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Emergence of novel methicillin-resistant Staphylococcus aureus strains in a tertiary care facility in Riyadh, Saudi Arabia

Authors Senok A, Somily AM, Nassar R, Garaween G, Kim Sing G, Müller E, Reissig A, Gawlik D, Ehricht R, Monecke S

Received 9 June 2019

Accepted for publication 10 August 2019

Published 3 September 2019 Volume 2019:12 Pages 2739—2746

DOI https://doi.org/10.2147/IDR.S218870

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Eric Nulens


Abiola Senok1, Ali M Somily2, Rania Nassar1, Ghada Garaween3, Garwin Kim Sing3, Elke Müller4,5, Annett Reissig4,5, Darius Gawlik6, Ralf Ehricht4,5, Stefan Monecke4,5,7

1Department of Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates; 2Department of Pathology and Laboratory Medicine, College of Medicine, King Khalid University Hospital and King Saud University, Riyadh, Saudi Arabia; 3Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 4InfectoGnostics Research Campus Jena, Jena, Germany; 5Leibniz Institute of Photonic Technology (IPHT), Jena, Germany; 6PTC - Phage Technology Center GmbH, Bönen, Germany; 7Medical Faculty “Carl Gustav Carus”, Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Dresden, Germany

Correspondence: Abiola Senok
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box 505055, Dubai, United Arab Emirates
Tel +971 4 383 8717
Email abiola.senok@mbru.ac.ae

Purpose: There is a need for continuous surveillance of methicillin-resistant Staphylococcus aureus (MRSA) to identify emergence of new strains. We hypothesize that MRSA strains are evolving with ongoing acquisition of SCCmec elements. This study was carried out to evaluate the evolution of MRSA at a tertiary care facility in Saudi Arabia.
Methods: MRSA isolates associated with invasive clinical infection, which were identified in 2017 at the microbiology laboratory, King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia, were studied. The molecular characterization of isolates was carried out using StaphyType DNA microarray (Alere Technologies GmbH/Abbott, Jena, Germany).
Results: The 125 MRSA isolates studied belonged to 18 clonal complexes (CC) which were distributed into 32 strain assignments. The predominant CC were CC5 (n=30), CC6 (n=17), CC80 (n=13), CC22 (n=12), CC361 (n=12). The findings demonstrated the first identification of CC152, CC361 and CC1153 MRSA as well as ST5-MRSA-[I+fus], “Geraldine Clone”, CC6-MRSA-IV (PVL+) and CC88-MRSA-V (PVL+), WA MRSA-117 in Saudi Arabia. Four novel variants were identified: CC5-MRSA-[VI+fus+tirS], CC22-MRSA-[V/VT+fus](PVL+), CC152-MRSA-[V+fus](PVL+) and CC361-MRSA-[VT+fus]. Fifty-four isolates (n/N=54/125; 43.2%) including the novel strains carried the Q6GD50 SCCfusC gene while the Panton-Valentine leukocidin genes were present in 30.4% (n/N=38/125).
Conclusion: The findings demonstrate an expanding MRSA repertoire in our setting including emergence of previously unreported clonal complexes and novel strains. The high carriage of fusC gene suggests a role for fusidic acid misuse in driving the evolution of the MRSA genome and underscores the need for increased monitoring of antibiotic use.

Keywords: DNA microarray, fusidic acid, clonal complex, panton-valentine leukocidin

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