Emergence of Vancomycin-Resistant Staphylococcus aureus in the Southwest of Iran

Document Type : Original Research

Authors
V. Al-Khamis
S. E. Rezatofighi
H. Motamedi
Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
Abstract
Aims: Following the emergence of methicillin-resistant Staphylococcus aureus (MRSA) isolates, the use of other antibiotics especially vancomycin in S. aureus infections has become inevitable, leading to the emergence of vancomycin-resistant S. aureus (VRSA) strains, which is considered as a major public health concern. This study aimed to determine the vancomycin susceptibility patterns of S. aureus clinical isolates in order to evaluate the current status of vancomycin resistance in the southwest of Iran.

Materials & Methods: In this study, 100 S. aureus clinical strains were collected from the hospitals of Khuzestan province in the southwest of Iran. Next, antibiotic susceptibility, vancomycin resistance, and the presence of mecA, vanA, vanB, vanC, and vanD genes were investigated in these isolates.

Findings: It was found that 1 and 2 isolates were vancomycin-intermediate S. aureus (VISA) and VRSA, respectively. All three strains showed methicillin-resistance pattern and carried mecA gene. vanA gene was detected in VRSA strains, whereas vanB, vanC, and vanD genes were detected in none of these isolates.

Conclusion: This study findings could be alarming regarding the emergence and spread of VRSA strains; therefore, the principles of infection control should be employed in the healthcare systems to prevent the spread of VRSA strains in healthcare facilities.

