Investigating the relation between resistance pattern and type of Staphylococcal cassette chromosome mec (SCCmec) in methicillin-resistant Staphylococcus aureus
,
Abstract
Background and Objectives: MRSA became a widely recognized cause of mortality worldwide with necessity of its epidemiological pattern study. Typing of MRSA isolates was performed molecularly based on SCCmec type and relation to resistance pattern was investigated.
Materials and Methods: Out of 200 clinical specimens, S. aureus was detected phenotypically and confirmed as MRSA by PCR in 124 isolates obtained from associated laboratories of different hospitals of Zagazig, during 2018-2019. Antimicrobial resistance pattern was detected and MRSA SCCmec was typed by two methods.
Results: S. aureus rate was high in wounds, sputum, blood, and urine isolates. Antimicrobial resistance rates against cefotaxime, tetracycline, gentamicin, ciprofloxacin, erythromycin, azithromycin, clindamycin, chloramphenicol, sulfamethoxazole-trimethoprim, linezolid and vancomycin were 82.3%, 65.3%, 56.4%, 45.1%, 37.1%, 32.3%, 32.3%, 25%, 7.3%, 2.4% and 0%, respectively. Multiplex-PCR(M-PCR ) was able to detect SCCmec element among 57% of isolates classified as SCCmec II (n=40), III (n=21), IVa (n=3), IVd (n=2), V(n=1), and four isolates contain both SCCmec ІІ and SCCmec ІV. Traditional typing by PCR for mec and ccr gene complexes was almost concordant with M-PCR. Furthermore, it was able to identify SCCmec types VI, IX, and XIV among 1, 3 and 18 isolates, respectively. No Statistical correlation was established between type of cassette and rate of antimicrobial resistance. Phylogenetic analysis reveals that all ccr types were related to each other and no significant variation in the same ccr type of different SCCmec cassettes.
Conclusion: Most MRSA isolates were MDR reflecting antimicrobials misuse. Detection of various SCCmec types among MRSA isolates indictae the complexity of MRSA epidemiology and increase chance for gene sharing creating new types.The presented investigation was important in understanding MRSA epidemiology and diversity in Egypt providing advice for improving therapeutic protocols.
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4. Chongtrakool P, Ito T, Ma XX, Kondo Y, Trakulsomboon S, Tiensasitorn C, et al. Staphylococcal cassette chromosome mec (SCCmec) typing of methicillin-resistant Staphylococcus aureus strains isolated in 11 Asian countries: a proposal for a new nomenclature for SCCmec elements. Antimicrob Agents Chemother 2006; 50: 1001-1012.
5. Yamaguchi T, Ono D, Sato A. Staphylococcal Cassette Chromosome mec (SCCmec) analysis of MRSA. Methods Mol Biol 2020; 2069: 59-78.
6. Turlej A, Hryniewicz W, Empel J. Staphylococcal cassette chromosome mec (SCCmec) classification and typing methods: an overview. Pol J Microbiol 2011; 60:95-103.
7. McClure JA, Conly JM, Obasuyi O, Ward L, Ugarte-Torres A, Louie T, et al. A novel assay for detection of methicillin-resistant Staphylococcus aureus directly from clinical samples. Front Microbiol 2020; 11: 1295.
8. Liu J, Chen D, Peters BM, Li L, Li B, Xu Z, Shirliff ME. Staphylococcal chromosomal cassettes mec (SCCmec): a mobile genetic element in methicillin-resistant Staphylococcus aureus. Microb Pathog 2016; 101: 56-67.
9. Zahng K, MCClure JA, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcus cassette cassette chromosome mec types І to ᴠ in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005; 43: 5026-5033.
10. Okuma K, Iwakawa K, Turnidge JD, Grubb WB, Bell JM, O'Brien FG, et al. Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002; 40: 4289-4294.
11. Elshabrawy WO, Zaki ME, Kamel MF. Genetic and phenotypic study of methicillin-resistant Staphylococcus aureus among patients and health care workers in Mansoura university hospital, Egypt. Iran J Microbiol 2017; 9: 82-88.
12. Collee JG, Mackie TJ, McCartney JE (1996). Mackie & McCartney practical Medical Microbiology: 14th ed. Churchillivingstone. New York.
