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Background  Methicillin-resistant  Staphylococcus aureus  (MRSA) is an established pathogen that causes hospital- and community-acquired infections worldwide. The prevalence rate of MRSA infections were reported to be the highest in Asia. As there is limited epidemiological study being done in Malaysia, this study aimed to determine the prevalence of MRSA infection and the molecular characteristics of MRSA bacteraemia.    Methods  Two hundred and nine MRSA strains from year 2011 to 2012 were collected from a tertiary teaching hospital in Malaysia. The strains were characterized by antimicrobial susceptibility testing, staphylococcal cassette chromosome  mec  (SCC mec ) typing, detection of Panton-Valentine leukocidin (PVL) gene, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Patient’s demographic and clinical data were collected and correlated with molecular data by statistical analysis.    Results  Male gender and patient >50 years of age ( p  < 0.0001) were significantly associated with the increased risk of MRSA acquisition. Fifty-nine percent of MRSA strains were HA-MRSA that carried SCC mec  type II, III, IV and V while 31% were CA-MRSA strains with SCC mec  III, IV and V. The prevalence of PVL gene among 2011 MRSA strains was 5.3% and no PVL gene was detected in 2012 MRSA strains. All of the strains were sensitive to vancomycin. However, vancomycin MIC creep phenomenon was demonstrated by the increased number of MRSA strains with MIC ≥1.5 μg/mL ( p  = 0.008) between 2011 and 2012. Skin disease ( p  = 0.034) and SCC mec  type III ( p  = 0.0001) were found to be significantly associated with high vancomycin MIC. Forty-four percent of MRSA strains from blood, were further subtyped by MLST and PFGE. Most of the bacteraemia cases were primary bacteraemia and the common comorbidities were diabetes, hypertension and chronic kidney disease. The predominant pulsotype was pulsotype C exhibited by SCC mec  III-ST239. This is a first study in Malaysia that reported the occurrence of MRSA clones such as SCC mec  V-ST5, untypeable-ST508, SCC mec  IV-ST1 and SCC mec  IV-ST1137.    Conclusions  SCC mec  type III remained predominant among the MRSA strains in this hospital. The occurrence of SCC mec  IV and V among hospital strains and the presence of SCC mec  III in CA-MRSA strains are increasing. MRSA strains causing bacteraemia over the two-year study period were found to be genetically diverse.

bmc infectious diseases

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection and the molecular characteristics of MRSA bacteraemia over a two-year period in a tertiary teaching hospital in Malaysia