Community-associated methicillin-resistant Staphylococcus aureus clonal complex 80 type IV (CC80-MRSA-IV) isolated from the Middle East: a heterogeneous expanding clonal lineage.

The emergence of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has caused a change in MRSA epidemiology worldwide. In the Middle East, the persistent spread of CA-MRSA isolates that were associated with multilocus sequence type (MLST) clonal complex 80 and with staphylococcal cassette chromosome mec (SCCmec) type IV (CC80-MRSA-IV), calls for novel approaches for infection control that would limit its spread.In this study, the epidemiology of CC80-MRSA-IV was investigated in Jordan and Lebanon retrospectively covering the period from 2000 to 2011. Ninety-four S. aureus isolates, 63 (67%) collected from Lebanon and 31 (33%) collected from Jordan were included in this study. More than half of the isolates (56%) were associated with skin and soft tissue infections (SSTIs), and 73 (78%) were Panton-Valentine Leukocidin (PVL) positive. Majority of the isolates (84%) carried the gene for exofoliative toxin d (etd), 19% had the Toxic Shock Syndrome Toxin-1 gene (tst), and seven isolates from Jordan had a rare combination being positive for both tst and PVL genes. spa typing showed the prevalence of type t044 (85%) and pulsed-field gel electrophoresis (PFGE) recognized 21 different patterns. Antimicrobial susceptibility testing showed the prevalence (36%) of a unique resistant profile, which included resistance to streptomycin, kanamycin, and fusidic acid (SKF profile).The genetic diversity among the CC80 isolates observed in this study poses an additional challenge to infection control of CA-MRSA epidemics. CA-MRSA related to ST80 in the Middle East was distinguished in this study from the ones described in other countries. Genetic diversity observed, which may be due to mutations and differences in the antibiotic regimens between countries may have led to the development of heterogeneous strains. Hence, it is difficult to maintain "the European CA-MRSA clone" as a uniform clone and it is better to designate as CC80-MRSA-IV isolates

Percentage distribution of resistance patterns.

1<p>STR: streptomycin; KAN: kanamycin; TET: tetracycline; GEN: gentamicin; FUS: fusidic acid; ERY: erythromycin; DA: clindamycin.</p

Demographics and molecular characteristics of isolates collected from Lebanon.

1<p>W: weeks; M: months.</p>2<p>ND: non-determinant.</p>3<p><i>eta</i>: exofoliative toxin a gene; <i>etd</i>: exofoliative toxin d gene; PVL: Panton-Valentine Leukocidin gene.</p>4<p>STR: streptomycin; KAN: kanamycin; TET: tetracycline; GEN: gentamicin; FUS: fusidic acid; ERY: erythromycin; DA: clindamycin.</p

Demographics and molecular characteristics of isolates collected from Jordan.

1<p>D: days; W: weeks; M: months.</p>2<p>ND: non-determinant.</p>3<p><i>etd</i>: exofoliative toxin d gene; <i>tst</i>: toxic shock syndrome toxin 1 gene; PVL: Panton-Valentine Leukocidin gene.</p>4<p>STR: streptomycin; KAN: kanamycin; TET: tetracycline; FUS: fusidic acid; ERY: erythromycin; DA: clindamycin.</p