title: Molecular and Phenotypic Characterization of Multidrug-Resistant Clones of Staphylococcus epidermidis in Iranian Hospitals: Clonal Relatedness to Healthcare-Associated Methicillin-Resistant Isolates in Northern Europe.
abstract: The aim of the study was to investigate the molecular epidemiology of Staphylococcus epidermidis in Iranian hospitals and to compare the genotypes with a previously characterized collection of >1,300 S. epidermidis isolates of nosocomial and community origin from Northern Europe, Australia, and USA. In total, 82 clinical S. epidermidis isolates from three Iranian hospitals were examined by multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and staphylococcal cassette chromosome mec (SCCmec) typing. In addition, antimicrobial susceptibility, the presence of the ica operon, and the predilection to biofilm formation were assessed. Three predominant PFGE clones were found. The PFGE patterns of the most common sequence type (PFGE type 040-ST2) showed 80% similarity to multidrug-resistant S. epidermidis (MDRSE) clinical isolates from eight hospitals in Northern Europe. The second most common (PFGE 024-ST22) showed an unique PFGE pattern, whereas the third most predominant genotype (PFGE 011-ST5) proved indistinguishable to the PFGE Co-ST5 identified in five hospitals in Northern Europe. In conclusion, the study documented the dissemination of three MDRSE clones within and between hospitals in Iran and revealed an intercontinental spread of two clonal multidrug-resistant lineages (ST2 and ST5) in the hospital environment. Isolates of the predominant clones were significantly more frequently associated with multidrug-resistance and biofilm formation compared to nonclonal isolates. Further studies are needed to explore and characterize the genetic traits that enable these successful MDRSE clones to persist and disseminate worldwide in the healthcare settings.
authors.affiliation: 1 Department of Microbiology, School of Medicine, Kerman University of Medical Sciences , Kerman, Iran .
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Saffari
authors.affiliation: 2 Department of Clinical Microbiology, Unit of Research, Education and Development-Östersund, Umeå University , Umeå, Sweden .
authors.forename: Micael
authors.initials: M
authors.lastname: Widerström
authors.affiliation: 3 Department of Clinical Microbiology, Umeå University , Umeå, Sweden .
authors.forename: Bharat Kumar
authors.initials: BK
authors.lastname: Gurram
authors.affiliation: 3 Department of Clinical Microbiology, Umeå University , Umeå, Sweden .
authors.forename: Helen
authors.initials: H
authors.lastname: Edebro
authors.affiliation: 4 Department of Microbiology, School of Medicine, Semnan University of Medical Sciences , Semnan, Iran .
authors.forename: Zoya
authors.initials: Z
authors.lastname: Hojabri
authors.affiliation: 3 Department of Clinical Microbiology, Umeå University , Umeå, Sweden .
authors.forename: Tor
authors.initials: T
authors.lastname: Monsen
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development*; D002874:Chromosome Mapping; D002999:Clone Cells; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D016521:Electrophoresis, Gel, Pulsed-Field; D005060:Europe / Q000453:epidemiology; D005798:Genes, Bacterial; D006761:Hospitals; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D009876:Operon; D010802:Phylogeny; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D013212:Staphylococcus epidermidis / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: MLST; Staphylococci; infection; molecular epidemiology; multidrug-resistant; nosocomial