title: Genetic characterization of a vancomycin-resistant Staphylococcus aureus isolate from the respiratory tract of a patient in a university hospital in northeastern Iran.
abstract: Emergence of vancomycin-intermediate Staphylococcus aureus (VISA) and vancomycin-resistant S. aureus (VRSA) strains has led to global concerns about treatments for staphylococcal infections. These strains are currently rare even though there is an upward trend in their reported incidence. Therefore, appropriate screening and epidemiological evaluation of VRSA strains can affect future global health care policies. Isolates of Staphylococcus aureus were obtained from various clinical samples and were then evaluated with agar screening, disk diffusion, and MIC methods to determine resistance to vancomycin and methicillin. After confirmation of the isolated VRSA strain, genetic analysis was performed by evaluating mecA and vanA gene presence, SCCmec, agr, and spa types, and toxin profiles. Multilocus sequence typing (MLST) and plasmid analysis were also performed. The VRSA strain was resistant to oxacillin (MIC of 128 μg/ml) and vancomycin (MIC of 512 μg/ml). Disk diffusion antimicrobial susceptibility tests showed resistance to oxacillin, vancomycin, levofloxacin, ciprofloxacin, trimethoprim-sulfamethoxazole, clindamycin, rifampin, and tetracycline. The isolate was susceptible to minocycline and gentamicin. PCRs were positive for the mecA and vanA genes. Other genetic characteristics include SCCmec type III, agr I, spa type t037, and sequence type (ST) 1283. The plasmid profile shows five plasmids with a size of ~1.7 kb to >10 kb. The isolated VRSA strain was obtained from a critically ill hospitalized patient. Genetic analysis of this strain suggested that the strain was a methicillin-resistant S. aureus (MRSA) clone endemic in Asia that underwent some genetic changes, such as mutation in the gmk gene and acquisition of the vanA gene.
authors.affiliation: Department of Pathobiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Azimian
authors.forename: Seyed Asghar
authors.initials: SA
authors.lastname: Havaei
authors.forename: Hosein
authors.initials: H
authors.lastname: Fazeli
authors.forename: Mahmood
authors.initials: M
authors.lastname: Naderi
authors.forename: Kiarash
authors.initials: K
authors.lastname: Ghazvini
authors.forename: Siamak Mirab
authors.initials: SM
authors.lastname: Samiee
authors.forename: Masoud
authors.initials: M
authors.lastname: Soleimani
authors.forename: Shahin Najar
authors.initials: SN
authors.lastname: Peerayeh
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D006785:Hospitals, University; D006801:Humans; D007492:Iran; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D046915:Penicillin-Binding Proteins; D010957:Plasmids / Q000032:analysis; D016133:Polymerase Chain Reaction; D012137:Respiratory System / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D046915:Penicillin-Binding Proteins; C071437:VanA ligase, Bacteria; C487789:mecA protein, Staphylococcus aureus; D019729:Carbon-Oxygen Ligases