title: Diversity of methicillin-resistant Staphylococcus aureus CC22-MRSA-IV from Saudi Arabia and the Gulf region.
abstract: OBJECTIVE
  CC22-MRSA-IV, UK-EMRSA-15/Barnim EMRSA, is a common and pandemic strain of methicillin-resistant Staphylococcus aureus (MRSA) that has been found mainly in Western Europe, but also in other parts of the world including some Gulf countries. One suspected case of an infection with this strain in a patient who was admitted to the surgical unit in Riyadh, Kingdom of Saudi Arabia (KSA) was investigated in order to check whether this strain has reached KSA.
  
  
  METHODS
  Besides the index isolate, 46 additional isolates of CC22-MRSA-IV from patients from KSA, Abu Dhabi, Kuwait, and Germany (patients with a history of travel in the Middle East), were characterized by microarray hybridization.
  
  
  RESULTS
  The study revealed a regional presence of as many as six distinct 'strains' of CC22-MRSA-IV that could be distinguished based on carriage of SCCmec IV subtypes and virulence factors. No true UK-EMRSA-15/Barnim EMRSA was identified in Riyadh; all suspected isolates from Riyadh were assigned to other, albeit related strains. However, this strain was identified in Abu Dhabi and Kuwait.
  
  
  CONCLUSIONS
  CC22-MRSA-IV from KSA could be linked to other epidemic strains from the Middle East and possibly India, rather than to the Western European UK-EMRSA-15/Barnim EMRSA. High-resolution typing methods, including SCCmec subtyping, might help to differentiate related epidemic strains and to monitor routes of transmission.
authors: Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
authors: Abiola
authors: A
authors: Senok
authors: Department of Pathology and Laboratory Medicine, College of Medicine, King Khalid University Hospital and King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors: Ali
authors: A
authors: Somily
authors: Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
authors: Adeola
authors: A
authors: Raji
authors: Institute for Medical Microbiology and Hygiene (IMMH), Technische Universität Dresden, Dresden, Germany; Hamm-Lippstedt University, Hamm, Germany.
authors: Darius
authors: D
authors: Gawlik
authors: Department of Medicine, Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
authors: Fatimah
authors: F
authors: Al-Shahrani
authors: Department of Medicine, Division of Infectious Diseases, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
authors: Shehla
authors: S
authors: Baqi
authors: Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.
authors: Samar
authors: S
authors: Boswihi
authors: Molecular Pathology Laboratory, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
authors: Leila
authors: L
authors: Skakni
authors: Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.
authors: Edet E
authors: EE
authors: Udo
authors: Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors: Stefan
authors: S
authors: Weber
authors: Alere Technologies GmbH, Jena, Germany; InfectoGnostics Research Campus, Jena, Germany.
authors: Ralf
authors: R
authors: Ehricht
authors: Institute for Medical Microbiology and Hygiene (IMMH), Technische Universität Dresden, Dresden, Germany; Alere Technologies GmbH, Jena, Germany; InfectoGnostics Research Campus, Jena, Germany. Electronic address: monecke@rocketmail.com.
authors: Stefan
authors: S
authors: Monecke
mesh_terms: D005858:Germany; D006801:Humans; D007194:India; D007730:Kuwait; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012529:Saudi Arabia / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D014479:United Arab Emirates; D037521:Virulence Factors
chemical_list: D037521:Virulence Factors
keywords: MRSA; Molecular typing; SCCmec; Staphylococcus aureus