Molecular epidemiology of methicillin-resistant Staphylococcus aureus clinical isolates by multilocus sequence typing in northwestern (Tabriz) and southern (Kerman) Iran: emergence of MRSA ST4848-SCCmec III (2023)

gene reporter

Volume 24,

September 2021

, 101212

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Methicillin-resistantStaphylococcus aureusis an invasive human pathogen that causes community- and hospital-acquired infections worldwide. The aim of this study was to investigate the molecular characteristics of MRSA isolates recovered from hospitalized patients in the cities of Tabriz and Kerman, Iran. A total of 111 MRSA isolates and their patterns were collectedantimicrobial resistancewas determined to exploitDisc Diffusionmethod. The minimum inhibitory concentration isVancomycinDecided toE. teston Mueller-Hinton agar plates.nookandmechanicA gene detected by PCR and SCCmechanicandMLSTThe isolates were typed. According to the results, the prevalence of MRSA was 40.8% in Tabriz and 57.1% in Kerman. All MRSA isolates were susceptible to vancomycin, the rate ofmultidrug resistance(MDR) 68.2% in Tabriz and 56.6% in Kerman. 29 (56.86%) and 33 (55%) MRSA isolates were recorded as positive for SCCmechanicType III in Tabriz and Kerman respectively. A total of 6 distinct clonal complexes (CC) were identified for MRSA isolates in 9 different sequence types (ST). ST4848 belonging to CC6 and ST859 belonging to CC88 were the dominant types in Tabriz (45.09%) and Kerman (43.33%). The results of this study support the need for more surveillance studies of MRSA isolates to identify potential new MRSA clones for more effective infection control.


gram positiveStaphylococcus aureus(Staphylococcus aureus) is one of the most prevalent pathogens responsible for severe morbidity and mortality from hospital- and community-acquired infections (Musicha et al., 2017). The incidence of this bacterium varies in different parts of the world. Although the incidence of this infection ranges from 10 to 30 cases per 100,000 person-years in developed countries, there are insufficient epidemiological data in developing countries. However, according to published data, it ranges from 2.5 to 630 per 100,000 person-years (among children under 5 years of age in Ghana) (Tong et al., 2015). Emergence of methicillin-resistant strainsStaphylococcus aureus(MRSA) had an important clinical impact in 1950, and a number of outbreaks attributed to these strains have occurred in different parts of the world (Lakhundi and Zhang, 2018) (Japoni-Nejad et al., 2013). MRSA isolates are often multidrug resistant (Tiwari et al., 2008) and have been shown to be resistant to macrolides, aminoglycosides, lincosamides, and nearly all currently available β-lactam antimicrobials Broad drug resistance. The distribution of antimicrobial resistance genes and the development of multidrug-resistant strains pose a serious therapeutic dilemma, making the control of nosocomial infections an even more challenging problem.

Epidemiological reporting using molecular typing is an important factor in the study of clonal associations, evolutionary pathways, genetic diversity of pathogens, and monitoring transmissionStaphylococcus aureusinfection (Goudarzi et al., 2016; Rahimi et al., 2016; Goudarzi et al., 2017a). Some methods, such as multilocus sequence typing (MLST), pulsed field gel electrophoresis (PFGE), SCCmechanicandhot springTyping is commonly used for molecular typing of MRSA isolates (David et al., 2013; Ruppitsch et al., 2006). Although all of these methods have high discriminatory power, the results suggest that a combination of genotype methods may be useful and valuable in identifying various MRSA clones (Goudarzi et al., 2016).

Mobile elements of staphylococcal cassette chromosomesmechanic(Shennan Circuitsmechanic) responsible for methicillin resistanceStaphylococcus aureusand at least 11 (I-XI) major types of SCCmechanichas been described asstaphylococcusspecies (Japoni-Nejad et al., 2013; Mohammadi et al., 2014; Sadeghi and Mansouri, 2014). SCCmechanicTypes I, II, and III are the most common types of SCCmechanicIn hospital-acquired MRSA (HA-MRSA), while SCCmechanicTypes IV and V are the main types of SCCmechanicIn community-acquired MRSA (CA-MRSA) (Japoni-Nejad et al., 2013; Mediavilla et al., 2012). Multilocus sequence typing (MLST) characterizes bacterial isolates by using the internal fragment sequences of seven housekeeping genes (Enright and Spratt, 1999; Maiden et al., 1998). MLST has been created and approved for use inStaphylococcus aureus(Enright et al., 2000) and provided a differential method to quickly identify similar strains recovered in different countries. MLST data can be used to test the evolution and population biology of bacterial pathogens and to predict ancestral genotypes and evolutionary decline patterns within groups of related genotypes (Feil et al., 2004; Pérez-Losada et al., 2006).

