The Evaluation of Five Commercial Bacteriophage Cocktail Against Methicillin Resistant Staphylococcus Aureus Isolated From Nasal Swab Samples

Abstract Infections due to methicillin-resistant Staphylococcus aureus (MRSA) are a growing concern for public health resulting in increase in morbidity, length of hospital stay, and cost of treatment. MRSA nasal-swab screening may give clinicians additional information for decision of empiric antimicrobial agents. While increasing antibiotic resistance leads to new treatment approaches, bacteriophages are one of the most promising methods for these alternatives. It was aimed to determine the effectiveness of bacteriophages against MRSA isolates. Nasal swab samples were collected from outpatients without any evidence of infection who applied to Hatay, Mersin and Gaziantep family and immigration health centers. A series (35) were isolate from Turkish patients, G series (64) were isolated from Syrian immigrants. Methicillin resistance were determined by phenotypically and genotypically. Also, antibiotic susceptibilities of all isolates were determined against erythromycin, clindamycin, gentamicin, linezolid, rifampicin, and mupirosin. The total antimicrobial resistance rates of isolates were found 11%, 28%, 8%, 5%, 16%, 19%, and 29% respectively. The high susceptibility rate against ciprofloxacin (88.8%) was remarkable. The overall susceptibility of MRSA strains to ENKO, INTESTI, PYO, SES, and STAPHYLOCOCCAL bacteriophages was 67.7%, 55.5%, 53.5%, 61.6% and 44.4%, respectively. The antibiotic susceptibility rates (except erythromycin), and efficacy of bacteriophages were higher in group A. Considering that high efficacy rates were not achieved in the study and the sensitivity rates of Turkish isolates to all phages were found higher than Syrian isolates, searching for phages in the geography where the pathogen is common, may be helpful to obtain suitable phages for treatment.

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Methicillin-resistant Staphylococcus aureus bloodstream infection: risk factors and clinical outcome in non-intensive-care units

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000200010 ◽

2012 ◽

Vol 45 (2) ◽

pp. 189-193 ◽

Cited By ~ 4

Author(s):

Karinne Spirandelli Carvalho Naves ◽

Natália Vaz da Trindade ◽

Paulo Pinto Gontijo Filho

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Bloodstream Infection ◽

Antimicrobial Agents ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Methicillin Resistant ◽

Staphylococcus Aureus Bloodstream Infection

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is spread out in hospitals across different regions of the world and is regarded as the major agent of nosocomial infections, causing infections such as skin and soft tissue pneumonia and sepsis. The aim of this study was to identify risk factors for methicillin-resistance in Staphylococcus aureus bloodstream infection (BSI) and the predictive factors for death. METHODS: A retrospective cohort of fifty-one patients presenting bacteraemia due to S. aureus between September 2006 and September 2008 was analysed. Staphylococcu aureus samples were obtained from blood cultures performed by clinical hospital microbiology laboratory from the Uberlândia Federal University. Methicillinresistance was determined by growth on oxacillin screen agar and antimicrobial susceptibility by means of the disk diffusion method. RESULTS: We found similar numbers of MRSA (56.8%) and methicillin-susceptible Staphylococcus aureus (MSSA) (43.2%) infections, and the overall hospital mortality ratio was 47%, predominantly in MRSA group (70.8% vs. 29.2%) (p=0.05). Age (p=0.02) was significantly higher in MRSA patients as also was the use of central venous catheter (p=0.02). The use of two or more antimicrobial agents (p=0.03) and the length of hospital stay prior to bacteraemia superior to seven days (p=0.006) were associated with mortality. High odds ratio value was observed in cardiopathy as comorbidity. CONCLUSIONS: Despite several risk factors associated with MRSA and MSSA infection, the use of two or more antimicrobial agents was the unique independent variable associated with mortality.