13. Wayne PA (2016). Performance standards for antimicrobial disk susceptibility tests; approved standard—11th ed. CLSI document M02-A11. Clinical and Laboratory Standards Institute.
14. Chapaval L, Moon DH, Gomes JE, Duarte FR, Tsai SM. An alternative method for Staphylococcus aureus DNA isolation. Arq Bras Med Vet Zootec 2008; 60: 299-306.
15. Sun J, Yang M, Sreevatsan S, Davies PR. Prevalence and characterization of Staphylococcus aureus in growing pigs in the USA. PLoS One 2015; 10(11): e0143670.
16. Ji Y. Methicillin-resistant Staphylococcus aureus (MRSA) protocols. Preface. Methods Mol Biol 2007; 391:v. :10.1007/978-1-59745-468-1.
17. Svensson K, Hellmark B, Söderquist B. Characterization of SCCmec elements in methicillin-resistant Staphylococcus epidermidis isolated from blood cultures from neonates during three decades. APMIS 2011; 119: 885-893.
18. Ito T, Katayama Y, Asada K, Mori N , Tsutsumimoto K, Tiensasitorn C, et al. Structural comparison of three types of staphylococcal cassette chromosome mec integrated in the chromosome in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2001; 45:1323-1336.
19. Kondo Y, Ito T, Ma XX, Watanabe S, Kreiswirth BN, Etienne J, et al. Combination of multiplex PCRs for staphylococcal cassette chromosome mec type assignment: rapid identification system for mec, ccr, and major differences in junkyard regions. Antimicrob Agents Chemother 2007; 51: 264-274.
20. Urushibara N, Paul SK, Hossain MA, Kawaguchiya M, Kobayashi1 N. Analysis of Staphylococcal cassette chromosome mec in Staphylococcus haemolyticus and Staphylococcus sciuri: identification of a novel ccr gene complex with a newly identified ccrA allotype (ccrA7). Microb Drug Resist 2011; 17: 291-297.
21. Kumar S, Stecher G, Li M, Knyaz C, Tamura K. MEGA X: Molecular evolutionary genetics analysis across computing platforms. Mol Biol Evol 2018; 35: 1547-1549.
22. El-Baz AM, Yahya G, Mansour B, El-Sokkary MMA, Alshaman R, Alattar A, et al. The Link between occurrence of class I integron and acquired aminoglycoside resistance in clinical MRSA isolates. Antibiotics (Basel) 2021; 10:488.
23. Youssef CR, Kadry AA, Shaker GH, El-Ganiny AM. The alarming association between antibiotic resistance and reduced susceptibility to biocides in nosocomial MRSA isolates from two regional hospitals in Egypt. Arch Microbiol 2021; 203: 3295-3303.
24. Morgan M, Evans-Williams D, Salmon R, Hosein I, Looker DN, Howard A. The population impact of MRSA in a country: the national survey of MRSA in Wales, 1997. J Hosp Infect 2000; 44: 227-239.
25. Humphreys H, Fitzpatick F , Harvey BJ. Gender differences in rates of carriage and bloodstream infection caused by methicillin-resistant Staphylococcus aureus: are they real, do they matter and why? Clin Infect Dis 2015; 61: 1708-1714.
26. Elshimy R, Khattab RA, Zedan H, Hosny AEDS , Elmorsy TH. Study on prevalence and genetic discrimination of methicillin-resistant Staphylococcus aureus (MRSA) in Egyptian hospitals. Afr J Microbiol Res 2018; 12: 629-646.
27. Algammal AM, Hetta HF, Elkelish A, Alkhalifah DHH, Hozzein WN, Batiha GE, et al. Methicillin-Resistant Staphylococcus aureus (MRSA): one health perspective approach to the bacterium epidemiology, virulence factors, antibiotic-resistance, and zoonotic impact. Infect Drug Resist 2020; 13: 3255-3265.
28. Lee MH, Lee HJ, Ryu PD. Public health risks: chemical and antibiotic residues-review. Asian-Australas J Anim Sci 2001; 14: 402-413.
29. Cassir N, Rolain JM, Brouqui P. A new strategy to fight antimicrobial resistance: the revival of old antibiotics. Front Microbiol 2014; 5: 551.
