Molecular Characterization, Drug Resistance and Virulence Analysis of Constitutive and Inducible Clindamycin Resistance Staphylococcus aureus Strains Recovered from Clinical Samples, Tehran – Iran

Figures & data

Table 1 Distribution of iMLS_B, cMLS_B and MS Phenotypes in 86 Nosocomial S. aureus Strains Isolated from Clinical Sources

Samples	Phenotypes			Total, n (%)
	iMLSB	cMLSB	MS
Wound	17 (60.7)	11 (39.3)	–	28 (32.6)
Pus	2 (9.5)	19 (90.5)	–	21 (24.4)
Blood	10 (52.6)	1 (5.3)	8 (42.1)	19 (22.1)
Sputum	–	7 (100)	–	7 (8.1)
CSF	–	4 (66.7)	2 (33.3)	6 (7)
Urine	–	5 (100)		5 (5.8)
Total	29 (33.7)	47 (54.7)	10 (11.6)	86 (100)

Table 2 Antimicrobial Resistance Pattern of Nosocomial MRSA and MSSA Isolates with Inducible and Constitutive Phenotype

Antibiotic	65 MRSA Isolates n (%)			21 MSSA Isolates n (%)			Total n (%)
	iMLSB	cMLSB	MS	cMLSB	iMLSB	MS
Penicillin	29 (39.7)	26 (35.6)	10 (13.7)	–	8 (11)	–	73 (84.8)
Ceftriaxone	24 (35.3)	24 (35.3)	9 (13.2)	–	11 (16.2)	–	68 (79.1)
Gentamicin	24 (43.6)	18 (32.7)	9 (16.4)	–	4 (7.3)	–	55 (64)
Kanamycin	8 (42.1)	3 (15.8)	–	–	8 (42.1)	–	19 (22.1)
Amikacin	8 (27.6)	3 (10.3)	–	–	18 (62.1)	–	29 (33.7)
Tobramycin	14 (51.9)	11 (40.7)	2 (7.4)	–	–	–	27 (31.4)
Tetracycline	19 (32.2)	18 (30.5)	4 (6.8)	–	18 (30.5)	–	59 (68.6)
Ciprofloxacin	14 (29.2)	17 (35.4)	3 (6.2)	–	14 (29.2)	–	48 (55.8)
Rifampicin	9 (69.2)	3 (23.1)	1 (7.7)	–	–	–	13 (15.1)
Mupirocin	5 (62.5)	2 (25)	1 (12.5)	–	–	–	8 (9.3)
Quinupristin-dalfopristin	5 (41.7)	2 (16.7)	1 (8.3)	-	4 (33.3)	-	12 (13.9)
Trimethoprim-sulfamethoxazole	6 (40)	-	6 (40)	-	3 (20)	-	15 (17.4)
Fusidic acid	-	-	-	-	4 (100)	-	4 (4.6)
Tigecycline	1 (50)	-	1 (50)	-	-	-	2 (2.3)

Table 3 Distribution of coa, SCCmec Types and Resistance Profiles of Nosocomial MRSA and MSSA Isolates with Inducible and Constitutive Phenotype

