Trends in methicillin-resistant Staphylococcus aureus in the Gulf Cooperation Council countries: antibiotic resistance, virulence factors and emerging strains

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a ubiquitous pathogen that is increasing in Gulf Cooperation Council (GCC) countries. It is implicated in a wide range of infections, from superficial skin infections to lifethreatening syndromes. MRSA has moved beyond healthcare facilities, affecting individuals in the community without substantial risk factors. Aims: To review the prevalence and molecular characterization of MRSA in GCC countries during 2011–2021. Methods: We comprehensively searched PubMed using the following keywords: MRSA, Staphylococcus aureus, GCC, Kuwait, Saudi Arabia, Bahrain, Oman, Qatar, UAE, prevalence, and molecular characterization for articles published after 2011. Results: Thirty-nine of 111 articles examined, fulfilled the purpose of this review. Most studies were in Kuwait (44%), Saudi Arabia (28%) and United Arab Emirates (10%). Studies from other GCC countries were sporadic. Several studies demonstrated a clear emergence in antibiotic resistance especially against fusidic acid, ciprofloxacin and clindamycin. Regional prevalence of MRSA is reported as 25–35%, with clear dominance of community-acquired (CA)-MRSA. Panton– Valentine leucocidin (PVL)-producing strains accounted for 35–45%, with clear association with CA-MRSA emergence, but there were some sporadic reports of incorporation of PVL in healthcare-associated (HA)-MRSA. The reported dominant strains included EUST80, USA1100 and WA-MRSA-51. Novel strains are more likely to produce PVL and show fusidic acid resistance. Conclusion: There is a need for national and regional MRSA surveillance programmes, especially with the emergence of strains that require no underlying risk factors to cause illness, as well as the propagation of chimeric resistance elements in both HA-MRSA and CA-MRSA.

Multidrug-Resistant Staphylococcus aureus Isolates in a Tertiary Care Hospital, Kingdom of Bahrain

“…Moreover, outpatient isolates amounted to 69% (n=42) of PVL-producing MRSA and 85% (n=21) of PVL-producing MSSA. PVL-producing MRSA prevalence reported in this study is higher than average regional rates at 35-45%, nevertheless, few prevalence reports from nearby countries have detected comparable rates as in Qatar at 66%, Saudi Arabia at 59%, and Iran at 53% [24,25,30,33]. Similarly, PVLproducing MSSA rates reported in this study were higher than regional reports for example in a tertiary hospital in Kuwait PVL was detected in 12% of MSSA isolates, furtherly asserting the regional emergence of PVL in healthcare facilities [34].…”

“…Despite resistance rates being within the regional ranges, they show a substantial decline from a previous report from 2008 that reported overall higher antibiotic resistance rates in MRSA isolated from SMC [24,27]. This favorable decline may be attributed to the implementation of the "Antibiotic Resistance and Antibiotic Stewardship Program" in SMC in 2010 which mainly concentrated on educating healthcare providers on the dangers of antibiotic resistance and the liberal prescription of antimicrobials without microbiological evidence, however, more investigations are needed to ascertain the efficacy of this program.…”

“…SCCmec typing illustrated a dominance for type IV at 61% (n=59) followed by type V at 32% (n=31), while types II and III comprised 7% (n=4 and 3 respectively). This clear prominence of type IV has been demonstrated regionally, as the most dominant SCCmec type was type IV in most reports from Gulf Council Cooperation (GCC) countries (19-90%) over the past 10 years, as well as in Iran over 58-71% [ 24 - 26 ]. Locally, in a 2008 study conducted on inpatients hospitalized in SMC, the vast majority of MRSA isolates harbored SCCmec type III (86.7%), and the rest were type IV (13.3%) [ 27 ].…”

“…These community-associated strains harbor SCCmec types IV and V at rates of 68% (n=58) and 32% (n=27) respectively as seen in Table 6 . This emergence has been reported regionally to higher levels, as in Kuwait (91%), Oman (91%), Qatar (95%), and United Arab Emirates (UAE) (98%), in fact, most SCCmec typing reports in the GCC report a dominance in type IV CA-MRSA ranging from 19 to 90% [ 24 , 28 - 31 ]. The reason for this global phenomenon is not well-understood but can be attributed to improved genomic fitness and the ability to produce a large spectrum of virulence factors [ 32 ].…”

Infection risks associated with the 2022 FIFA World Cup in Qatar

“…In 2018, a fox and a camel were found rabid in Qatar demonstrating that rabies virus is still present in Qatar, at least in rural areas [ 29 ]. Other possible infectious disease risks include measles, hepatitis A and B, travellers' diarrhoea and possible acquisition of multi-drug resistant bacteria (MDR) [ 30 ], with possible dissemination of MDR bacteria in MG [ 31 ]. To mitigate the afore-mentioned risks, visitors to the tournament should be up to date with their routine vaccinations and observe the rules for safe consumption of food and drinks.…”