<p>Emergence of Methicillin-Resistant <em>Staphylococcus aureus</em> Belonging to Clonal Complex 15 (CC15-MRSA) in Kuwait Hospitals</p>

Abstract

Purpose: Methicillin-resistant S. aureus (MRSA) belonging to clonal complex 15 (CC15-MRSA) is rare among clinical isolates with few reports from retail camel meat and human patients. This study investigated the genetic relatedness of CC15-MRSA isolated for the first time from patients in Kuwait hospitals. Methods: Antibiotic susceptibility was tested by the disk diffusion method. Minimum inhibitory concentration was determined using Etest strips. Molecular typing was performed using spa tying, multilocus sequence tying and DNA microarray. Results: Of 1327 MRSA isolates, 42 (3.1%) were identified as CC15-MRSA. The 42 isolates belonged to sequence type ST1535-harbored SCCmec type V and spa types t084 (36 isolates), t346 (3 isolates) and one of t114, t228 and t7583. All 42 isolates were resistant to gentamicin, kanamycin, fusidic acid and cadmium acetate; 38 isolates were resistant to tetracycline. The isolates harbored aacA-aphD and fusC that codes for gentamicin and fusidic acid resistance, respectively. Tet(K) was present in the tetracycline-resistant isolates. In addition, the 42 isolates carried inu(A) (lincosamide nucleotidyltransferase) that confers resistance to lincomycin and clindamycin although phenotypically susceptible to these antibiotics. The isolates belonged to accessory gene regulator type II and capsular polysaccharide group 8 but lacked genes for Staphylococcus enterotoxins, toxic shock syndrome toxin, collagen-binding adhesins and Panton-Valentine leukocidin. Conclusion: This study revealed the emergence and transmission of a previously rare MRSA clone among human patients in Kuwait hospitals and highlights the increasing infiltration of rare MRSA into the human population.

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

“…Please note that this is an abridged version; for a more detailed version, see Supplement 5 . References 28 , 30 , 32 , 34 . **Split across two or more contigs so that the correct order of SCC elements and/or individual genes cannot be determined.…”

“…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 .…”

Prospective genomic surveillance reveals cryptic MRSA outbreaks with local to international origins among NICU patients

“…Recent observations of confirmed and suspected MDR SCCs encoding mecA with other antimicrobial resistance genes, including several with fusC , raises concerns globally for Staphylococcal infections requiring complicated antimicrobial therapy 49-51 . fusC fusidic acid resistance has been seen in non- mec SCC and SCC mec elements 49,52,53 . The SCC mec sequence from the closed isolate genomes were highly similar to draft SCC mec sequences reported by Senok, et al 40 .…”

Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries

“…Studies report varying rates for CA-MRSA infections over time: in Kuwait and Saudi Arabia, CA-MRSA comprised of about 60% of infections [33,35,36]; and 90% in Oman [41]. A recent publication in 2020 by Udo et al [42] earlier study published in 2008 [34] may include a different patient demographic, and may also reflect the status quo prior to the shift in MRSA source in recent years [43].…”

“…Across the 5 Gulf countries, MRSA has been shown to be resistant to many antimicrobials used to treat SSTI, including fusidic acid, ciprofloxacin, erythromycin, tetracycline, trimethoprim, streptomycin, kanamycin, and gentamicin (Table 2). In a recent study in 2019 by Alfouzan et al [42] 58% of all MRSA isolates from Kuwait were reported to have a minimum inhibitory concentration > 1 µg/mL for vancomycin, which is associated with clinical failure of the drug. Although MRSA has been widely reported to be susceptible to teicoplanin, Alkharsah et al [33] in 2018 reported MRSA resistance to this agent, which limits treatment options for patients with renal failure.…”