Genotyping of methicillin-resistant Staphylococcus aureus from sepsis patients in Pakistan and detection of antibodies against staphylococcal virulence factors
- 140 Downloads
In order to obtain more information on the MRSA population structure in the border region of Afghanistan and Pakistan, we collected and genotyped MRSA causing bloodstream infections from a tertiary care hospital in Peshawar, Pakistan, that serves the local population as well as Afghan immigrants and refugees. Thirty-one MRSA isolates from 30 patients were included and characterized by microarray hybridisation. For 25 patients, serum samples were tested using protein microarrays in order to detect antibodies against staphylococcal virulence factors. The most conspicuous result was the high rate of PVL-positive MRSA. Twenty-two isolates (71%) harboured lukF/S-PV genes. The most common lineage was CC772-MRSA-V/VT (PVL+) to which eleven isolates were assigned. The second most common strain was, surprisingly, CC8-MRSA-[IV+ACME] (PVL+), “USA300” (9 isolates). Two isolates were tst1 positive CC22-MRSA-IV, matching the Middle Eastern “Gaza Epidemic Strain”. Another two were PVL-positive CC30-MRSA-IV. The remaining isolates belonged to, possibly locally emerging, CC1, CC5, and CC8 strains with SCC mec IV elements. Twenty-three patient sera were positive for anti-PVL-IgG antibodies. Several questions arise from the present study. It can be assumed that MRSA and high rates of PVL-positive S. aureus/MRSA are a public health issue in the Afghanistan/Pakistan border region. A possible emergence of the “USA300” clone as well as of the CC772 lineage warrants further investigation.
KeywordsStaphylococcus aureus MRSA mecA PVL
The authors thank Peter Slickers (Abbott/Alere Jena) for bioinformatic work designing the microarrays used for the present study. We would like to acknowledge the staff of Lady Reading Hospital Peshawar for their cooperation in sample collection.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Aro T, Kantele A (2018) High rates of meticillin-resistant Staphylococcus aureus among asylum seekers and refugees admitted to Helsinki University hospital, 2010 to 2017. Euro Surveill 23(45)Google Scholar
- 6.Arfat Y (2013) Genotyping of methicillin resistant Staphylococcus aureus (MRSA) from local hospital of Rawalpindi/Islamabad, Pakistan. Local Hospital of Rawalpindi/Islamabad. Quaid-i-Azam University, Islamabad, IslamabadGoogle Scholar
- 7.Jamil B, Gawlik D, Syed MA, Shah AA, Abbasi SA, Müller E, Reißig A, Ehricht R, Monecke S (2017) Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) from Pakistan: molecular characterisation by microarray technology. Eur J Clin Microbiol Infect DisGoogle Scholar
- 8.Khan S, Sung K, Iram S, Nawaz M, Xu J, Marasa B (2016) Draft genome sequences of two methicillin-resistant clinical Staphylococcus aureus isolates. Genome Announc 4(1)Google Scholar
- 10.Monecke S, Slickers P, Gawlik D, Müller E, Reissig A, Ruppelt-Lorz A, Akpaka P, Bandt D, Bes M, Boswihi S, Coleman D, Coombs G, Dorneanu O, Gostev V, Ip M, Jamil B, Jatzwauk L, Narvaez M, Roberts R, Senok A, Shore A, Sidorenko S, Skakni L, Somily A, Syed M, Thürmer A, Udo E, Vremeră T, Zurita J, Ehricht R (2018) Molecular typing of ST239-MRSA-III from diverse geographic locations and the evolution of the SCCmec III element during its intercontinental spread. Front Microbiol 9(1436)Google Scholar
- 15.Kupfer M, Jatzwauk L, Monecke S, Mobius J, Weusten A (2010) MRSA in a large German University hospital: male gender is a significant risk factor for MRSA acquisition. GMS Krankenhhyg Interdiszip 5(2)Google Scholar
- 16.Monecke S, Coombs G, Shore AC, Coleman DC, Akpaka P, Borg M, Chow H, Ip M, Jatzwauk L, Jonas D, Kadlec K, Kearns A, Laurent F, O'Brien FG, Pearson J, Ruppelt A, Schwarz S, Scicluna E, Slickers P, Tan H-L, Weber S, Ehricht R (2011) A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus. PLoS One 6(4):e17936CrossRefGoogle Scholar
- 21.Kohler C, Dunachie SJ, Müller E, Kohler A, Jenjaroen K, Teparrukkul P, Baier V, Ehricht R, Steinmetz I (2016) Rapid and sensitive multiplex detection of Burkholderia pseudomallei-specific antibodies in melioidosis patients based on a protein microarray approach. PLoS Negl Trop Dis 10(7):e0004847CrossRefGoogle Scholar
- 24.Stieber B, Monecke S, Müller E, Baier V, Coombs G, Ehricht R (2013) Development and usage of protein microarrays for the quantitative measurement of Panton-Valentine leukocidin. Mol Cell ProbesGoogle Scholar
- 26.Miko BA, Uhlemann AC, Gelman A, Lee CJ, Hafer CA, Sullivan SB, Shi Q, Miller M, Zenilman J, Lowy FD (2012) High prevalence of colonization with Staphylococcus aureus clone USA300 at multiple body sites among sexually transmitted disease clinic patients: an unrecognized reservoir. Microbes Infect 14(12):1040–1043CrossRefGoogle Scholar
- 27.Seybold U, Kourbatova EV, Johnson JG, Halvosa SJ, Wang YF, King MD, Ray SM, Blumberg HM (2006) Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 42(5):647–656CrossRefGoogle Scholar
- 28.Weber S, Ehricht R, Slickers P, Abdel-Wareth L, Donnelly G, Pitout M, Monecke S (2010) Genetic fingerprinting of MRSA from Abu Dhabi. ECCMID, ViennaGoogle Scholar
- 32.Earls MR, Shore AC, Brennan GI, Simbeck A, Schneider-Brachert W, Vremerǎ T, Dorneanu OS, Slickers P, Ehricht R, Monecke S, Coleman DC (2019) A novel multidrug-resistant PVL-negative CC1-MRSA-IV clone emerging in Ireland and Germany likely originated in South-Eastern Europe. Infect Genet Evol 69:117–126CrossRefGoogle Scholar
- 34.Monecke S, Müller E, Buechler J, Rejman J, Stieber B, Akpaka PE, Bandt D, Burris R, Coombs G, Hidalgo-Arroyo GA, Hughes P, Kearns A, Abos SM, Pichon B, Skakni L, Soderquist B, Ehricht R (2013) Rapid detection of Panton-Valentine leukocidin in Staphylococcus aureus cultures by use of a lateral flow assay based on monoclonal antibodies. J Clin Microbiol 51(2):487–495CrossRefGoogle Scholar
- 35.Rasigade JP, Trouillet-Assant S, Breurec S, Antri K, Lina G, Bes M, Tristan A, Badiou C, Bernelin M, Fall C, Ramdani-Bouguessa N, Etienne J, Vandenesch F, Laurent F (2015) The levels of antibodies to Panton-Valentine leukocidin (PVL) vary with PVL prevalence along a north-to-south gradient. Eur J Clin Microbiol Infect Dis 34(5):927–933CrossRefGoogle Scholar