Abiola Senok1, Ali Somily2, Adeola Raji1, Darius Gawlik3, Fatimah Al-Shahrani4, Shehla Baqi4, Samar Boswihi5, Leila Skakni6, Edet E Udo5, Stefan Weber7, Ralf Ehricht8, Stefan Monecke9. 1. Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia. 2. Department of Pathology and Laboratory Medicine, College of Medicine, King Khalid University Hospital and King Saud University, Riyadh, Kingdom of Saudi Arabia. 3. Institute for Medical Microbiology and Hygiene (IMMH), Technische Universität Dresden, Dresden, Germany; Hamm-Lippstedt University, Hamm, Germany. 4. Department of Medicine, Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. 5. Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait. 6. Molecular Pathology Laboratory, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. 7. Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. 8. Alere Technologies GmbH, Jena, Germany; InfectoGnostics Research Campus, Jena, Germany. 9. Institute for Medical Microbiology and Hygiene (IMMH), Technische Universität Dresden, Dresden, Germany; Alere Technologies GmbH, Jena, Germany; InfectoGnostics Research Campus, Jena, Germany. Electronic address: monecke@rocketmail.com.
Abstract
OBJECTIVES: CC22-MRSA-IV, UK-EMRSA-15/Barnim EMRSA, is a common and pandemic strain of methicillin-resistant Staphylococcus aureus (MRSA) that has been found mainly in Western Europe, but also in other parts of the world including some Gulf countries. One suspected case of an infection with this strain in a patient who was admitted to the surgical unit in Riyadh, Kingdom of Saudi Arabia (KSA) was investigated in order to check whether this strain has reached KSA. METHODS: Besides the index isolate, 46 additional isolates of CC22-MRSA-IV from patients from KSA, Abu Dhabi, Kuwait, and Germany (patients with a history of travel in the Middle East), were characterized by microarray hybridization. RESULTS: The study revealed a regional presence of as many as six distinct 'strains' of CC22-MRSA-IV that could be distinguished based on carriage of SCCmec IV subtypes and virulence factors. No true UK-EMRSA-15/Barnim EMRSA was identified in Riyadh; all suspected isolates from Riyadh were assigned to other, albeit related strains. However, this strain was identified in Abu Dhabi and Kuwait. CONCLUSIONS: CC22-MRSA-IV from KSA could be linked to other epidemic strains from the Middle East and possibly India, rather than to the Western European UK-EMRSA-15/Barnim EMRSA. High-resolution typing methods, including SCCmec subtyping, might help to differentiate related epidemic strains and to monitor routes of transmission.
OBJECTIVES: CC22-MRSA-IV, UK-EMRSA-15/Barnim EMRSA, is a common and pandemic strain of methicillin-resistant Staphylococcus aureus (MRSA) that has been found mainly in Western Europe, but also in other parts of the world including some Gulf countries. One suspected case of an infection with this strain in a patient who was admitted to the surgical unit in Riyadh, Kingdom of Saudi Arabia (KSA) was investigated in order to check whether this strain has reached KSA. METHODS: Besides the index isolate, 46 additional isolates of CC22-MRSA-IV from patients from KSA, Abu Dhabi, Kuwait, and Germany (patients with a history of travel in the Middle East), were characterized by microarray hybridization. RESULTS: The study revealed a regional presence of as many as six distinct 'strains' of CC22-MRSA-IV that could be distinguished based on carriage of SCCmec IV subtypes and virulence factors. No true UK-EMRSA-15/Barnim EMRSA was identified in Riyadh; all suspected isolates from Riyadh were assigned to other, albeit related strains. However, this strain was identified in Abu Dhabi and Kuwait. CONCLUSIONS: CC22-MRSA-IV from KSA could be linked to other epidemic strains from the Middle East and possibly India, rather than to the Western European UK-EMRSA-15/Barnim EMRSA. High-resolution typing methods, including SCCmec subtyping, might help to differentiate related epidemic strains and to monitor routes of transmission.
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