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Prevalence of Methicillin Resistant and Virulence Determinants in Clinical Isolates of Staphylococcus aureus

The Open Infectious Diseases Journal ◽

10.2174/1874279301810010108 ◽

2018 ◽

Vol 10 (1) ◽

pp. 108-115

Author(s):

Manjunath Chavadi ◽

Rahul Narasanna ◽

Ashajyothi Chavan ◽

Ajay Kumar Oli ◽

Chandrakanth Kelmani. R

Keyword(s):

Staphylococcus Aureus ◽

Cell Morphology ◽

Methicillin Resistance ◽

Protein A ◽

Clinical Isolates ◽

Clinical Samples ◽

Virulence Determinants ◽

Methicillin Resistant ◽

Alternative Medicines ◽

Mrsa Strains

Introduction:Methicillin-resistantStaphylococcus aureus(MRSA) is the major threat that is a result of the uncontrolled use of antibiotics causing a huge loss in health, so understanding their prevalence is necessary as a public health measure.Objective:The aim of this study was to determine the prevalence of methicillin-resistant MRSA and virulence determinant among associatedS. aureusfrom the clinical samples obtained from various hospital and health care centers of the Gulbarga region in India.Materials and Methods:All the collected samples were subjected for the screening ofS. aureusand were further characterized by conventional and molecular methods including their antibiotic profiling. Further, the response of methicillin antibiotic on cell morphology was studied using scanning electron microscopy.Results:A total 126S. aureuswas isolated from the clinical samples which showed, 100% resistant to penicillin, 55.5% to oxacillin, 75.3% to ampicillin, 70.6% to streptomycin, 66.6% to gentamicin, 8.7% to vancomycin and 6.3% to teicoplanin. The selected MRSA strains were found to possessmecA(gene coding for penicillin-binding protein 2A) andfemA(factor essential for methicillin resistance)genetic determinants in their genome with virulence determinants such as Coagulase (coa) and the X region of the protein A (spa)gene. Further, the methicillin response in resistantS. aureusshowed to be enlarged and malformed on cell morphology.Conclusion:The molecular typing of clinical isolates ofS. aureusin this study was highly virulent and also resistant to methicillin; this will assist health professionals to control, exploration of alternative medicines and new approaches to combat Staphylococcal infections more efficiently by using targeted therapy.

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Comparison of Methicillin-Resistant Staphylococcus aureus Isolates from Cellulitis and from Osteomyelitis in a Taiwan Hospital, 2016–2018

Journal of Clinical Medicine ◽

10.3390/jcm8060816 ◽

2019 ◽

Vol 8 (6) ◽

pp. 816 ◽

Cited By ~ 1

Author(s):

Kuo-Ti Peng ◽

Tsung-Yu Huang ◽

Yao-Chang Chiang ◽

Yu-Yi Hsu ◽

Fang-Yi Chuang ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Resistance ◽

Methicillin Resistant Staphylococcus Aureus ◽

Joint Infection ◽

Sccmec Type ◽

Multidrug Resistant ◽

Chang Gung Memorial Hospital ◽

Methicillin Resistant ◽

Mrsa Strains ◽

Resistance Rates

Methicillin-resistant Staphylococcus aureus (MRSA) causes superficial infections such as cellulitis or invasive infections such as osteomyelitis; however, differences in MRSA isolates from cellulitis (CL-MRSA) and from osteomyelitis (OM-MRSA) at the same local area remain largely unknown. A total of 221 MRSA isolates including 106 CL-MRSA strains and 115 OM-MRSA strains were collected at Chang-Gung Memorial Hospital in Taiwan between 2016 and 2018, and their genotypic and phenotypic characteristics were compared. We found that OM-MRSA isolates significantly exhibited higher rates of resistance to multiple antibiotics than CL-MRSA isolates. Genotypically, OM-MRSA isolates had higher proportions of the SCCmec type III, the sequence type ST239, and the spa type t037 than CL-MRSA isolates. Besides the multidrug-resistant lineage ST239-t037-SCCmecIII more prevalent in OM-MRSA, higher antibiotic resistance rates were also observed in several other prevalent lineages in OM-MRSA as compared to the same lineages in CL-MRSA. Furthermore, when prosthetic joint infection (PJI) associated and non-PJI-associated MRSA strains in osteomyelitis were compared, no significant differences were observed in antibiotic resistance rates between the two groups, albeit more diverse genotypes were found in non-PJI-associated MRSA. Our findings therefore suggest that deep infections may allow MRSA to evade antibiotic attack and facilitate the convergent evolution and selection of multidrug-resistant lineages.