Infection control policies play an important role in preventing the spread of community-acquired infections to hospitalized patients, and vice versa. Because Shennan CircuitsmechanicIII is usually located on large motor elements that cannot normally be transferred by horizontal gene transferStaphylococcus aureus, isolates carrying SCC obtained from CAmechanicIII may have been transferred from healthcare workers to the community (Rybak and LaPlante, 2005; David and Daum, 2010). Therefore, identifyStaphylococcus aureusTransmission among staff and patients helps us reduce the prevalence of MRSA and its infection in healthcare settings. The aim of this study was to investigate the molecular characteristics of MRSA isolates collected from patients at eight hospitals in the Iranian cities of Tabriz and Kerman between January and December 2018, using multilocus sequence typing. Indeed, the incidence of hospital-acquired (HA-) and community-acquired (CA-acuried) MRSA isolates was investigated.

partial fragment

bacterial isolate

A total of 111 MRSA isolates were collected from eight hospitals, four in the northwest (Tabriz city, including Sina, Imam Reza, Shahid Madani and Asad Abadi hospitals), four in the southeast (Kerman city, including Afzalipour , Shafa, Kolahdouz and Bahonar Hospitals) Jan-Dec 2018 Part of Iran (Author), this work was approved by the Ethics Committee of Kerman Medical University (ref. IR.KMU.REC.1398.442). Routine and biochemical tests are

bacterial isolate

Of the 111 MRSA isolates collected from eight medical centers in the cities of Tabriz and Kerman between January and December 2018, 51 belonged to Tabriz hospitals (36/51 (70.5%) and 15/ 51 (29.4%) isolates were HA-MRSA and CA-MRSA, respectively) and 60 isolates belonged to Kerman Hospital (34/60 (56.6%) and 26/60 (43.3%) isolates were HA- MRSA and CA-MRSA). Most CA-MRSA isolates were isolated from urine and wounds, whereas most HA-MRSA were isolated from wounds and blood


The emergence of MRSA, especially MDR-MRSA, poses a great challenge to the management of the disease.Staphylococcus aureusInfect. Since there are no approved vaccines available forStaphylococcus aureus, antibiotics remain the main treatment option for the control of this bacterium. Therefore, it is important to monitor the prevalence of MRSA burden and the typing of these isolates. In this study, MRSA prevalence, MDR-MRSA prevalence, antibiotic resistance patterns

in conclusion

In our study of northwestern and southeastern Iran, a highly diverse population of MRSA isolates has been identified from patients. The high incidence of MDR-MRSA isolates suggests revisions to infection control methods. We show nine different sequence types (ST6, ST22, ST239, ST396, ST859, ST4190, ST4848, ST2344 and ST4359). Our study supports temporal dynamics in MRSA clonal diversity and also provides important lessons about the importance of ongoing monitoring

Funding information

This work was supported by the first author.

ethics approval

This work was approved by the Ethics Committee of Kerman Medical University (reference number IR.KMU.REC.1398.442).

CRediT Author Contribution Statement

SH.A., N.K., J.S.: Survey, data curation.

SH.A., M.N., N.K., J.S.: Data management, writing.

B.KH., SH.A.: Resources.

M.N., J.S.: Writing, review and final editing.

Statement of Competing Interests

The authors declare that they have no conflicts of interest.

thank you

We would like to thank all members of the Department of Microbiology, Kerman Islamic Azad University and Tabriz University of Medical Sciences for their technical assistance, a source report from a database prepared for the first author's doctoral thesis, which Registered with Kerman Islamic Azad University.