30. Jian Y, Lv H, Liu J, Huang Q, Liu Y, Liu Q , Li M. Dynamic changes of Staphylococcus aureus susceptibility to vancomycin, teicoplanin, and linezolid in a central teaching hospital in Shanghai, China, 2008–2018. Front Microbiol 2020; 11: 908.
31. Ito T, Ma XX, Takeuchi F, Okuma K, Yuzawa H, Hiramatsu K. Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC. Antimicrob Agents Chemother 2004; 48: 2637-2651.
32. Sadeghi Y, Salami SA, Kananizadeh P, Mozhgani SH, Pourmand MR. Real-time PCR followed by high-resolution melting analysis–a new robust approach to evaluate SCCmec typing of methicillin-resistant Staphylococcus aureus. Future Microbiol 2019; 14:155-164.
33. Abd El-Hamid MI, Bendary MM. Comparative phenotypic and genotypic discrimination of methicillin resistant and susceptible Staphylococcus aureus in Egypt. Cell Mol Biol (Noisy-le-grand) 2015; 61: 101-112.
34. Sobhy N, Aly F, El Kader OA, Ghazal A, Elbaradei A. Community-acquired methicillin-resistant Staphylococcus aureus from skin and soft tissue infections (in a sample of Egyptian population): Analysis of mec gene and staphylococcal cassette chromosome. Braz J Infect Dis 2012; 16: 426-431.
35. Perez-Roth E, Lorenzo-Diaz F, Batista N, Moreno A, Mendez Alvarez S. Tracking methicillin-resistant Staphylococcus aureus clones during a five-year period (1998 to 2002) in a Spanish hospital. J Clin Microbiol 2004; 42: 4649-4656.
36. Chung M, Dickinson G, De Lencastre H, Tomasz A. International clones of methicillin-resistant Staphylococcus aureus in two hospitals in Miami, Florida. J Clin Microbiol 2004; 42: 542-547.
37. Berglund C, Soderquist B. The origin of a methicillin-resistant Staphylococcus aureus isolate at a neonatal ward in Sweden-possible horizontal transfer of a staphylococcal cassette chromosome mec between methicillin-resistant Staphylococcus haemolyticus and Staphylococcus aureus. Clin Microbiol Infect 2008; 14: 1048-1056.
38. Ruppe E, Barbier F, Mesli Y, Maiga A, Cojocaru R, Benkhalfat M, et al. Diversity of staphylococcal cassette chromosome mec structures in methicillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus strains among outpatients from four countries. Antimicrob Agents Chemother 2009; 53: 442-449.
39. Bhutia KO, Singh T, Adhikari L, Biswas S. Molecular characterization of community- & hospital-acquired methicillin-resistant & methicillin-sensitive Staphylococcus aureus isolates in Sikkim. Indian J Med Res 2015; 142: 330-335.
40. Nagasundaram N , Sistla S. Existence of multiple SCCmec elements in clinical isolates of methicillin-resistant Staphylococcus aureus. J Med Microbiol 2019; 68: 720-727.
41. Bimanand L, Taherikalani M, Jalilian FA, Sadeghifard N, Ghafourian S, Mahdavi Z, et al. Association between biofilm production, adhesion genes and drugs resistance in different SCCmec types of methicillin resistant Staphylococcus aureus strains isolated from several major hospitals of Iran. Iran J Basic Med Sci 2018; 21: 400-403.
42. Murugesan S, Perumal N, Mahalingam SP, Dilliappan SK , Krishnan P. Analysis of antibiotic resistance genes and its associated SCCmec types among nasal carriage of methicillin resistant coagulase negative staphylococci from community settings, Chennai, Southern India. J Clin Diagn Res 2015; 9: DC01-5.
43. Bouchami O, Achour W, Mekni MA, Rolo J , Hassen AB. Antibiotic resistance and molecular characterization of clinical isolates of methicillin-resistant coagulase-negative staphylococci isolated from bacteremic patients in oncohematology. Folia Microbiol (Praha) 2011; 56:122-130.
44. Ito T, Kuwahara-Arai K, KatayamaY, Uehara Y, Han X, Kondo Y, et al. Staphylococcal cassette chromosome mec (SCCmec) analysis of MRSA. Methods Mol Biol 2014; 1085: 131-148.