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Methicillin-resistant Staphylococcus aureus (MRSA) in a tertiary surgical and trauma hospital in Benghazi, Libya

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1701 ◽

2011 ◽

Vol 5 (10) ◽

pp. 723-726 ◽

Cited By ~ 14

Author(s):

Najat Buzaid ◽

Abdel-Naser Elzouki ◽

Ibrahim Taher ◽

Khalifa Sifaw Ghenghesh

Keyword(s):

Staphylococcus Aureus ◽

Fusidic Acid ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Age Groups ◽

Resistant Organism ◽

Surveillance Program ◽

Term Care ◽

Methicillin Resistant ◽

Mrsa Strains

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism that threatens the continued effectiveness of antibiotics worldwide and causes a threat almost exclusively in hospitals and long-term care settings. This study investigated the prevalence of MRSA strains and their sensitivity patterns against various antibiotics used for treating hospitalized patients in a major tertiary surgical hospital in Benghazi, Libya. Methodology: We investigated 200 non-duplicate S. aureus strains isolated from different clinical specimens submitted to the Microbiology Laboratory at Aljala Surgical and Trauma Hospital, Benghazi, Libya from April to July 2007. Isolates were tested for methicillin resistance by the oxacillin disc-diffusion assay according to Clinical and Laboratory Standards Institute guidelines. MRSA strains were tested for antimicrobial resistance (i.e., vancomycin, ciprofloxacin, erythromycin, chloramphenicol and fusidic acid) using commercial discs. Information on patient demographics and clinical disease was also collected. Results: Of the isolates examined 31% (62/200) were MRSA. No significant differences were observed in the prevalence of MRSA among S. aureus from females or males or from different age groups. Most MRSA were isolated from burns and surgical wound infections. Antibiotic resistance patterns of 62 patients with MRSA to vancomycin, ciprofloxacin, fusidic acid, chloramphenicol and erythromycin were 17.7%, 33.9%, 41.9%, 38.7% and 46.8% of cases, respectively. Conclusion: MRSA prevalence in our hospital was high and this may be the case for other hospitals in Libya. A sound surveillance program of nosocomial infections is urgently needed to reduce the incidence of infections due to MRSA and other antimicrobial-resistant pathogens in Libyan hospitals.

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Molecular analysis of methicillin-resistant Staphylococcus aureus isolates from four teaching hospitals in Iran: The emergence of Novel MRSA ST- SCCmec clones

10.21203/rs.2.24014/v1 ◽

2020 ◽

Author(s):

Farzaneh Firoozeh ◽

Mitra Omidi ◽

Mahmood Saffari ◽

Hossein Sedaghat ◽

Mohammad Zibaei

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Teaching Hospitals ◽

Diffusion Method ◽

Methicillin Resistant ◽

Resistance Patterns ◽

Mrsa Strains ◽

Type V ◽

Resistance Rates ◽

Antibiotic Resistance Patterns

Abstract Background: The global spread of methicillin-resistant Staphylococcus aureus (MRSA) infections necessitates the use of validated methods for the identification and typing of this bacterium. This study aimed to determine the distribution of main molecular types of MRSA strain circulating among hospitalized patients in teaching hospitals in Isfahan and Kashan. Methods: A total of 146 Staphylococcus aureus strains were isolated from patients in four teaching hospitals in Isfahan and Kashan during June 2017 to September 2018. The antibiotic resistance patterns of Staphylococcus aureus strains were performed by disc diffusion method. The MRSA strains were identified phenotypically and confirmed by PCR assay. The prevalence of microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) genes among MRSA strains was evaluated by multiplex PCR. The genotypes of MRSA strains were determined by multi-locus sequence type and SCC mec typing. Results: Of 146 Staphylococcus aureus isolates 24 (16.4%) isolates identified as MRSA strains. According to antibiotic susceptibility testing the highest resistance rates were seen to erythromycin, cefoxitin and clindamycin. All of Staphylococcus aureus isolates were sensitive to vancomycin whereas 3 (2.1%) isolates were resistant to linezolid. Three different SCC mec types were obtained among MRSA strains including 16 (66.7%) SCC mec type V, 3 (12.5%) SCC mec type III and 5 (20.8%) SCC mec type II. Of 24 MRSA isolates 20 (83.3%) carried MSCRAMMs genes including eno (70.8%), fib (54.1%) , cna (25.0%), fnbB (16.6%) , ebps 5 (20.8%), and fnbA , bbp and clfA genes were not detected. MLST analysis revealed 11 sequence types among MRSA isolates as follows: ST239, ST239, ST291, ST22, ST861, ST 889, ST8, ST59, ST343, ST772, ST6 and ST1465. Also seven MLST-based clonal complexes (CCs) were identified among MRSA strains including: CC8, CC7, CC398, CC59, CC22, CC1 and CC5. Conclusions: A relatively high diversity was found in MRSA genotypes in Kashan and Isfahan hospitals, and seven clonal complexes were identified. Pandemic MRSA clones including CC8 and CC22 were the most prevalent clones and the novel ST types including ST1465, ST861, ST 889 and ST772 are reported for the first time in Iran in the present study. In addition the high prevalence of MSCRAMMs genes in MRSA isolates demonstrates the high potential of these strains for pathogenicity.