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    What does it mean to be mecA positive? ›

    mecA is a gene found in bacterial cells which allows them to be resistant to antibiotics such as methicillin, penicillin and other penicillin-like antibiotics. The bacteria strain most commonly known to carry mecA is methicillin-resistant Staphylococcus aureus (MRSA).

    Does the presence of the mecA gene confirm MRSA? ›

    MRSA is resistant to all β-lactams because of the presence of mecA, a gene that produces a pencillin binding protein (PBP2a) with low affinity for β-lactam antibiotics.

    What does the mecA gene code for? ›

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important causes of hospital infections worldwide. High-level resistance to methicillin is caused by the mecA gene, which encodes an alternative penicillin-binding protein, PBP 2a.

    What are the molecular methods for detection of MRSA? ›

    To limit the spread of MRSA, early detection and proper treatment are essential. Because conventional culture as gold standard is time consuming, new techniques such as PCR-based and hybridization assays have emerged for the rapid detection of MRSA.

    What does a positive MRSA culture mean? ›

    If your MRSA test is positive, you are considered "colonized" with MRSA. Being colonized simply means that at the moment your nose was swabbed, MRSA was present. If the test is negative, it means you aren't colonized with MRSA.

    How do you know if you are MRSA positive? ›

    People carrying MRSA harmlessly on their skin or in their nose show no signs or symptoms and it is impossible tell if a person has MRSA by looking at them. If infection is suspected then a doctor will take a swab or specimen of the pus or wound discharge and send it to a laboratory for testing.

    What internal organ is most affected by MRSA? ›

    MRSA most commonly causes relatively mild skin infections that are easily treated. However, if MRSA gets into your bloodstream, it can cause infections in other organs like your heart, which is called endocarditis. It can also cause sepsis, which is the body's overwhelming response to infection.

    How do you know if staph aureus is MRSA? ›

    The only way to know for sure if you have a MRSA or staph infection is to see a provider. A cotton swab is used to collect a sample from an open skin rash or skin sore. Or, a sample of blood, urine, sputum, or pus from an abscess may be collected.

    What does it mean to be isolated with MRSA? ›

    In the hospital, people who are infected or colonized with MRSA often are placed in isolation as a measure to prevent the spread of MRSA . Visitors and health care workers caring for people in isolation may need to wear protective garments. They also must follow strict hand hygiene procedures.

    Which one is the most predominant strain of community acquired MRSA? ›

    Genetics changes in MRSA

    They chose the USA300 strain, one of two strains that cause the majority of CA-MRSA cases, because it has emerged as the predominant strain causing skin infections, as well as more serious infections, in both pediatric and adult patients in many states.

    How do you treat MRSA infection? ›

    Few antibiotics are available to treat more serious MRSA infections. These include vancomycin (Vancocin, Vancoled), trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS) and linezolid (Zyvox).

    What mutation causes MRSA? ›

    Genetic studies for MRSA identified structural genes responsible for methicillin resistance and it is known as mecA genes, also referred to as the staphylococcal chromosomal cassette gene SCCmec. There are three common types of SCCmecA, type I (34 kb), type II (52 kb), and type III (66 kb).

    What is the gold standard method to detect MRSA? ›

    The PCR assay is considered to be the gold standard for the detection of MRSA.

    Is MRSA difficult to treat? ›

    MRSA infections can be more difficult to treat than other bacterial infections. But they're still treatable because the MRSA bacteria aren't resistant to all antibiotics. Minor skin infections may not always require any treatment, other than draining away any pus from the site of the infection.

    How do you collect MRSA culture? ›

    The sample is often taken from the infection site, such as a wound, using a sterile swab. Fluid samples can also be taken from saliva, urine, or blood. A sample may be taken from your nose to find out whether you are "colonized" with MRSA.

    What are 4 signs of MRSA? ›

    MRSA usually appear as a bump or infected area that is red, swollen, painful, warm to the touch, or full of pus. If you or someone in your family experiences these signs and symptoms, cover the area with a bandage and contact your healthcare professional.