45. International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC). Classification of staphylococcal cassette chromosome mec (SCCmec): guidelines for reporting novel SCCmec elements. Antimicrob Agents Chemother 2009; 53: 4961-4967.
46. Bouchami O, Hassen AB, De Lencastre H , Miragaia M. High prevalence of mec complex C and ccrC is independent of SCCmec type V in Staphylococcus haemolyticus. Eur J Clin Microbiol Infect Dis 2012; 31: 605-614.
2. Raygada JL, Levine DP. Methicillin-resistant Staphylococcus aureus: a growing risk in the hospital and in the community. Am Health Drug Benefits 2009; 2: 86-95.
3. Miragaia M. Factors contributing to the evolution of Meca-mediated β-lactam resistance in Staphylococci: update and new insights from whole genome sequencing (WGS). Front Microbiol 2018; 9: 2723.
4. Chongtrakool P, Ito T, Ma XX, Kondo Y, Trakulsomboon S, Tiensasitorn C, et al. Staphylococcal cassette chromosome mec (SCCmec) typing of methicillin-resistant Staphylococcus aureus strains isolated in 11 Asian countries: a proposal for a new nomenclature for SCCmec elements. Antimicrob Agents Chemother 2006; 50: 1001-1012.
5. Yamaguchi T, Ono D, Sato A. Staphylococcal Cassette Chromosome mec (SCCmec) analysis of MRSA. Methods Mol Biol 2020; 2069: 59-78.
6. Turlej A, Hryniewicz W, Empel J. Staphylococcal cassette chromosome mec (SCCmec) classification and typing methods: an overview. Pol J Microbiol 2011; 60:95-103.
7. McClure JA, Conly JM, Obasuyi O, Ward L, Ugarte-Torres A, Louie T, et al. A novel assay for detection of methicillin-resistant Staphylococcus aureus directly from clinical samples. Front Microbiol 2020; 11: 1295.
8. Liu J, Chen D, Peters BM, Li L, Li B, Xu Z, Shirliff ME. Staphylococcal chromosomal cassettes mec (SCCmec): a mobile genetic element in methicillin-resistant Staphylococcus aureus. Microb Pathog 2016; 101: 56-67.
9. Zahng K, MCClure JA, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcus cassette cassette chromosome mec types І to ᴠ in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005; 43: 5026-5033.
10. Okuma K, Iwakawa K, Turnidge JD, Grubb WB, Bell JM, O'Brien FG, et al. Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002; 40: 4289-4294.
11. Elshabrawy WO, Zaki ME, Kamel MF. Genetic and phenotypic study of methicillin-resistant Staphylococcus aureus among patients and health care workers in Mansoura university hospital, Egypt. Iran J Microbiol 2017; 9: 82-88.
12. Collee JG, Mackie TJ, McCartney JE (1996). Mackie & McCartney practical Medical Microbiology: 14th ed. Churchillivingstone. New York.
13. Wayne PA (2016). Performance standards for antimicrobial disk susceptibility tests; approved standard—11th ed. CLSI document M02-A11. Clinical and Laboratory Standards Institute.
14. Chapaval L, Moon DH, Gomes JE, Duarte FR, Tsai SM. An alternative method for Staphylococcus aureus DNA isolation. Arq Bras Med Vet Zootec 2008; 60: 299-306.
15. Sun J, Yang M, Sreevatsan S, Davies PR. Prevalence and characterization of Staphylococcus aureus in growing pigs in the USA. PLoS One 2015; 10(11): e0143670.
16. Ji Y. Methicillin-resistant Staphylococcus aureus (MRSA) protocols. Preface. Methods Mol Biol 2007; 391:v. :10.1007/978-1-59745-468-1.
17. Svensson K, Hellmark B, Söderquist B. Characterization of SCCmec elements in methicillin-resistant Staphylococcus epidermidis isolated from blood cultures from neonates during three decades. APMIS 2011; 119: 885-893.
18. Ito T, Katayama Y, Asada K, Mori N , Tsutsumimoto K, Tiensasitorn C, et al. Structural comparison of three types of staphylococcal cassette chromosome mec integrated in the chromosome in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2001; 45:1323-1336.
19. Kondo Y, Ito T, Ma XX, Watanabe S, Kreiswirth BN, Etienne J, et al. Combination of multiplex PCRs for staphylococcal cassette chromosome mec type assignment: rapid identification system for mec, ccr, and major differences in junkyard regions. Antimicrob Agents Chemother 2007; 51: 264-274.