Phenotypes No. (%)	Virulence Genes (No.; %)	coa Type (No.; %)	SCCmec Type (No.; %)	Phenotypic Resistance Profile ^a (No.; %)	Genetic Resistance Profile (No.; %)	Hospitals (No.;%)	Methicillin Pattern (No.; %)
cMLSB	tst (8; 30.8), eta (3; 11.5)	III (1; 3.8)	III (1; 3.8)	PG, CRO, GM, K, AK, TN, T, RI (1; 3.8)	mecA (26; 100), tet(M) (15; 57.7), erm(C) (18; 69.2), erm(A) (5; 19.2), erm(B) (2; 7.7), ant (4΄)-Ia (10; 38.5), aph (3΄)-IIIa (3; 11.5), aac (6΄)-Ie/aph (2˝) (6; 23.1)	H1 (9; 34.6), H2 (7; 26.9), H3 (6; 23.1), H4 (4; 15.4)	MRSA (26; 30.2)
		II (2; 7.7), III (6; 23.1), V (7; 26.9)	III (10; 38.5), II (5; 19.2)	PG, CRO, GM, T, CIP (15; 57.7)
		V (4; 15.4), II (4; 15.4)	III (3; 11.6), IV (5; 19.2)	PG, CRO, TN (8; 30.8)
		II (2; 7.7)	II (2; 7.7)	PG, GM, K, AK, TN, T, RI, CIP, SYN, MUP (2; 7.7)
	pvl (9; 42.9), eta (2; 9.5)	III (7; 33.3)	–	PG, AK, T, CRO, CIP (7; 33.3)	fusB (3; 14.3), fusC (1; 4.8), tet(M) (12; 57.1), erm(C) (17;80.9), erm(A) (2; 9.6), erm(B) (3; 14.3), ant (4΄)-Ia (8; 38.1), aph (3΄)-IIIa (5; 23.8), aac (6΄)-Ie/aph (2˝) (7; 33.3)	H1 (5; 23.8), H2 (6; 28.6), H4 (10; 47.6)	MSSA (21; 24.4)
		III (4; 19)		CRO, GM, K, AK, T, CIP, SYN, FC (4; 19)
		III (3; 14.3)		K, AK, T, CIP, TS (3; 14.3)
		III (4; 19)		AK, T (4; 19)
		III (1; 4.8)		PG, K (1; 4.8)
		III (2; 9.6)		Without resistance (2; 9.6)
iMLSB	pvl (15; 51.7), tst (10; 34.5),	II (4; 13.8)	II (4; 13.8)	PG, CRO, GM, K, AK, TN, T, RI (4; 13.8)	mecA (29; 100), mupA (5; 17.2), tet(M) (13; 44.8), msr(A) (15; 51.7), msr(B) (6; 20.7), erm(B) (6; 20.7), ant (4΄)-Ia (5; 17.2), aph (3΄)-IIIa (2; 6.9), aac (6΄)-Ie/aph (2˝) (5; 17.2)	H1 (9; 31.1), H2 (5; 17.2), H3 (10; 34.5), H4 (5; 17.2)	MRSA (29; 33.8)
		II (4; 13.8), V (6; 20.7)	II (4; 13.8), IV (6; 20.7)	PG, CRO, GM, T, CIP (10; 34.5)
		II (5; 17.2)	II (5; 17.2)	PG, CRO, GM, TS (5; 17.2)
		II (5; 17.2)	III (5; 17.2)	PG, CRO, TN, (5; 17.2)
		II (4; 13.8)	III (4; 13.8)	PG, GM, K, AK, TN, T, RI, CIP, SYN, MUP (4; 13.8)
		V (1; 3.5)	IV (1; 3.5)	PG, GM, TN, T, RI, MUP, TS, SYN, TIG (1; 3.5)
MS	pvl (4; 40)	I (3; 30)	III (10; 100)	PG, CRO, GM, T, CIP (3; 30)	mecA (10; 100), mupA (1; 10), tet(M) (3; 30), msr(A) (3; 30), msr(B) (2; 20), erm(B) (1; 10), ant (4΄)-Ia (2; 20), aph (3΄)-IIIa (2; 20),	H1 (2; 20), H2 (2; 20), H3 (2; 20), H4 (4; 40)	MRSA (10; 11.6)
		I (5 50)		PG, CRO, GM, TS (5; 50)
		I (1; 10)		PG, CRO, TN (1; 10)
		I (1; 10)		PG, GM, TN, T, RI, MUP, TS, SYN, TIG (1; 10)

Abbreviations: PG, penicillin; CRO, ceftriaxone; GM, gentamicin; K, kanamycin; AK, amikacin; TN, tobramycin; T, tetracycline; TS, trimethoprim-sulfamethoxazole; FC, fusidic acid; CIP, ciprofloxacin; SYN, quinupristin-dalfopristin; TIG, tigecycline; RI, rifampicin; MUP, mupirocin.