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Livestock-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) in Purulent Subcutaneous Lesions of Farm Rabbits

Foods ◽

10.3390/foods9040439 ◽

2020 ◽

Vol 9 (4) ◽

pp. 439 ◽

Cited By ~ 1

Author(s):

Vanessa Silva ◽

Telma de Sousa ◽

Paula Gómez ◽

Carolina Sabença ◽

Madalena Vieira-Pinto ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antimicrobial Agents ◽

Methicillin Resistant Staphylococcus Aureus ◽

Multidrug Resistant ◽

Diffusion Method ◽

Spa Typing ◽

Disk Diffusion Method ◽

Methicillin Resistant ◽

Resistance To Penicillin ◽

Mrsa Strains

Methicillin-resistant Staphylococcus aureus (MRSA) are one of the main pathogens associated with purulent infections. MRSA clonal complex 97 (CC97) has been identified in a wide diversity of livestock animals. Therefore, we aimed to investigate the antibiotic resistance profiles of MRSA strains isolated from purulent lesions of food-producing rabbits. Samples from purulent lesions of 66 rabbits were collected in a slaughterhouse in Portugal. Samples were seeded onto ORSAB plates with 2 mg/L of oxacillin for MRSA isolation. Susceptibility to antibiotics was tested by the disk diffusion method against 14 antimicrobial agents. The presence of resistance genes, virulence factors and the immune evasion cluster (IEC) system was studied by polymerase chain reaction. All isolates were characterized by multilocus sequence typing (MLST), agr and spa typing. From the 66 samples analyzed, 16 (24.2%) MRSA were detected. All strains were classified as multidrug-resistant as they were resistant to at least three classes of antibiotics. All isolates showed resistance to penicillin, erythromycin and clindamycin. Seven isolates were resistant to gentamicin and harbored the aac(6′)-Ie-aph (2″)-Ia gene. Resistance to tetracycline was detected in 10 isolates harboring the tet(K) gene. The IEC genes were detected in three isolates. MRSA strains belonged to CC97, CC1, CC5, CC15 or CC22. The isolates were assigned to six different spa types. In this study we found a moderate prevalence of multidrug-resistant MRSA strains in food-producing rabbits. This may represent concern for food safety and public health, since cross-contamination may occur, leading to the spread of MRSA and, eventually, the possibility of ingestion of contaminated meat.

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Role of the Accessory Gene Regulatoragrin Community-Associated Methicillin-Resistant Staphylococcus aureus Pathogenesis

Infection and Immunity ◽

10.1128/iai.00046-11 ◽

2011 ◽

Vol 79 (5) ◽

pp. 1927-1935 ◽

Cited By ~ 167

Author(s):

