Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a serious concern of the global health sector and more recently, an escalating problem in the community. Objectives: This study was performed to investigate the incidence of MRSA in hospital staff and community students in Duhok, Kurdistan, Iraq, and make a molecular comparison between the strains based on the detection of mecA gene and Panton-Valentine Leukocidin (PVL) gene. Methods: We obtained 109 and 103 samples from the nares of hospital staff and community students, respectively. Conventional laboratory tests were performed for the detection of Staphylococcus aureus (S. aureus) and antibiotic sensitivity testing to identify MRSA isolates. Besides, PCR was utilized for molecular analysis. Results: All isolates from hospital staff were identified as S. aureus. Out of the 109 isolates, 55 (50.4%) were MRSA carrying the mecA gene, among which 4/55 (3.7%) were MRSA-PVL positive. Additionally, 54/109 (49.5%) isolates were methicillin-sensitive S. aureus (MSSA) but four isolates (3.7%) were MSSA-PVL positive. Furthermore, 23/103 (22.3%) samples from community students were identified as S. aureus, among which 5/23 (21.7%) and 17/23 (73.9%) isolates were MSSA-PVL positive and MSSA-PVL negative, respectively. Moreover, 1/23 (4.3%) was found as MRSA and was PVL gene-positive. Conclusions: The results showed that MRSA is swarming in hospitals and community in Duhok, Iraq. The highest rate of PVL was associated with community-acquired-MSSA (CA-MRSA). With further genotypic study, immediate action is needed to control and reduce the spread of MRSA clones, determine their clonal relations, and conduct epidemiological investigations.

Background: Staphylococcus aureus is a common commensal bacterium of the human body and a potential pathogen, causing public health hazards. Due to various virulent factors and growing antibiotic resistance, bacteria could cause various infections, ranging from minor skin infections to life-threating sepsis. Objectives: The present study aimed to evaluate the prevalence rate of S. aureus and determine its antimicrobial sensitivity profile in the secondary school students in Duhok City, Iraq. Methods: Samples were collected from the anterior nares of 492 volunteers aged more than 16 years in different cities, including Akre, Amedye, Bardarash, and Duhok. Conventional laboratory tests were performed for the identification of the bacterial isolates. In addition, the antimicrobial sensitivity test was carried out in accordance with the Clinical and Laboratory Standards Institute (CLSI). Results: Out of 492 subjects, 185 cases (37.6%) were carriers of S. aureus, including 57/185 (30.8%) males. The oxacillin resistance rate was estimated at 41.08%, while the resistance rate against tetracycline, fusidic acid, ciprofloxacin, gentamicin, vancomycin, clindamycin and rifampicin was 27.02%, 19.46%, 9.19%, 8.65%, 7.56%, 3.78%, and 1.08%, respectively. All the isolates were susceptible to teicoplanin. Conclusions: According to the results, the prevalence rate of S. aureus was high, and the species were more common in females. Therefore, further investigations are required to monitor the S. aureus antimicrobial profile and implement proper plans to manage the associated issues.

A B S T R A C TObjectives: The aim was to investigate methicillin-resistant Staphylococcus aureus (MRSA) carriage rates and to characterize the staphylococcal cassette chromosome mec (SCCmec) among Syrian refugees and the host community in Duhok, Iraq. Methods: A total of 492 host community and 355 Syrian refugee subjects were recruited. Participant bioinformation was collected using a study questionnaire. MRSA carriage was identified as recommended in the Clinical and Laboratory Standards Institute guidelines. PCR was performed for typing the mecA gene and SCCmec groups. Results: In the host community, 76/492 (15.4%) carried MRSA, whereas 49/355 (13.8%) Syrian refugees carried MRSA (p = 0.505). Refugees were classified according to their arrival date; 36/278 (13%) existing refugees and 13/77 (16.9%) new refugee arrivals were identified as MRSA carriers (p = 0.375). Regarding the risk factors influencing MRSA spread, no association was found between MRSA prevalence and risk factors. The most common types of SCCmec in both communities were types IVa and V: 67.1% and 5.26%, and 49% and 2.04%, respectively. Conclusions: It is inferred that the effect of MRSA in refugees on the host community will be negligible. However, the refugee carriage rate is higher than that found in Western countries, the final destination of refugees. Therefore, screening for MRSA is mandated and the rapid detection of carriers would prevent its spread.

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious public health problem. There is limited information regarding the genetics of MRSA strains among the native Iraqi and incoming Syrian refugee communities. We aimed to characterize the genotypes and different virulence factors of MRSA in strains isolated from these two communities. Frozen MRSA strains (125) isolated from the native Iraqi and Syrian refugee communities were used in this study. PCR (singleplex and multiplex) and agr typing was used for the genotypic analysis of different virulence genes. We tested for the presence of virulence genes including pvl, arcA, tst, lukE/lukD, hla, hlb, eta, etb and agr. Prevalence of arcA MRSA in the Iraqi community (56.58%) was significantly higher (p = 0.008) than that in the Syrian refugee community (32.66%). Prevalence of lukE-lukD was also significantly higher (p = 0.001) in the Iraqi (82.89%) compared to that in the Syrian refugee community (57.14%). Further, prevalence of hla MRSA in the Iraqi community was (93.4%) and in the Syrian refugee community was (71.4%); (p = 0.0008). No significant differences were observed in the prevalence of pvl, tst, eta, etb and hlb. The most dominant agr types in both Iraqi (76.1% and 10.5%) and Syrian refugee (44.9% and 18.37%) communities were I and III. To sum up, no significant differences were observed between the groups for a majority of virulence factors. This is the first investigation of MRSA genotypes and virulence in both these communities. These results could be useful for further studies that assess the genetic relatedness of strains in the region for epidemiological and monitoring purposes, which would be crucial to limiting the spread of MRSA.