Antimicrobial resistance profiling and molecular typing of methicillin-resistant Staphylococcus aureus isolated from a Malaysian teaching hospital

Abstract

The annual prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Malaysia has been estimated to be 30 % to 40 % of all S. aureus infections. Nevertheless, data on the antimicrobial resistance and genetic diversity of Malaysian MRSAs remain few. In 2009, we collected 318 MRSA strains from various wards of our teaching hospital located in Kuala Lumpur, the capital city of Malaysia, and performed antimicrobial susceptibility testing on these strains. The strains were then molecularly characterized via staphylococcal cassette chromosome (SCC) mec and virulence gene (cna, sea, seb, sec, sed, see, seg, seh, sei, eta, etb, Panton-Valentine leukocidin and toxic shock syndrome toxin-1) typing; a subset of 49 strains isolated from the intensive care unit was also typed using PFGE. Most strains were found to be resistant to ciprofloxacin (92.5 %), erythromycin (93.4 %) and gentamicin (86.8 %). The majority (72.0 %) of strains were found to harbour SCCmec type III-SCCmercury with the presence of ccrC, and carried the sea+cna gene combination (49.3 %), with cna as the most prevalent virulence gene (94.0 %) detected. We identified four PFGE clusters, with pulsotype C (n=19) as the dominant example in the intensive care unit, where this pulsotype was found to be associated with carriage of SCCmec type III and the sea gene (P=0.05 and P=0.02, respectively). In summary, the dominant MRSA circulating in our hospital in 2009 was a clone that was ciprofloxacin, erythromycin and gentamicin resistant, carried SCCmec type III-SCCmercury with ccrC and also harboured the sea+cna virulence genes. This clone also appears to be the dominant MRSA circulating in major hospitals in Kuala Lumpur.

Staphylococcus aureus Infections in Malaysia: A Review of Antimicrobial Resistance and Characteristics of the Clinical Isolates, 1990–2017

“…A similar observation was also reported among 124 MSSA and 34 MRSA isolates obtained in 2008 from HUSM, where all the isolates showed full sensitivity towards teicoplanin [19]. Teicoplanin-resistant isolates were also not detected among the 318 MRSA isolates collected in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009 [20].…”

“…The prevalence of gentamicin resistance among Malaysian S. aureus isolates, 1990–2017. Data from the National Surveillance of Antibiotic Resistance (NSAR) reports, 2003–2005 [24], 2007 [26], 2008 [25], 2009 [27], 2010 [28], 2011 [29], 2012 [30], 2013 [31], 2014 [32], 2015 [33], 2016 [4], and 2017 [5]; Hospital Kuala Lumpur (HKL) between 1990 and 1991 [13]; Various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; Hospital Universiti Sains Malaysia (HUSM) between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; University of Malaya Medical Centre (UMMC) in 2003 and 2008 [18], and in 2013 [22]; Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009 [20]; Hospital Raja Permaisuri Bainun (HRPB), KPJ Ipoh Specialist Hospital (KPJ) and Gribbles Pathology Ipoh (GP) between 2011 and 2012 [21]; and Hospital Sultanah Nur Zahirah (HSNZ) between 2016 and 2017 [23]. …”

“…The prevalence of erythromycin resistance among Malaysian S. aureus isolates, 1990–2017. Data from the NSAR reports; HKL between 1990 and 1991 [13]; Various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; HUSM between 2002 and 2007 [15] and in 2008 [19]; not specified (N/S) between 2003 and 2004 and in 2007 [16], and between 2006 and 2007 [17]; UMMC in 2003 and 2008 [18], and in 2013 [22]; UKMMC in 2009 [20]; HRPB, KPJ and GP between 2011 and 2012 [21]; and HSNZ between 2016 and 2017 [23]. …”

“…The prevalence of chloramphenicol resistances in Malaysian MRSA isolates, 1997–2017. Data from the NSAR reports; various, collected from ten hospitals throughout Malaysia between 1997 and 1999 [14]; not specified (N/S) between 2006 and 2007 [17]; HUSM in 2008 [19]; UKMMC in 2009 [20]; and HSNZ in 2016 and 2017 [23]. …”

Simplified protocol of gel-based multiple locus variable number of tandem repeats analysis (MLVA) for Staphylococcus aureus typing

“…2 In a molecular epidemiology study on methicillin-resistant S. aureus (MRSA) isolated from our medical center carried out in 2009, the strains were typed using PFGE and four major MRSA pulsotypes were identified. 4 We find the PFGE labor-intensive and the technique requires a long turnaround-time (TAT) before final results could be obtained. This will not be ideal in outbreak investigations as techniques with rapid TAT and simpler workflow may help reduce morbidity and mortality in infections.…”