Molecular characterisation of methicillin-resistant Staphylococcus aureus (MRSA) from South Africa

Abstract

ABSTRACT Few antibiotics are left that are effective against methicillin-resistant Staphylococcus aureus (MRSA) and even strains resistant to these agents have been isolated. Previous studies have identified five distinct MRSA clonotypes, which are present globally. No comprehensive national study has previously been undertaken to investigate the MRSA types in South Africa, and this study was aimed at elucidating the genotypic population structure of South African MRSA isolates. SmaI digested genomic DNA, separated by pulsed-field gel electrophoresis, was used to characterise 349 S. aureus isolates, obtained from various state and private diagnostic laboratories. PFGE results were complemented with those of spa typing and staphylococcal cassette chromosome mec (SCCmec) typing results. Two-hundred-and-five different PFGE patterns were identified, which were grouped into twenty-four clusters. Three were major lineages, containing more than 20% of the isolates with a similarity cut-off of 70%. Only thirty-seven spa types were identified (fourteen novel spa types), which clustered into six spa-Clonal Complexes after BURP analysis. SCCmec types I-IV were identified, including variants of each type. Data suggest that the Archaic clone (RSA05), oldest of the epidemic clones, represents one of the major clones in South Africa. Strains that were part of this complex (n=98 (28.2%); t064; SCCmec type I-pls) clustered together with strain E2125/ATCC BAA-38 (t051; SCCmec type I). Another major complex, RSA16 (n=90 (25.7%); t012; SCCmec type II/IIB) possessed a single-locus variant (SLV) spa type and the same or a SLV SCCmec types as EMRSA-16 (t018; SCCmec type II). The third major complex, RSA03 (n=74 (21.2%); t037; SCCmec type III/IIIE), had similar spa and SCCmec types to control strainANS46 (t037; SCCmec type III). One MRSA and twelve MSSA isolates were also identified as carrying genes for the toxin Panton-Valentine leukocidin, which was confirmed by DNA nucleotide sequencing.