Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt

Abstract

Epidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA) prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureus and MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureus isolates were characterized by antibiotic susceptibility, presence of mecA and PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL(+) isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80) were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence.

Keywords: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA); Outpatients in Egypt and Saudi Arabia; SCCmec typing; Spa typing.

Fig. 1

Number of S. aureus, MRSA, MSSA isolates with PVL(+) percentage in Egypt and Saudi Arabia.

Fig. 2

Number and percentage of Isolates of MRSA per spa types.

Fig. 3

Phylogenetic similarity of MRSA isolates from Egyptian outpatients. A Neighbor-joining tree was constructed using spa gene sequences. The sequences analyzed using the BioNumerics software version 7.1 (APPLIED MATHS, Austin, USA), EG; Egyptian isolates.

Fig. 4

Phylogenetic similarity of MRSA isolates from Saudi Arabian outpatients. A Neighbor-joining tree was constructed using spa gene sequences. The sequences analyzed using the BioNumerics software version 7.1 (APPLIED MATHS, Austin, USA), SA; Saudi Arabian isolates.

Fig. 5

Phylogenetic similarity of MRSA isolates from Egyptian (EG) and Saudi Arabian (SA) outpatients. A Neighbor-joining tree was constructed using spa gene sequences. The sequences analyzed using the BioNumerics software version 7.1 (APPLIED MATHS, Austin, USA).