Keywords

Subjects

[1] McGuinness WA, Malachowa N, DeLeo FR. Vancomycin Resistance in Staphylococcus aureus. The Yale journal of biology and medicine 2017;90:269-81.
[2] Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG, Jr., Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Archives of internal medicine 2009;169:463-73.
[3] Saadat S, Solhjoo K, Norooz-Nejad MJ, Kazemi A. VanA and VanB Positive Vancomycin-resistant Staphylococcus aureus Among Clinical Isolates in Shiraz, South of Iran. Oman medical journal 2014;29:335-9.
[4] Perichon B, Courvalin P. VanA-type vancomycin-resistant Staphylococcus aureus. Antimicrobial agents and chemotherapy 2009;53:4580-7.
[5] Azimian A, Havaei SA, Fazeli H, Naderi M, Ghazvini K, Samiee SM, et al. Genetic characterization of a vancomycin-resistant Staphylococcus aureus isolate from the respiratory tract of a patient in a university hospital in northeastern Iran. Journal of clinical microbiology 2012;50:3581-5.
[6] Cui L, Ma X, Sato K, Okuma K, Tenover FC, Mamizuka EM, et al. Cell wall thickening is a common feature of vancomycin resistance in Staphylococcus aureus. Journal of clinical microbiology 2003;41:5-14.
[7] Gardete S, Tomasz A. Mechanisms of vancomycin resistance in Staphylococcus aureus. The Journal of clinical investigation 2014;124:2836-40.
[8] Lalueza A, Chaves F, San Juan R, Daskalaki M, Otero JR, Aguado JM. Is high vancomycin minimum inhibitory concentration a good marker to predict the outcome of methicillin-resistant Staphylococcus aureus bacteremia? The Journal of infectious diseases 2010;201:311-2.
[9] Holland TL, Fowler VG, Jr. Vancomycin minimum inhibitory concentration and outcome in patients with Staphylococcus aureus bacteremia: pearl or pellet? The Journal of infectious diseases 2011;204:329-31.
[10] Holmes NE, Johnson PD, Howden BP. Relationship between vancomycin-resistant Staphylococcus aureus, vancomycin-intermediate S. aureus, high vancomycin MIC, and outcome in serious S. aureus infections. Journal of clinical microbiology 2012;50:2548-52.
[11] Arthur M, Molinas C, Depardieu F, Courvalin P. Characterization of Tn1546, a Tn3-related transposon conferring glycopeptide resistance by synthesis of depsipeptide peptidoglycan precursors in Enterococcus faecium BM4147. Journal of bacteriology 1993;175:117-27.
[12] Arthur M, Reynolds P, Courvalin P. Glycopeptide resistance in enterococci. Trends in microbiology 1996;4:401-7.
[13] Zhu W, Murray PR, Huskins WC, Jernigan JA, McDonald LC, Clark NC, et al. Dissemination of an Enterococcus Inc18-Like vanA plasmid associated with vancomycin-resistant Staphylococcus aureus. Antimicrobial agents and chemotherapy 2010;54:4314-20.
[14] Saderi H, Owlia P, Maleki Z, Habibi M, Rahmati N. Susceptibility to vancomycin in Staphylococcus aureus isolated from patients of four university-affiliated hospitals in Tehran. Iranian Journal of Pathology 2008;3:161-7.
[15] Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant enterococci. Clinical microbiology reviews 2000;13:686-707.
[16] Perl TM. The threat of vancomycin resistance. The American journal of medicine 1999;106:26S-37S.
[17] CLSI, Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. 2015; CLSI document M100-S25.
[18] Emaneini M, Bigverdi R, Kalantar D, Soroush S, Jabalameli F, Noorazar Khoshgnab B, et al. Distribution of genes encoding tetracycline resistance and aminoglycoside modifying enzymes in Staphylococcus aureus strains isolated from a burn center. Annals of burns and fire disasters 2013;26:76-80.
[19] Clark NC, Cooksey RC, Hill BC, Swenson JM, Tenover FC. Characterization of glycopeptide-resistant enterococci from U.S. hospitals. Antimicrobial agents and chemotherapy 1993;37:2311-7.
[20] Clark NC, Teixeira LM, Facklam RR, Tenover FC. Detection and differentiation of vanC-1, vanC-2, and vanC-3 glycopeptide resistance genes in enterococci. Journal of clinical microbiology 1998;36:2294-7.
[21] Weisburg WG, Barns SM, Pelletier DA, Lane DJ. 16S ribosomal DNA amplification for phylogenetic study. Journal of bacteriology 1991;173:697-703.
[22] Hasan R, Acharjee M, Noor R. Prevalence of vancomycin resistant Staphylococcus aureus (VRSA) in methicillin resistant S. aureus (MRSA) strains isolated from burn wound infections. Ci ji yi xue za zhi = Tzu-chi medical journal 2016;28:49-53.
[23] Shekarabi M, Hajikhani B, Salimi Chirani A, Fazeli M, Goudarzi M. Molecular characterization of vancomycin-resistant Staphylococcus aureus strains isolated from clinical samples: A three year study in Tehran, Iran. PloS one 2017;12:e0183607.
[24] Bamigboye BT, Olowe OA, Taiwo SS. Phenotypic and molecular identification of vancomycin resistance in clinical Staphylococcus aureus isolates in Osogbo, Nigeria. European journal of microbiology & immunology 2018;8:25-30.
[25] Wootton M, Howe RA, Walsh TR, Bennett PM, MacGowan AP. In vitro activity of 21 antimicrobials against vancomycin-resistant Staphylococcus aureus (VRSA) and heteroVRSA (hVRSA). The Journal of antimicrobial chemotherapy 2002;50:760-1.
[26] Moravvej Z, Estaji F, Askari E, Solhjou K, Naderi Nasab M, Saadat S. Update on the global number of vancomycin-resistant Staphylococcus aureus (VRSA) strains. International Journal of antimicrobial agents 2013; 42:370-1
[27] Hiramatsu K. The emergence of Staphylococcus aureus with reduced susceptibility to vancomycin in Japan. The American journal of medicine 1998;104:7S-10S.
[28] Tenover FC, Biddle JW, Lancaster MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerging infectious diseases 2001;7:327-32.
[29] Severin A, Wu SW, Tabei K, Tomasz A. Penicillin-binding protein 2 is essential for expression of high-level vancomycin resistance and cell wall synthesis in vancomycin-resistant Staphylococcus aureus carrying the enterococcal vanA gene complex. Antimicrobial agents and chemotherapy 2004;48:4566-73.
[30] Noto MJ, Fox PM, Archer GL. Spontaneous deletion of the methicillin resistance determinant, mecA, partially compensates for the fitness cost associated with high-level vancomycin resistance in Staphylococcus aureus. Antimicrobial agents and chemotherapy 2008;52:1221-9.
[31] Tiwari HK, Sen MR. Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India. BMC infectious diseases 2006;6:156.
Infection Epidemiology and Microbiology
Volume 5, Issue 4
December 2019
Pages 9-16