We aimed to determine the prevalence of antimicrobial resistance, carriage of Panton-Valentine leucocidin (PVL), and the clonal structure of MRSA isolates collected from skin and soft tissue infections at a tertiary care hospital in Pakistan. Between August 2021 and May 2022, 154 non-repetitive MRSA isolates were consecutively collected and characterized by antimicrobial susceptibility testing, SCCmec typing, spa typing, and detection of PVL by PCR. MLST clonal complexes (CCs) were inferred from spa type using the Based Upon Repeat Pattern (BURP) algorithm. High levels of resistance were observed to ciprofloxacin (85.7%), erythromycin (76.0%), sulfamethoxazole (68.8%), gentamicin (68.8%), fusidic acid (57.8%), tetracycline (55.8%), and clindamycin (42.2%). Clonal analysis revealed 16 lineages, with the most frequent being CC8-MRSA-IV (27.3%), PVL-positive "Bengal Bay" CC1/ST772-MRSA-V (26.0%), and CC1-MRSA-IV (16.2%). PVL was detected in 45.5% of isolates across multiple lineages. Our findings highlight the coexistence of high antimicrobial resistance and frequent PVL carriage among MRSA in Pakistan. Given the association of PVL with severe infections and the limited treatment options for multidrug-resistant strains, these data underscore a significant public health concern and the need for systematic surveillance and prudent antibiotic use.

Department of Medical Laboratory Technology https ror org 057d2v504Kohat University of Science and Technology Kohat Pakistan

Department of Medical Microbiology Charles University 2nd Faculty of Medicine and Motol University Hospital Prague Czech Republic

Department of Veterinary and Animal Sciences University of Copenhagen Copenhagen Denmark

Institute of Health Sciences Kohat https ror org 00nv6q035Khyber Medical University Peshawar Pakistan

Institute of Paramedical Sciences https ror org 00nv6q035Khyber Medical University Peshawar Pakistan

Zobrazit více v PubMed

Tong SY, et al. (2015) PubMed PMC

David MZ and Daum RS (2017) Treatment of PubMed

David MZ and Daum RS (2010) Community-associated methicillin-resistant PubMed PMC

Saeed K, et al. (2018) Panton-valentine leukocidin-positive PubMed

Ahmad MK and Asrar A (2014) Prevalence of methicillin resistant PubMed

Madzgalla S, et al. (2016) Molecular characterization of PubMed

Baede VO, et al. (2022) MRSA surveillance programmes worldwide: Moving towards a harmonised international approach. International Journal of Antimicrobial Agents 59, 106538. PubMed

Stefani S, et al. (2012) Meticillin-resistant PubMed

Kondo Y, et al. (2007) Combination of multiplex PCRs for staphylococcal cassette chromosome PubMed PMC

Clinical and Laboratory Standards Institute (CLSI) (2018) Performance Standards for Antimicrobial Susceptibility Testing, 28th Edn. Wayne, PA: Clinical and Laboratory Standards Institute.

Magiorakos AP, et al. (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection 18, 268–281. PubMed

Stegger M, et al. (2012) Rapid detection, differentiation and typing of methicillin-resistant PubMed

Harmsen D, et al. (2003) Typing of methicillin-resistant PubMed PMC

Idrees MM, et al. (2023) Prevalence of PubMed PMC

Siddiqui T, et al. (2017) MRSA: Prevalence and susceptibility pattern in health care setups of Karachi. Pakistan Journal of Pharmaceutical Sciences 30, 2417–2421. PubMed

Ullah A, et al. (2016) High frequency of methicillin-resistant PubMed PMC

Chen CJ and Huang YC (2014) New epidemiology of PubMed

Arfat Y, et al. (2013) Epidemiology of methicillin resistant

Khan AA, et al. (2020) First report of PubMed

Monecke S, et al. (2020) Genotyping of methicillin-resistant PubMed

Frisch MB, et al. (2018) Invasive methicillin-resistant PubMed PMC

Li M, et al. (2009) Evolution of virulence in epidemic community-associated methicillin-resistant PubMed PMC

Tkadlec J, et al. (2023) Epidemiology of methicillin-resistant PubMed PMC

Huang YC and Chen CJ (2022) USA300 (sequence type 8) has become a major clone of methicillin-resistant PubMed

Steinig EJ, et al. (2019) Evolution and global transmission of a multidrug-resistant, community-associated methicillin-resistant PubMed PMC

Jamil B, et al. (2018) Hospital-acquired methicillin-resistant PubMed

Earls MR, et al. (2021) Exploring the evolution and epidemiology of European CC1-MRSA-IV: Tracking a multidrug-resistant community-associated meticillin-resistant PubMed PMC

Abrudan MI, et al. (2023) Novel multidrug-resistant sublineages of PubMed PMC

Naimi HM, et al. (2021) Antibiotic resistance profile and molecular characterization of PubMed

Grundmann H, et al. (2010) Geographic distribution of PubMed PMC

Gostev V, et al. (2021) Comparative genome analysis of global and Russian strains of community-acquired methicillin-resistant PubMed

Rolo J, et al. (2012) High genetic diversity among community-associated PubMed PMC

Hetem DJ, et al. (2016) Molecular epidemiology of MRSA in 13 ICUs from eight European countries. Journal of Antimicrobial Chemotherapy 71, 45–52. PubMed

Mustafa T, et al. (2023) Regional and national trends in consumption of antimicrobials in Pakistan; pre and post-COVID (2019-2021). Clinical Infectious Diseases 77, S569–S577. PubMed PMC

Mirha HT, et al. (2024) The impact of antibiotic resistance on the rampant spread of infectious diseases in Pakistan: Insights from a narrative review. Health Science Reports 7, e2050. PubMed PMC

Klein EY, et al. (2024) Global trends in antibiotic consumption during 2016-2023 and future projections through 2030. Proceedings of the National Academy of Sciences of the United States of America 121, e2411919121. PubMed PMC