title: Epidemiological typing of meticillin-resistant Staphylococcus aureus isolates from Pakistan and India.
abstract: The levels of meticillin-resistant Staphylococcus aureus (MRSA) in Pakistan and India are known to be high, but few studies have described the epidemiology of the different MRSA clones present. In order to gain an understanding of the epidemiology of MRSA within this region, 60 MRSA isolates from Pakistan (49) and India (11) were genotyped. All isolates were typed using PFGE, staphylococcal interspersed repeat units (SIRUs), a restriction-modification method and staphylococcal cassette chromosome mec (SCCmec) typing. A subset of isolates that were distinct by PFGE and SIRUs were typed using multilocus sequence typing (MLST). Clonal complex (CC) 8 was the dominant clonal complex (57/60) and was present in both Pakistan and India. Within CC8, there were 10 SIRU profiles and 24 PFGE profiles. Two SIRU profiles were present in isolates from both India and Pakistan, whilst seven were distinct for Pakistan and one for India. All PFGE profiles were distinct for each of the two countries. Thirty-four of the 57 isolates carried SCCmec type III/IIIa and the remainder carried type IV SCCmec. MLST analysis of 14 CC8 isolates with diverse SIRU and PFGE profiles showed that all were single-locus variants, with nine belonging to sequence type (ST) 239, three to ST8 and two to ST113. From a single hospital in Pakistan, three isolates belonged to CC30 and all were indistinguishable by PFGE and SIRUs and carried the Panton-Valentine leukocidin gene. Thus, epidemiological typing of strains from three distinct locations in India and Pakistan revealed the predominance of one clonal complex and highly related STs. The ability of SIRUs and PFGE to differentiate within ST239 demonstrates their utility in defining local epidemiology in these countries.
authors.affiliation: West Midlands Public Health Laboratory, Health Protection Agency, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Sahida
authors.initials: S
authors.lastname: Shabir
authors.affiliation: Division of Infection and Immunity, University of Birmingham, Birmingham B15 2TT, UK.|West Midlands Public Health Laboratory, Health Protection Agency, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hardy
authors.affiliation: Department of Biochemistry, Faculty of Biosciences, Quaid-E-Azam University, Islamabad, Pakistan.
authors.forename: Waseem S
authors.initials: WS
authors.lastname: Abbasi
authors.affiliation: West Midlands Public Health Laboratory, Health Protection Agency, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Claire L
authors.initials: CL
authors.lastname: McMurray
authors.affiliation: Department of Biochemistry, Faculty of Biosciences, Quaid-E-Azam University, Islamabad, Pakistan.
authors.forename: Salman A
authors.initials: SA
authors.lastname: Malik
authors.affiliation: Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 10061, India.
authors.forename: Chand
authors.initials: C
authors.lastname: Wattal
authors.affiliation: Division of Infection and Immunity, University of Birmingham, Birmingham B15 2TT, UK.|West Midlands Public Health Laboratory, Health Protection Agency, Heart of England Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hawkey
mesh_terms: D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006801:Humans; D007194:India / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D017720:Molecular Epidemiology; D010154:Pakistan / Q000453:epidemiology; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*