Gordon Y. C. Cheung ◽

Rong Wang ◽

Burhan A. Khan ◽

Daniel E. Sturdevant ◽

Michael Otto

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistance ◽

Regulatory System ◽

Accessory Gene ◽

Methicillin Resistant ◽

Content Type ◽

Fibrinogen Binding ◽

Gene Regulatory System ◽

Differential Gene ◽

Mrsa Strains

ABSTRACTThe molecular basis underlying the pathogenic success of community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) is not completely understood, but differential gene expression has been suggested to account at least in part for the high virulence of CA-MRSA strains. Here, we show that theagrgene regulatory system has a crucial role in the development of skin infections in the most prevalent CA-MRSA strain USA300. Importantly, our data indicate that this is due to discrepancies between theagrregulon of CA-MRSA and those of hospital-associated MRSA and laboratory strains. In particular,agrregulation in strain USA300 led to exceptionally strong expression of toxins and exoenzymes, upregulation of fibrinogen-binding proteins, increased capacity to bind fibrinogen, and increased expression of methicillin resistance genes. Our findings demonstrate thatagrfunctionality is critical for CA-MRSA disease and indicate that an adaptation of theagrregulon contributed to the evolution of highly pathogenic CA-MRSA.

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Presence of egc-positive major clones ST 45, 30 and 22 among methicillin-resistant and methicillin-susceptible oral Staphylococcus aureus strains

Scientific Reports ◽

10.1038/s41598-020-76009-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ewa Kwapisz ◽

Katarzyna Garbacz ◽

Maja Kosecka-Strojek ◽

Justyna Schubert ◽

Jacek Bania ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Oral Cavity ◽

Protein A ◽

Methicillin Resistant ◽

Dental Patients ◽

Genes Encoding ◽

Clonal Distribution ◽

Toxic Shock Syndrome Toxin ◽

Mrsa Strains ◽

Resistance Rates

Abstract The oral cavity may comprise a significant reservoir for Staphylococcus aureus but the data on molecular epidemiology and clonal distribution of oral strains are really scarce. This study aimed to evaluate the clonal relatedness in S. aureus isolated from oral cavity and their relationship with carriage of virulence genes, and antimicrobial resistance profiles. A total of 139 oral S. aureus isolates were obtained from 2327 analysed oral samples of dental patients. Antimicrobial susceptibility testing was performed. Isolates were characterized using protein A gene (spa) typing, spa-CC clonal complexes, toxin genes and SCCmec typing for MRSA. High resistance rates for penicillin, tetracycline and gentamicin were detected, respectively 58.3%, 42.4%, and 35.2%. Twelve (8.6%) S. aureus isolates were identified as MRSA. All of MRSA isolates were mecA-positive and mecC-negative. SCCmec IV was the most common type (66.7%), which was typical for community-acquired MRSA (CA-MRSA). Overall, the enterotoxin gene cluster (egc) was the most frequent detected virulence factor (44.9%), both in MSSA and MRSA isolates. Presence of genes encoding for the enterotoxins (sea, seb, sec, seh, sek), exfoliative toxin A (eta), and toxic shock syndrome toxin-1 (tst) was also observed. Strains carrying lukS-PV/lukF-PV genes belonged to SCCmecV- spa type t437. The most prevalent spa types were t091, t015, t084, t002, t571, and t026 among all 57 identified. Spa types, including 3 new ones, grouped in 6 different spa-CC clonal complexes, with four major dominated; CC45, CC30, CC5, and CC15. This study demonstrated that both methicillin-susceptible and methicillin-resistant major European clones of S. aureus could be isolated from the oral cavity of dental patients, with the emergence of PVL-positive CA-MRSA strains. The oral cavity should be considered as a possible source of toxigenic egc-positive S. aureus strains, in terms of potential risk of cross-infection and dissemination to other body sites.

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Staphylococcus aureus PBP4 Is Essential for β-Lactam Resistance in Community-Acquired Methicillin-Resistant Strains

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00049-08 ◽

2008 ◽

Vol 52 (11) ◽

pp. 3955-3966 ◽

Cited By ~ 105

Author(s):

