Genotyping of methicillin resistant Staphylococcus aureus from the United Arab Emirates

Abstract

Reports from Arabian Gulf countries have demonstrated emergence of novel methicillin resistant Staphylococcus aureus (MRSA) strains. To address the lack of data from the United Arab Emirates (UAE), genetic characterisation of MRSA identified between December 2017 and August 2019 was conducted using DNA microarray-based assays. The 625 MRSA isolates studied were grouped into 23 clonal complexes (CCs) and assigned to 103 strains. CC5, CC6, CC22 and CC30 represented 54.2% (n/N = 339/625) of isolates with other common CCs being CC1, CC8, CC772, CC361, CC80, CC88. Emergence of CC398 MRSA, CC5-MRSA-IV Sri Lanka Clone and ST5/ST225-MRSA-II, Rhine-Hesse EMRSA/New York-Japan Clone in our setting was detected. Variants of pandemic CC8-MRSA-[IVa + ACME I] (PVL+) USA300 were detected and majority of CC772 strains were CC772-MRSA-V (PVL+), “Bengal- Bay Clone”. Novel MRSA strains identified include CC5-MRSA-V (edinA+), CC5-MRSA-[VT + fusC], CC5-MRSA-IVa (tst1+), CC5-MRSA-[V/VT + cas + fusC + ccrA/B-1], CC8-MRSA-V/VT, CC22-MRSA-[IV + fusC + ccrAA/(C)], CC45-MRSA-[IV + fusC + tir], CC80-MRSA-IVa, CC121-MRSA-V/VT, CC152-MRSA-[V + fusC] (PVL+). Although several strains harboured SCC-borne fusidic acid resistance (fusC) (n = 181), erythromycin/clindamycin resistance (ermC) (n = 132) and gentamicin resistance (aacA-aphD) (n = 179) genes, none harboured vancomycin resistance genes while mupirocin resistance gene mupR (n = 2) and cfr gene (n = 1) were rare. An extensive MRSA repertoire including CCs previously unreported in the region and novel strains which probably arose locally suggest an evolving MRSA landscape.

The Dissemination and Molecular Characterization of Clonal Complex 361 (CC361) Methicillin-Resistant Staphylococcus aureus (MRSA) in Kuwait Hospitals

“…The CC361-MRSA isolates in this study were negative for genes encoding PVL similar to CC631-MRSA isolates reported previously in Oman (Udo et al, 2014), UAE (Senok et al, 2020), Australia (Coombs et al, 2011), and most of the isolates in Saudi Arabia (Senok et al, 2019). However, two isolates consisting of, an isolate of CC361-MRSA-V/VT (PVL+) isolated in Saudi Arabia (Senok et al, 2019) and an isolate of ST361-MRSA-/t315 isolated from ready-to-eat food sample in Bangladesh (Islam et al, 2019), were positive for PVL suggesting that PVL is rare among CC361-MRSA isolates.…”

“…The number of CC361-MRSA obtained from human patients increased from two isolates identified for the first time in Kuwait in 2010 (Boswihi et al, 2016), to 55 in 2016, 56 in 2017 and 71 in 2018. Similarly, increases in the proportion of CC361-MRSA in human patients have been observed in the UAE and Saudi Arabia (Senok et al, 2020), making the CC361-MRSA no longer a rare but an evolving clone in the Arabian Gulf region.…”

“…Despite the smaller numbers reported in Saudi Arabia (8 0f 12 isolates) (Senok et al, 2019) and the UAE (20 of 35 isolates) (Senok et al, 2020) compared to those in Kuwait, CC361-MRSA [V/VT + fus] isolates were also the most common strain type reported in these countries. Similarly, the second common genotype in this study, CC361-MRSA-IV, WA-MRSA 29, was also the second most common CC361-MRSA in the UAE blaZ, beta-lactamase gene; blaI, beta lactamase repressor (inhibitor); blaR, beta-lactamase regulatory protein; mecA, penicillin binding protein 2; erm(B) + erm(C), rRNA methyltransferase associated with macrolide/lincosamide resistance; linA, lincosaminide nucleotidyltransferase; msr(A), macrolide efflux pump; mph(C), macrolide phosphotransferase II; vatA, virginiamycin A acetyltransferase; vatB, acetyltransferase inactivating streptogramin A; vga(A), ABC transporter conferring resistance to streptogramin A; aacA-aphD, aminoglycoside adenyl-/phosphotransferase (gentamicin, tobramycin); aadD, aminoglycoside adenyltransferase (neomycin, kanamycin, and tobramycin); aphA3, aminoglycoside phosphotransferase (neomycin, kanamycin); dfrS1, dihydrofolate reductase mediating trimethoprim resistance; fusC + fusB (far1), fusidic acid resistance gene; tet(K), tetracycline efflux protein; Cfr, 23S rRNA methyltransferase; mupA, isoleucyl-tRNA synthetase; qacA, multidrug efflux protein A; qacC, multidrug efflux protein C; sat, streptothricin acetyltransferase; fosB, metallothiol transferase; ugpQ, glycerophosphoryl diester phosphodiesterase (associated with mecA); plsSCC (COL), plasmin-sensitive surface protein; delta_mecR, truncated signal transducer protein MecR1; Q9XB68-dcs, hypothetical protein from SCCmec elements; ccrC, cassette chromosome recombinase gene C; ccrB-2, cassette chromosome recombinase gene B-2; ccrA-2, cassette chromosome recombinase gene A-2; ccrA-3, cassette chromosome recombinase gene A-3; ccrAA, Putative protein homologue to cassette chromosome recombinase A genes.…”

Characterisation of S. aureus/MRSA CC1153 and review of mobile genetic elements carrying the fusidic acid resistance gene fusC

“…This might result in importation, exchange and exportation of MRSA strains epidemic to other regions of the world. Indeed, in these countries, a high degree of diversity of MRSA strains has been observed with several strains being linked to other parts of the world 12 – 15 .…”

“…Unfortunately, an excessive consumption of fusidic acid might quickly lead to an emergence of resistance, as it is well documented from New Zealand 16 , 17 . Fusidic acid resistance is common in Middle Eastern/Arabian Gulf states, usually being due to plasmid-borne fusB/far1 13 , 18 – 24 or SCC-associated fusC 12 , 25 – 32 .…”