 with the term 'recurrent furunculosis', 2778 with the term 'skin abscess', and 1526 with the term 'recurrent boils'. After excluding articles not referring to S. aureus furunculosis, 86 articles were included for this review. CONCLUSIONS Furunculosis is increasing within the U.S.A. secondary to the CA-MRSA epidemic and the resistant organism's close association with the Panton-Valentine leucocidin (PVL) virulence factor. PVL is associated with follicular infections in general, having its strongest association with furunculosis and its recurrence. The majority of furuncles in the U.S.A. are caused by CA-MRSA, while elsewhere in the world they are caused by methicillin-sensitive S. aureus. Nasal carriage of S. aureus is the primary risk factor for recurrent furunculosis and occurs in 60% of individuals.
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Affiliation(s)
- M Demos
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Gamblin J, Jefferies JM, Harris S, Ahmad N, Marsh P, Faust SN, Fraser S, Moore M, Roderick P, Blair I, Clarke SC. Nasal self-swabbing for estimating the prevalence of Staphylococcus aureus in the community. J Med Microbiol 2012; 62:437-440. [PMID: 23222858 DOI: 10.1099/jmm.0.051854-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Staphylococcus aureus remains a significant cause of morbidity and mortality and, therefore, a burden on healthcare systems. Our aim was to estimate the current rate of nasal S. aureus carriage in the general population and to determine the feasibility of nasal self-swabbing as a means of detection. Two thousand people (1200 adults and 800 children) from a single NHS general practice in Southampton, UK, were randomly selected from a general practice age sex register, stratified by age and sex, and invited to undertake nasal self-swabbing in their own home. Overall, 362 (32.5%) swabs from adults and 168 (22%) from children were returned. Responses were greater for adults and those of increased age, female gender and decreasing socio-economic deprivation. The overall estimated practice carriage rate of S. aureus directly standardized for age sex was 28% [95% confidence interval (CI) 26.1-30.2%]. Carriage of meticillin-susceptible S. aureus was 27% (95% CI 26.1-30.2%), whilst that of meticillin-resistant S. aureus was 1.9% (95% CI 0.7-3.1%). Although nasal self-swabbing rates were relatively low, they are comparable to other studies and may allow large population-based carriage studies to be undertaken at relatively low cost. Importantly, this study updates prevalence data for S. aureus carriage in the community.
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Affiliation(s)
- Jenny Gamblin
- Health Protection Agency, Hampshire and Isle of Wight Health Protection Unit, Unit 8, Fulcrum 2, Solent Way, Whiteley, Hampshire PO15 7FN, UK
| | - Johanna M Jefferies
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton Foundation NHS Trust, South Academic Block, Southampton SO16 6YD, UK
| | - Scott Harris
- Academic Unit of Primary and Population Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton Foundation NHS Trust, South Academic Block, Southampton SO16 6YD, UK
| | - Nusreen Ahmad
- HPA Public Health Laboratory, Southampton Laboratory Level B, South Pathology Block, University Hospital Southampton Foundation NHS Trust, Southampton SO16 6YD, UK
| | - Peter Marsh
- HPA Public Health Laboratory, Southampton Laboratory Level B, South Pathology Block, University Hospital Southampton Foundation NHS Trust, Southampton SO16 6YD, UK
| | - Saul N Faust
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton SO16 6YD, UK.,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton Foundation NHS Trust, Southampton SO16 6YD, UK.,Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton Foundation NHS Trust, South Academic Block, Southampton SO16 6YD, UK
| | - Simon Fraser
- Grove Medical Practice, Shirley Health Centre, Grove Road, Southampton SO15 3UA, UK
| | - Michael Moore
- Academic Unit of Primary and Population Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton Foundation NHS Trust, South Academic Block, Southampton SO16 6YD, UK
| | - Paul Roderick
- Academic Unit of Primary and Population Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton Foundation NHS Trust, South Academic Block, Southampton SO16 6YD, UK
| | - Iain Blair
- Institute of Public Health, College of Medicine & Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates
| | - Stuart C Clarke