Guido Memmi ◽

Sergio R. Filipe ◽

Mariana G. Pinho ◽

Zhibiao Fu ◽

Ambrose Cheung

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistance ◽

Healthy Individuals ◽

Penicillin Binding Protein ◽

Methicillin Resistant ◽

Fold Reduction ◽

Resistant Strains ◽

Mrsa Strains ◽

Hospital Acquired ◽

Major Target

ABSTRACT Recent cases of infections caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) strains in healthy individuals have raised concerns worldwide. CA-MRSA strains differ from hospital-acquired MRSAs by virtue of their genomic background and increased virulence in animal models. Here, we show that in two common CA-MRSA isolates, USA300 and MW2 (USA400), a loss of penicillin binding protein 4 (PBP4) is sufficient to cause a 16-fold reduction in oxacillin and nafcillin resistance, thus demonstrating that mecA, encoding PBP2A, is not the sole determinant of methicillin resistance in CA-MRSA. The loss of PBP4 was also found to severely affect the transcription of PBP2 in cells after challenge with oxacillin, thus leading to a significant decrease in peptidoglycan cross-linking. Autolysis, which is commonly associated with the killing mechanism of penicillin and β-lactams, does not play a role in the reduced resistance phenotype associated with the loss of PBP4. We also showed that cefoxitin, a semisynthetic β-lactam that binds irreversibly to PBP4, is synergistic with oxacillin in killing CA-MRSA strains, including clinical CA-MRSA isolates. Thus, PBP4 represents a major target for drug rediscovery against CA-MRSA, and a combination of cefoxitin and synthetic penicillins may be an effective therapy for CA-MRSA infections.

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Extensive Genetic Diversity Identified among Sporadic Methicillin-Resistant Staphylococcus aureus Isolates Recovered in Irish Hospitals between 2000 and 2012

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02653-13 ◽

2014 ◽

Vol 58 (4) ◽

pp. 1907-1917 ◽

Cited By ~ 23

Author(s):

Peter M. Kinnevey ◽

Anna C. Shore ◽

Grainne I. Brennan ◽

Derek J. Sullivan ◽

Ralf Ehricht ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antimicrobial Agents ◽

Sequence Type ◽

Methicillin Resistant ◽

Content Type ◽

Type Assignment ◽

Antimicrobial Resistance Genes ◽

Microarray Profiling ◽

Mrsa Strains ◽

Ongoing Surveillance

ABSTRACTClonal replacement of predominant nosocomial methicillin-resistantStaphylococcus aureus(MRSA) strains has occurred several times in Ireland during the last 4 decades. However, little is known about sporadically occurring MRSA in Irish hospitals or in other countries. Eighty-eight representativepvl-negative sporadic MRSA isolates recovered in Irish hospitals between 2000 and 2012 were investigated. These yielded unusual pulsed-field gel electrophoresis and antibiogram-resistogram typing patterns distinct from those of the predominant nosocomial MRSA clone, ST22-MRSA-IV, during the study period. Isolates were characterized byspatyping and DNA microarray profiling for multilocus sequence type (MLST) clonal complex (CC) and/or sequence type (ST) and SCCmectype assignment, as well as for detection of virulence and antimicrobial resistance genes. Conventional PCR-based SCCmecsubtyping was undertaken when necessary. Extensive diversity was detected, including 38spatypes, 13 MLST-CCs (including 18 STs among 62 isolates assigned to STs), and 25 SCCmectypes (including 2 possible novel SCCmecelements and 7 possible novel SCCmecsubtypes). Fifty-four MLST-spa-SCCmectype combinations were identified. Overall, 68.5% of isolates were assigned to nosocomial lineages, with ST8-t190-MRSA-IID/IIE ± SCCM1predominating (17.4%), followed by CC779/ST779-t878-MRSA-ψSCCmec-SCC-SCCCRISPR(7.6%) and CC22/ST22-t032-MRSA-IVh (5.4%). Community-associated clones, including CC1-t127/t386/t2279-MRSA-IV, CC59-t216-MRSA-V, CC8-t008-MRSA-IVa, and CC5-t002/t242-MRSA-IV/V, and putative animal-associated clones, including CC130-t12399-MRSA-XI, ST8-t064-MRSA-IVa, ST398-t011-MRSA-IVa, and CC6-t701-MRSA-V, were also identified. In total, 53.3% and 47.8% of isolates harbored genes for resistance to two or more classes of antimicrobial agents and two or more mobile genetic element-encoded virulence-associated factors, respectively. Effective ongoing surveillance of sporadic nosocomial MRSA is warranted for early detection of emerging clones and reservoirs of virulence, resistance, and SCCmecgenes.

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