    What happens if you are a MRSA carrier? ›

    If you are a MRSA carrier, you still have the bacteria on your skin and in your nose. If you don't wash your hands properly, things that you use or touch with your hands can give the bacteria to other people. MRSA can also be found in the liquid that comes out of your nose or mouth when you cough or sneeze.

    What happens if you test positive for Staphylococcus aureus? ›

    It is the leading cause of skin and soft tissue infections such as abscesses (boils), furuncles, and cellulitis. Although most staph infections are not serious, S. aureus can cause serious infections such as bloodstream infections, pneumonia, or bone and joint infections.

    Should I be worried if I have MRSA? ›

    MRSA can cause serious infections that can become life-threatening if left untreated. If you or someone in your family has been diagnosed with MRSA, there are steps you should take to avoid spreading it to your family and friends. Follow the recommendations and practice good hygiene to take care of yourself.

    Can you live with MRSA and not know it? ›

    Not everyone who has MRSA has an infection. Some people can have MRSA just living on their skin. These people are considered colonized with MRSA. These people have no symptoms and might not know they have it.

    How long can you have MRSA without knowing? ›

    The incubation period for MRSA ranges from one to 10 days.

    MRSA is a contagious skin infection that spreads easily through skin-to-skin contact or indirectly from person to person.

    What are 2 complications of a MRSA infection? ›

    In the community (where you live, work, shop, and go to school), MRSA most often causes skin infections. In some cases, it causes pneumonia (lung infection) and other infections. If left untreated, MRSA infections can become severe and cause sepsis—the body's extreme response to an infection.

    Can stress cause MRSA outbreaks? ›

    When the patient encountered an intensely stressful situation an outbreak of MRSA occurred. The patient had additional underlying health issues that suppressed her immune system and made her more susceptible to stress. Gluten allergy and hypothyroidism were discovered and alleviated but did not end the MRSA outbreaks.

    How do I know if MRSA has spread to organs? ›

    In rare instances, MRSA can enter the bloodstream, spread to internal organs and cause death. Signs of internal organ infection include fever, chills, low blood pressure, joint pains, severe headaches, shortness of breath and a rash over most of the body.

    What do the first signs of MRSA look like? ›

    MRSA may look like a bump on the skin that may be red, swollen, warm to the touch, painful, filled with pus, or draining. The pus or drainage contains the infectious bacteria that can be spread to others. People with MRSA may have a fever.

    What is the survival rate of MRSA in the bloodstream? ›

    In adults, MRSA infections that reach the bloodstream are responsible for numerous complications and fatalities, killing 10 percent to 30 percent of patients. An important predictor of morbidity and mortality in adults is the blood concentrations of vancomycin, the antibiotic of choice to treat this condition.

    How serious is MRSA staph infection? ›

    Methicillin-resistant Staphylococcus aureus (MRSA)

    Staph bacteria are usually harmless, but they can cause serious infections that can lead to sepsis or death. Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of staph infection that is difficult to treat because of resistance to some antibiotics.

    How do you get rid of MRSA colonization? ›

    Because MRSA carriage is most common in the nares and on the skin (particularly in sites such as the axilla and groin), MRSA decolonization therapy typically includes intranasal application of an antibiotic or antiseptic, such as mupirocin or povidone-iodine, and topical application of an antiseptic, such as ...

    How do you treat multidrug resistant Staphylococcus aureus? ›

    At home — Treatment of MRSA at home usually includes a 7- to 10-day course of an antibiotic (by mouth) such as trimethoprim-sulfamethoxazole (brand name: Bactrim), clindamycin, minocycline, linezolid, or doxycycline.

    Can MRSA cause permanent damage? ›

    Infections of the skin or other soft tissues by the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function.

    What is the strongest antibiotic for staph infection? ›

    For serious staph infections, vancomycin may be required. This is because so many strains of staph bacteria have become resistant to other traditional antibiotics. This means other antibiotics can no longer kill the staph bacteria.

    What is the most powerful antibiotic for MRSA? ›


    Vancomycin is one of the most powerful antibiotics in the world. It's available in both oral and IV forms. But it's only used as an oral medication in very specific circumstances. For MRSA treatment, people usually get the IV form of vancomycin.

