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The oral cavity may comprise a significant reservoir for  Staphylococcus aureus  but the data on molecular epidemiology and clonal distribution of oral strains are really scarce. This study aimed to evaluate the clonal relatedness in  S. aureus  isolated from oral cavity and their relationship with carriage of virulence genes, and antimicrobial resistance profiles. A total of 139 oral  S. aureus  isolates were obtained from 2327 analysed oral samples of dental patients. Antimicrobial susceptibility testing was performed. Isolates were characterized using protein A gene ( spa ) typing,  spa -CC clonal complexes, toxin genes and SCC mec  typing for MRSA. High resistance rates for penicillin, tetracycline and gentamicin were detected, respectively 58.3%, 42.4%, and 35.2%. Twelve (8.6%)  S. aureus  isolates were identified as MRSA. All of MRSA isolates were  mec A-positive and  mec C-negative. SCC mec  IV was the most common type (66.7%), which was typical for community-acquired MRSA (CA-MRSA). Overall, the enterotoxin gene cluster ( egc ) was the most frequent detected virulence factor (44.9%), both in MSSA and MRSA isolates. Presence of genes encoding for the enterotoxins ( sea ,  seb ,  sec ,  seh ,  sek ), exfoliative toxin A ( eta ), and toxic shock syndrome toxin-1 ( tst ) was also observed. Strains carrying  lukS- PV /lukF- PV genes belonged to SCC mec V-  spa  type t437. The most prevalent  spa  types were t091, t015, t084, t002, t571, and t026 among all 57 identified.  Spa  types, including 3 new ones, grouped in 6 different  spa -CC clonal complexes, with four major dominated; CC45, CC30, CC5, and CC15. This study demonstrated that both methicillin-susceptible and methicillin-resistant major European clones of  S. aureus  could be isolated from the oral cavity of dental patients, with the emergence of PVL-positive CA-MRSA strains. The oral cavity should be considered as a possible source of toxigenic  egc- positive  S. aureus  strains, in terms of potential risk of cross-infection and dissemination to other body sites.

Presence of egc-positive major clones ST 45, 30 and 22 among methicillin-resistant and methicillin-susceptible oral Staphylococcus aureus strains