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton SO16 6YD, UK.,HPA Public Health Laboratory, Southampton Laboratory Level B, South Pathology Block, University Hospital Southampton Foundation NHS Trust, Southampton SO16 6YD, UK.,Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton Foundation NHS Trust, South Academic Block, Southampton SO16 6YD, UK
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Nimmo G. USA300 abroad: global spread of a virulent strain of community-associated methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2012; 18:725-34. [DOI: 10.1111/j.1469-0691.2012.03822.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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High genetic diversity among community-associated Staphylococcus aureus in Europe: results from a multicenter study. PLoS One 2012; 7:e34768. [PMID: 22558099 PMCID: PMC3338755 DOI: 10.1371/journal.pone.0034768] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/05/2012] [Indexed: 01/22/2023] Open
Abstract
Background Several studies have addressed the epidemiology of community-associated
Staphylococcus aureus (CA-SA) in Europe; nonetheless, a
comprehensive perspective remains unclear. In this study, we aimed to
describe the population structure of CA-SA and to shed light on the origin
of methicillin-resistant S. aureus (MRSA) in this
continent. Methods and Findings A total of 568 colonization and infection isolates, comprising both MRSA and
methicillin-susceptible S. aureus (MSSA), were recovered in
16 European countries, from community and community-onset infections. The
genetic background of isolates was characterized by molecular typing
techniques (spa typing, pulsed-field gel electrophoresis
and multilocus sequence typing) and the presence of PVL and ACME was tested
by PCR. MRSA were further characterized by SCCmec typing.
We found that 59% of all isolates were associated with
community-associated clones. Most MRSA were related with USA300 (ST8-IVa and
variants) (40%), followed by the European clone (ST80-IVc and
derivatives) (28%) and the Taiwan clone (ST59-IVa and related clonal
types) (15%). A total of 83% of MRSA carried Panton-Valentine
leukocidin (PVL) and 14% carried the arginine catabolic mobile
element (ACME). Surprisingly, we found a high genetic diversity among MRSA
clonal types (ST-SCCmec), Simpson’s index of
diversity = 0.852 (0.788–0.916). Specifically,
about half of the isolates carried novel associations between genetic
background and SCCmec. Analysis by BURP showed that some
CA-MSSA and CA-MRSA isolates were highly related, suggesting a probable
local acquisition/loss of SCCmec. Conclusions Our results imply that CA-MRSA origin, epidemiology and population structure
in Europe is very dissimilar from that of USA.
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Abstract
BACKGROUND In industrialized countries, Staphylococcus aureus (SA) is a leading cause of late-onset neonatal sepsis. METHODS Culture-proven episodes were identified prospectively from neonatal units participating in the neonatal infection surveillance network. Demographic, risk factor, and outcome data were collected. RESULTS Between 2004 and 2009, there were 117 episodes of SA infections (including 8 methicillin-resistant SA) in 116 infants from 13 units. The median gestational age and birth-weight were 27 weeks (90% ≤ 37 weeks, 85% ≤ 32 weeks) and 850 g (90% ≤ 2500 g), respectively. The overall incidence was 0.6 per 1000 live births and 23/1000 in infants <1500 g. Most episodes (94%) occurred more than 48 hours after birth (late onset). There were 7 early-onset episodes (< 48 hours) (median gestational age, 38.5 weeks), all due to methicillin-susceptible SA. At the time of culture, 67 of 95 (71%) infants were receiving respiratory support and 47 of 94 (50%) had a central line in situ. The majority of infants had nonspecific clinical features although evidence of focal infection (skin, soft tissue, bone, joint, or pneumonia) was ultimately seen in 41 of 91 (45%). There were 18 deaths, 4 (all late onset) directly due to methicillin-susceptible SA sepsis (4.4%). CONCLUSIONS SA is the second most common pathogen causing late-onset neonatal infections in this neonatal network. Infants who weigh < 1500 g in intensive care settings are the most vulnerable group. Clinical signs are not sufficiently distinctive to allow targeted therapy, suggesting that an antistaphylococcal agent should be part of empiric therapy for late-onset sepsis in premature infants.
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