Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt

Abstract

Epidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA) prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureus and MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureus isolates were characterized by antibiotic susceptibility, presence of mecA and PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL(+) isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80) were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence.

Molecular characterization of methicillin-resistant Staphylococcus aureus in nosocomial infections in a tertiary-care facility: emergence of new clonal complexes in Saudi Arabia

“…CC-15 MRSA isolates have been identified in few reports [6], [16], [17]. Two CC-15 MRSA isolates which were nasal colonizers were reported from Iran and Saudi Arabia [6], [17]. Our findings therefore indicate the first report of CC-15 MRSA isolate causing nosocomial infection in the region.…”

“…This is rather different than the situation in the United States, where “USA300” dominates, or the Western Europe, where PVL-negative CC22-MRSA-IV (UK-EMRSA-15/Barnim EMRSA) are most abundant [1]. In addition, our findings confirm that a shift has occurred, with what are presumably CA-MRSA clonal lineages now predominating within the healthcare, setting as majority of the isolates harboured SCC mec IV and V [6], [8]. Of significance, however, is that we now report the first identification of new MRSA strains, including rare and pandemic ones, in Saudi Arabia.…”

“…Recent work from Riyadh, Saudi Arabia, found CC15-MSSA as the predominant nasal colonization MSSA isolate [13]. CC-15 MRSA isolates have been identified in few reports [6], [16], [17]. Two CC-15 MRSA isolates which were nasal colonizers were reported from Iran and Saudi Arabia [6], [17].…”

“…However, there are few data describing the MRSA clonal complexes in Saudi Arabia [6], [7], [8]. A 2005 report showed the predominance of the hospital-acquired lineage ST239 MRSA-III [7].…”

“…Published literature from the Arabian Gulf region has shown the spread of CA-MRSA into the healthcare setting, with differences in the predominant strains reported from countries in the region [2], [3], [4], [5]. However, there are few data on the molecular characterization of MRSA isolates in Saudi Arabia, where a different population structure of MRSA might be expected as a result of the large number of pilgrims who visit the country annually; the large immigrant workforces from the Indian subcontinent, Maghreb countries, Egypt and Yemen; and a relative absence of Northern American and European tourists [6], [7], [8].…”