    What is the main cause of staph infection? ›

    Staph infections are caused by staphylococcus bacteria. These types of germs are commonly found on the skin or in the nose of many healthy people. Most of the time, these bacteria cause no problems or cause relatively minor skin infections.

    How fast does MRSA progress? ›

    MRSA infections can rapidly progress, over hours or a day. When you see the first signs of it – you develop a fever above 101.3, your heart rate is faster than 90 beats per minute, you feel disoriented – see a doctor.

    Who is most likely to get a MRSA infection Why? ›

    MRSA infection affects all ages and genders. Animals can carry MRSA, although they often get it from people. Intravenous drug users who share needles are 16 times more likely to get MRSA infection. Certain workers and members of the community are more at risk for MRSA infection.

    What causes recurrent MRSA infections? ›

    Patients who were recently treated for a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection face a higher risk of recurrent infections if their households are contaminated with the same MRSA strain, a small study published this week in JAMA Internal Medicine suggests.

    What is mecA C on blood culture? ›

    mecA/C – indicates methicillin-resistant (MR) staphylococci (not Staphylococcus aureus). This resistance marker will be reported with Staphylococcus epidermidis or lugdunesis.

    How does mecA gene cause antibiotic resistance? ›

    The mec-A gene, is a genetic element found in MRSA strains. It encodes an additional penicillin binding protein PBP2a, which has a low affinity to all ß-lactam antibiotics and is responsible for the meticillin resistance of MRSA strains (2, 3).

    Is MRSA contagious with staph? ›

    MRSA is contagious and can be spread to other people through skin-to- skin contact. If one person in a family is infected with MRSA, the rest of the family may get it. MRSA was first identified in the 1960's and was mainly found in hospitals and nursing homes.

    Can MRSA be fully cured? ›

    These strains are known as MRSA, which cannot be cured with traditional penicillin-related drugs. Instead, MRSA must be treated with alternate antibiotics. Initially, after problems with MRSA were recognized, most cases of MRSA infection occurred in people who were hospitalized or lived in nursing homes.

    Can your body heal MRSA on its own? ›

    The MRSA might go away on its own. However, your doctor may order a special antibiotic cream to be put into your nose and on any wounds you might have. It is important that you apply this cream as prescribed for the recommended number of days. You may be asked to wash your body with a special skin antiseptic.

    What causes MRSA to flare up? ›

    MRSA infections typically occur when there's a cut or break in your skin. MRSA is very contagious and can be spread through direct contact with a person who has the infection. It can also be contracted by coming into contact with an object or surface that's been touched by a person with MRSA.

    Can you get a false positive MRSA test? ›

    A clear performance issue with competing, commercially available technologies for MRSA is the unacceptably high number of MRSA false negative results—ranging from 6% to 30%—and false positive rates as high as 20%.

    What is MRSA blood test for? ›

    Blood Test

    A test can also be used to determine whether you're infected with methicillin-resistant Staphylococcus aureus (MRSA), a type of staph that's resistant to common antibiotics. Like other staph infections, MRSA can spread to bones, joints, blood, and organs, causing serious damage.

    What bacteria has mecA gene? ›

    The mecA gene is a gene found in bacterial cells which allows a bacterium to be resistant to antibiotics such as methicillin, penicillin and other penicillin-like antibiotics. The most commonly known carrier of the mecA gene is the bacterium known as Methicillin-resistant Staphylococcus aureus (MRSA).

    How do I stop being a staph carrier? ›

    Keep your hands clean by washing them thoroughly with soap and water. Or use an alcohol-based hand sanitizer. Keep cuts and scrapes clean and covered with bandages until they heal. Avoid contact with other people's wounds or bandages.

    How long does it take to get rid of MRSA staph infection? ›

    You may need antibiotics for a few days or up to a few months, depending on how serious the infection is. If you get complications, you may need further treatment, such as surgery to drain a build-up of pus (abscess).

    What happens if MRSA is left untreated? ›

    In the community (where you live, work, shop, and go to school), MRSA most often causes skin infections. In some cases, it causes pneumonia (lung infection) and other infections. If left untreated, MRSA infections can become severe and cause sepsis—the body's extreme response to an infection.


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