Spread of a single multiresistant methicillin-resistant Staphylococcus aureus (MRSA) clone carrying staphylococcal cassette chromosome mec type III in a public hospital in Malaysia
Objective: The purpose of the study was to molecularly characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates cultured from skin and soft tissue infections from patients treated in a public hospital and identify the predominant clone circulating. Methods: Among the 198 infectious MRSA isolates collected from October 2007 to March 2008, 32 samples obtained from skin and soft tissue infections were studied. Phenotypic identification of the isolates as MRSA was confirmed by the detection of the Sa442 and mecA genes. The MRSA isolates were further characterized by Staphylococcus protein A gene (spa) typing, SCCmec typing and single PCR assays for virulent determinants such as cna (collagen adhesion), fnbA (fibronectin binding protein) icaA and icaD (intracellular adhesion) genes. Results: The MRSA isolates were found to be multiresistant, in addition to resistance to beta-lactam agents, they demonstrated resistance to cotrimoxazole, erythromycin, and gentamicin. Expect for 4 isolates, all others were genetically identical and shared a common spa type t037. Two isolates from bone marrow shared spa type t421, while other two isolates were t2575 and t032. T037 is an established strain with MLST as ST 239, ST-240 and ST 241 under the clonal complex (CC) 8. SCCmec typing with I, II, III, IV (a, b, c) and V primers, 10 MRSA isolates were identified to harbor SCCmec type III, while other isolates which are non-typeable need to be tested for type III variants. All isolates irrespective of the spa and SCCmec types were positive for cna, fnbA, icaA and icaD genes. None of the isolates showed positive signal for pvl gene. Conclusions: The overwhelming majority of isolates (28 of 32 or 87.5%) belonged to minor variants of a single clonal type resembling the Brazilian and Hungarian epidemic MRSA clones CC8, that showed a common spa type and were either sequence type 239 (ST239) or ST240 or ST241 (variants of ST239) in association with SCCmec type III. No CA-MRSA or PVL positive strain was detected, hence the strains are truly nosocomial. The results of this study indicate that a successful multi-virulent and multi-resistant nosocomial MRSA clone is spreading in the hospital and may be responsible for all skin and soft tissues infections. Efficient infection control measures are urgently needed to prevent the further spread of this dangerous clone.