Livestock-Associated Methicillin-Resistant Staphylococcus aureus in Patients Admitted to Kuwait Hospitals in 2016–2017

Abstract

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) has been reported to colonize and cause infections in animals as well as in humans. LA-MRSA isolates have only recently been identified in patients admitted to Kuwait hospitals. This study was conducted to characterize LA-MRSA isolates obtained from patients admitted to Kuwait hospitals. A total of 202 (7.1%) of 2,823 MRSA isolates obtained from clinical samples in 2016 and 2017 in 11 public Kuwait hospitals were assigned to lineages previously known to be associated with livestock. They were characterized using antibiogram, spa typing, and DNA microarray for the assignment of clonal complexes (CCs) and detection of antibiotic resistance and virulence determinants. Identification as putative LA-MRSA clones was based on the molecular definition inferred from DNA microarray. The LA-MRSA isolates consisted of CC96 (N = 31), CC97 (N = 169), and CC398 (N = 2). Isolates belonging to CC96 and CC398 were resistant to erythromycin and clindamycin mediated by erm(A) and erm(C). CC97 isolates were multiresistant to gentamicin, kanamycin, erythromycin, clindamycin, tetracycline, chloramphenicol, fusidic acid, trimethoprim, and ciprofloxacin and harbored aacA-aphD, erm(A), erm(C), msr(A), tet(K), cat, fusC, and dfrS1. In total, 35 spa types were identified among the isolates. CC398 isolates consisted of t899 and t034. Ten spa types were identified among CC96 with t11822 (N = 13) as the most prevalent. CC97 consisted of 26 spa types with most belonging to t267 (N = 73) followed by t359 (N = 39). CC398 was composed of CC398-MRSA-IV and CC398-MRSA-V (PVL +). CC96 belonged to CC96-MRSA-IV and CC96-MRSA-IV (PVL +) Central Asian caMRSA/WA MRSA-119. CC97 consisted of six strains including CC97-MRSA-V (fusC +), CC97-MRSA-IV WA MRSA-54/63, CC97-MRSA-V, CC97-MRSA-(V+fus), CC97-MRSA-(mec VI+fus), and CC97-MRSA (mecV/V T +fus+ccrAB2). Whereas CC96 and CC97 isolates were identified in 2016 and 2017, CC398 isolates were detected only in 2016. This study identified four LA-MRSA clones among MRSA isolated from patients in Kuwait hospitals in 2016-2017 with CC97-MRSA-V (fusC +) as the dominant clone. The presence of LA-MRSA with different genetic backgrounds suggests its independent acquisition from different sources.

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

“…CC97 isolates belonged to either spa-type t1190 or t2802. spa-type t1190 is a rabbit-specific strain since it has been previously found in rabbit meat [36,37] and lesions [38]. As for spa-type t2802, it has been reported mostly associated with bovine livestock but also with humans [39,40].…”

Multidrug-Resistant Bacteria Isolated from Different Aquatic Environments in the North of Spain and South of France

“…In addition, the presence of gene mecC has been reported for the first time in a Spanish river, highlighting the potential role of water in the dissemination of mecC MRSA [ 19 ]. S. aureus mecC was also isolated from animals and an urban wastewater treatment plant [ 55 ] and other studies highlighted the emergence of S. aureus mecC in livestock production, particularly in pigs in European countries [ 56 ]. In this sense, our two MRSA strains (negative for the mecA gene in the PBP2a test) were isolated from rivers (numbers 54 and 55 in Table 6 ) with high incidence from pig exploitations, which would reinforce this hypothesis.…”

The Dissemination and Molecular Characterization of Clonal Complex 361 (CC361) Methicillin-Resistant Staphylococcus aureus (MRSA) in Kuwait Hospitals

“…In contrast, CA-MRSA are usually more susceptible to non-beta-lactam antibiotics and carry SCC mec types IV, V, or VI ( David and Daum, 2010 ). The Livestock-associated MRSA (LA-MRSA) initially caused major problems in agriculture and were the leading cause of bovine mastitis ( Fluit, 2012 ) but have now become prominent among livestock, people associated with livestock and those with no previous contact with livestock ( Graveland et al, 2011 ; Köck et al, 2013 ; Wagenaar et al, 2009 ; Boswihi et al, 2020a ).…”

“…Molecular typing tools including staphylococcal protein A (spa) typing, multilocus sequence typing (MLST), pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec (SCC mec ) typing, DNA microarray, and whole genome sequencing (WGS) have been used in the epidemiologic surveillance of MRSA strains to detect and monitor emerging and reemerging infections as well as monitoring geographic spread and shifts of epidemic and endemic clones ( Pfaller, 1999 ; van Belkum et al, 2001 ; Monecke et al, 2011 ; Boswihi et al, 2016 , 2020a , 2020b ; Rebic et al, 2016 ). The application of these typing techniques to type MRSA from different geographic regions have shown that most of the MRSA infections reported worldwide were caused by a limited number of pandemic MRSA clones belonging to clonal complexes 5 (CC5), CC8/ST239, CC22, CC30, and CC45 ( Robinson and Enright, 2003 ; Monecke et al, 2011 ; Guthrie et al, 2020 ) although CA-MRSA isolates belong to more diverse genetic backgrounds compared to HA-MRSA ( Monecke et al, 2011 ; Udo, 2013 ; Tong et al, 2015 ; Guthrie et al, 2020 ).…”

“…Methicillin-resistant Staphylococcus aureus strains belonging to CC361 (CC361-MRSA) were described as rare and were reported sporadically in humans ( Afroz et al, 2008 ; Weber et al, 2010 ; Coombs et al, 2011 ; Monecke et al, 2011 ; Shambat et al, 2012 ; Kinnevey et al, 2014 ), Rhesus monkeys ( Roberts et al, 2019 ), Cattle ( Tegegne et al, 2017 ), and in ready-to-eat food items ( Islam et al, 2019 ). However, the CC361-MRSA have been increasingly isolated from human patients in the Arabian Gulf countries of Saudi Arabia ( Senok et al, 2019 ), United Arab Emirates ( Senok et al, 2020 ) and Kuwait ( Boswihi et al, 2018 , 2020a , 2020b ).…”