MRSA Clonal Complex 22 Strains Harboring Toxic Shock Syndrome Toxin (TSST-1) Are Endemic in the Primary Hospital in Gaza, Palestine

Abstract

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in both community and healthcare-related settings worldwide. Current knowledge regarding the epidemiology of S. aureus and MRSA in Gaza is based on a single community-based carriage study. Here we describe a cross-sectional analysis of 215 clinical isolates collected from Al-Shifa Hospital in Gaza during 2008 and 2012.MethodsAll isolates were characterized by spa typing, SCCmec typing, and detection of genes encoding Panton-Valentine leukocidin (PVL) and toxic shock syndrome toxin (TSST-1). Representative genotypes were also subjected to multilocus sequence typing (MLST). Antibiotic susceptibility testing was performed using VITEK2 and MicroScan.ResultsMRSA represented 56.3% of all S. aureus strains, and increased in frequency from 2008 (54.8%) to 2012 (58.4%). Aside from beta-lactams, resistance was observed to tetracycline, erythromycin, clindamycin, gentamicin, and fluoroquinolones. Molecular typing identified 35 spa types representing 17 MLST clonal complexes (CC), with spa 998 (Ridom t223, CC22) and spa 70 (Ridom t044, CC80) being the most prevalent. SCCmec types I, III, IV, V and VI were identified among MRSA isolates, while type II was not detected. PVL genes (lukF/S-PV) were detected in 40.0% of all isolates, while the TSST-1 gene (tst) was detected in 27.4% of all isolates, with surprisingly high frequency within CC22 (70.4%). Both PVL and TSST-1 genes were found in several isolates from 2012.ConclusionsMolecular typing of clinical isolates from Gaza hospitals revealed unusually high prevalence of TSST-1 genes among CC22 MRSA, which is noteworthy given a recent community study describing widespread carriage of a CC22 MRSA clone known as the ‘Gaza strain’. While the latter did not address TSST-1, tst-positive spa 998 (Ridom t223) has been detected in several neighboring countries, and described as endemic in an Italian NICU, suggesting international spread of a ‘Middle Eastern variant’ of pandemic CC22 strain EMRSA-15.

Detection and antibiotic resistance pattern of Staphylococcus aureusand (MRSA) isolated from healthcare workers Nares at three Gaza hospitals, Palestine

“…Nasal carriage of S. aureus and MRSA in HCWs can reflect carriage of their 'own' isolate versus a transiently acquired isolate from patients. Accordingly, the MRSA prevalence rate detected here among HCWs could reflect a high MRSA rate in hospitalized patients, as was recently investigated in Gaza [29] but also a high MRSA carriage rate in the community as was shown in a recent communitybased nasal carriage study in Gaza [30]. Both studies showed a predominant lineage of S. aureus, with spa type t223, ST22-MRSA-IVa.…”

“…Previous reports have mostly focused on Northern Palestine [28] and the West Bank [16], with absence or relatively little details regarding epidemiology of S. aureus in HCWs. Recently, a community-based nasal carriage among healthy children and hospital-based studies addressed the epidemiology of S. aureus and MRSA in Gaza Strip for the first time [29,30]. In this study, we described the nasal colonization rate of S. aureus and MRSA among a convenience sample of HCWs in three Gaza hospitals.…”

“…Kaibni et al, from West Bank, Palestine identified 13.9% MRSA in 72 HCWs working in internal medicine department at Ramallah Governmental hospital [16]. All other reports of MRSA prevalence in Palestine have involved nasal carriage among healthy personnel who have not contact with hospital environment or hospital-based studies [16,[28][29][30]41], although notably, 45% of the S. aureus isolates from the Gaza carriage study were methicillin-resistant [30]. Other studies from Arabic countries and worldwide showed lower prevalence of MRSA among HCWs as in Jordan (10.1%) [13], in USA (12%, 15.2%) [12,19], in Iran (17.2%) [20] and in Libya (36.8%) [22].…”

“…Epidemiological data about S. aureus and MRSA in HCWs in Palestine are generally scarce and insufficient [16,28] with current knowledge regarding the epidemiology of S. aureus in Gaza Strip based on two recent studies; a hospital-acquired and a community-based carriage respectively [29,30].…”

Bacteriological analysis of indoor air of three hospitals in lahore, pakistan

“…23,24 S. aureus is the most notorious pathogen for nosocomial infections and can cause diseases in immunocompromised hospitalized patients. 25 A study showed that P. aeruginosa is responsible for 11% of all nosocomial infections and may cause surgical and wound infections, pneumonia, cystic fibrosis and bacteremia. 26 K. pneumonia, the eighth significant pathogen in healthcare settings, may be involved in neonatal septicemia, pneumonia, wound infections and septicemia.…”