Investigating the relation between resistance pattern and type of Staphylococcal cassette chromosome mec (SCCmec) in methicillin-resistant Staphylococcus aureus

Christiana Rezk  Bottros Youssef; Ashraf Ahmed Kadry; Amira Mohammed El-Ganiny

doi:10.18502/ijm.v14i1.8802

Christiana Rezk Bottros Youssef Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
Ashraf Ahmed Kadry Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
Amira Mohammed El-Ganiny Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt

DOI: https://doi.org/10.18502/ijm.v14i1.8802

Keywords: Methicillin resistant Staphylococcus aureus; Antimicrobial; Resistance; Molecular typing; Cassette chromosome recombinase

Abstract

Background and Objectives: MRSA became a widely recognized cause of mortality worldwide with necessity of its ep- idemiological pattern study. Typing of MRSA isolates was performed molecularly based on SCCmec type and relation to resistance pattern was investigated.

Materials and Methods: Out of 200 clinical specimens, S. aureus was detected phenotypically and confirmed as MRSA by PCR in 124 isolates obtained from associated laboratories of different hospitals of Zagazig, during 2018-2019. Antimicrobial resistance pattern was detected and MRSA SCCmec was typed by two methods.

Results: S. aureus rate was high in wounds, sputum, blood, and urine isolates. Antimicrobial resistance rates against cefo- taxime, tetracycline, gentamicin, ciprofloxacin, erythromycin, azithromycin, clindamycin, chloramphenicol, sulfamethoxaz- ole-trimethoprim, linezolid and vancomycin were 82.3%, 65.3%, 56.4%, 45.1%, 37.1%, 32.3%, 32.3%, 25%, 7.3%, 2.4% and 0%, respectively. Multiplex-PCR(M-PCR ) was able to detect SCCmec element among 57% of isolates classified as SCCmec II (n=40), III (n=21), IVa (n=3), IVd (n=2), V(n=1), and four isolates contain both SCCmec ІІ and SCCmec ІV. Traditional typing by PCR for mec and ccr gene complexes was almost concordant with M-PCR. Furthermore, it was able to identify SCCmec types VI, IX, and XIV among 1, 3 and 18 isolates, respectively. No Statistical correlation was established between type of cassette and rate of antimicrobial resistance. Phylogenetic analysis reveals that all ccr types were related to each other and no significant variation in the same ccr type of different SCCmec cassettes.

Conclusion: Most MRSA isolates were MDR reflecting antimicrobials misuse. Detection of various SCCmec types among MRSA isolates indictae the complexity of MRSA epidemiology and increase chance for gene sharing creating new types. The presented investigation was important in understanding MRSA epidemiology and diversity in Egypt providing advice for improving therapeutic protocols.