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      Molecular characterization of methicillin-resistant Staphylococcus aureus isolates in three different Arab world countries

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          Abstract

          Molecular characterization of methicillin-resistant Staphylococcus aureus (MRSA) isolates in three different Arab world countries (West Bank of Palestine, Jordan, and Iraq) was the aim of the study presented here. This is done on the basis of spa sequencing and staphylococcal cassette chromosome mec (SCC mec) typing. The majority (92%) of the spa-tested isolates belonged to spa type t932 and possessed the (SCC mec) type III. These data suggest that MRSA clone, which harbors the spa type t932 and (SCC mec) type III, had been transferred throughout the three studied countries.

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          Most cited references 13

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          The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges.

          To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges. A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections. A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts. Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score. Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; 19,212 dollars vs 26,424 dollars, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of 6916 dollars. Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.
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            spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro- and macrovariation.

            Strain typing of microbial pathogens has two major aims: (i). to index genetic microvariation for use in outbreak investigations and (ii). to index genetic macrovariation for use in phylogenetic and population-based analyses. Until now, there has been no clear indication that one genetic marker can efficiently be used for both purposes. Previously, we had shown that DNA sequence analysis of the protein A gene variable repeat region (spa typing) provides a rapid and accurate method to discriminate Staphylococcus aureus outbreak isolates from those deemed epidemiologically unrelated. Here, using the hypothesis that the genetic macrovariation within a low-level recombinogenic species would accurately be characterized by a single-locus marker, we tested whether spa typing could congruently index the extensive genetic variation detected by a whole-genome DNA microarray in a collection of 36 isolates, which was recovered from 10 countries on four continents over a period of four decades, that is representative of the breadth of diversity within S. aureus. Using spa and coa typing, pulsed-field gel electrophoresis (PFGE), and microarray and multilocus enzyme electrophoresis (MLEE) data in molecular epidemiologic and evolutionary analyses, we determined that S. aureus likely has a primarily clonal population structure and that spa typing can singly index genetic variation with 88% direct concordance with the microarray and can correctly assign isolates to phylogenetic lineages. spa typing performed better than MLEE, PFGE, and coa typing in discriminatory power and in the degree of agreement with the microarray at various phylogenetic depths. This study showed that genetic analysis of the repeat region of protein A comprehensively characterizes both micro- and macrovariation in the primarily clonal population structure of S. aureus.
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              Antibiotic resistance and molecular epidemiology of Staphylococcus aureus in Nigeria

              Background Staphylococcus aureus is an important pathogen causing a wide range of infections in the hospital and community setting. In order to have adequate information for treatment of S. aureus infections, it is crucial to understand the trends in the antibiotic-resistance patterns. In addition, the occurrence and changes in types of S. aureus, clonal identities, and their geographic spread is essential for the establishment of adequate infection control programmes. In this study, 68 S. aureus isolates obtained from clinical and non-clinical sources in Nigeria between January and April 2009 were characterized using phenotypic and molecular methods. Results All the S. aureus isolates were susceptible to teicoplanin, vancomycin, phosphomycin, fusidic acid, rifampicin, daptomycin, mupirocin, linezolid and tigecycline. Sixteen percent of the isolates were resistant to oxacillin, while 55% and 72% of isolates were resistant to tetracycline and trimethoprim/sulphamethoxazole (cotrimoxazole), respectively (Table 1). There was excellent correlation between the broth microdilution assay and detection of antibiotic resistance genes by the multiplex PCR, in the determination of S. aureus resistance to erythromycin, gentamicin, methicillin and tetracycline. A total of 28 spa types were identified in the study, and the predominant spa type among the methicillin-susceptible S. aureus (MSSA) isolates was t084 (13 isolates). The t037-ST241-SCCmecIII type was the only clone identified in Maiduguri (North-East Nigeria) while in South-West Nigeria, diversity among the MRSA isolates (t451-ST8-SCCmecV; t008-ST94-SCCmecIV; t002-ST5-SCCmecV; t064-ST8-SCCmecV) was observed. The toxin genes seh and etd were detected in isolates affiliated with clonal complexes CC1, CC80 and sequence type ST25, respectively. The proportion of PVL-positive isolates among MSSA was high (40%). Most of the PVL-positive MSSA isolates were obtained from wound infections and associated with clonal complexes CC1, CC30, CC121 and with sequence type ST152. Table 1 Antibiotic resistance profile of S. aureu s (MSSA and MRSA) from Nigeria Number (%) of resistant isolates among: Antibiotic MSSA(n = 57) MRSA(n = 11) Total(n = 68) Penicillin 49 (86) 11 (100) 60 (88.2) Oxacillin 0 (0) 11 (100) 11 (16.2) Teicoplanin 0 (0) 0 (0) 0 (0) Vancomycin 0 (0) 0 (0) 0 (0) Gentamicin 1 (1.8) 9 (81.8) 10 (14.7) Tetracycline 27 (47.4) 11 (100) 38 (55.9) Ciprofloxacin 12 (21.1) 8 (72.7) 20 (29.4) Moxifloxacin 0 (0) 7 (63.6) 7 (10.3) Trimethoprim/sulfamethoxazole 39 (68.4) 10 (90.9) 49 (72.1) Phosphomycin 0 (0) 0 (0) 0 (0) Fusidic acid 0 (0) 0 (0) 0 (0) Erythromycin 2 (3.5) 6 (54.5) 8 (11.8) Clindamycin 0 (0) 6 (54.5) 6 (8.8) Rifampicin 0 (0) 0 (0) 0 (0) Daptomycin 0 (0) 0 (0) 0 (0) Mupirocin 0 (0) 0 (0) 0 (0) Linezolid 0 (0) 0 (0) 0 (0) Tigecycline 0 (0) 0 (0) 0 (0) Conclusions The use of phenotypic and molecular methods provided useful information on antibiotic resistance and molecular diversity of S. aureus in Nigeria. The high proportion of PVL-positive MSSA isolates affiliated to various clonal complexes and detected in all the health institutions is a major concern, both as a source of severe infections and as a potential reservoir that could lead to the emergence of PVL-positive MRSA. This study presents the first baseline information on the nature of the antibiotic resistance genes from S. aureus isolates in Nigeria. There is the need to curtail the spread and establishment of MRSA and PVL-positive MSSA clones in Nigerian health care institutions.
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                Author and article information

                Journal
                1886
                122234
                European Journal of Microbiology and Immunology
                EuJMI
                Akadémiai Kiadó, co-published with Springer Science+Business Media B.V., Formerly Kluwer Academic Publishers B.V.
                2062-509X
                2062-8633
                1 September 2013
                : 3
                : 3
                : 183-187
                Affiliations
                [ 1 ] Master Program in Clinical Laboratory Science (MCLS), Birzeit University, Birzeit, Palestine
                [ 2 ] Department of Biology and Biotechnology, An-Najah National University, P.O. Box (7), Nablus, Palestine
                Author notes
                Article
                5
                10.1556/EuJMI.3.2013.3.5
                3832105
                24265936
                Categories
                Original Article

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