20. Urushibara N, Paul SK, Hossain MA, Kawaguchiya M, Kobayashi1 N. Analysis of Staphylococcal cassette chromosome mec in Staphylococcus haemolyticus and Staphylococcus sciuri: identification of a novel ccr gene complex with a newly identified ccrA allotype (ccrA7). Microb Drug Resist 2011; 17: 291-297.
21. Kumar S, Stecher G, Li M, Knyaz C, Tamura K. MEGA X: Molecular evolutionary genetics analysis across computing platforms. Mol Biol Evol 2018; 35: 1547-1549.
22. El-Baz AM, Yahya G, Mansour B, El-Sokkary MMA, Alshaman R, Alattar A, et al. The Link between occurrence of class I integron and acquired aminoglycoside resistance in clinical MRSA isolates. Antibiotics (Basel) 2021; 10:488.
23. Youssef CR, Kadry AA, Shaker GH, El-Ganiny AM. The alarming association between antibiotic resistance and reduced susceptibility to biocides in nosocomial MRSA isolates from two regional hospitals in Egypt. Arch Microbiol 2021; 203: 3295-3303.
24. Morgan M, Evans-Williams D, Salmon R, Hosein I, Looker DN, Howard A. The population impact of MRSA in a country: the national survey of MRSA in Wales, 1997. J Hosp Infect 2000; 44: 227-239.
25. Humphreys H, Fitzpatick F , Harvey BJ. Gender differences in rates of carriage and bloodstream infection caused by methicillin-resistant Staphylococcus aureus: are they real, do they matter and why? Clin Infect Dis 2015; 61: 1708-1714.
26. Elshimy R, Khattab RA, Zedan H, Hosny AEDS , Elmorsy TH. Study on prevalence and genetic discrimination of methicillin-resistant Staphylococcus aureus (MRSA) in Egyptian hospitals. Afr J Microbiol Res 2018; 12: 629-646.
27. Algammal AM, Hetta HF, Elkelish A, Alkhalifah DHH, Hozzein WN, Batiha GE, et al. Methicillin-Resistant Staphylococcus aureus (MRSA): one health perspective approach to the bacterium epidemiology, virulence factors, antibiotic-resistance, and zoonotic impact. Infect Drug Resist 2020; 13: 3255-3265.
28. Lee MH, Lee HJ, Ryu PD. Public health risks: chemical and antibiotic residues-review. Asian-Australas J Anim Sci 2001; 14: 402-413.
29. Cassir N, Rolain JM, Brouqui P. A new strategy to fight antimicrobial resistance: the revival of old antibiotics. Front Microbiol 2014; 5: 551.
30. Jian Y, Lv H, Liu J, Huang Q, Liu Y, Liu Q , Li M. Dynamic changes of Staphylococcus aureus susceptibility to vancomycin, teicoplanin, and linezolid in a central teaching hospital in Shanghai, China, 2008–2018. Front Microbiol 2020; 11: 908.
31. Ito T, Ma XX, Takeuchi F, Okuma K, Yuzawa H, Hiramatsu K. Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC. Antimicrob Agents Chemother 2004; 48: 2637-2651.
32. Sadeghi Y, Salami SA, Kananizadeh P, Mozhgani SH, Pourmand MR. Real-time PCR followed by high-resolution melting analysis–a new robust approach to evaluate SCCmec typing of methicillin-resistant Staphylococcus aureus. Future Microbiol 2019; 14:155-164.
33. Abd El-Hamid MI, Bendary MM. Comparative phenotypic and genotypic discrimination of methicillin resistant and susceptible Staphylococcus aureus in Egypt. Cell Mol Biol (Noisy-le-grand) 2015; 61: 101-112.
34. Sobhy N, Aly F, El Kader OA, Ghazal A, Elbaradei A. Community-acquired methicillin-resistant Staphylococcus aureus from skin and soft tissue infections (in a sample of Egyptian population): Analysis of mec gene and staphylococcal cassette chromosome. Braz J Infect Dis 2012; 16: 426-431.
35. Perez-Roth E, Lorenzo-Diaz F, Batista N, Moreno A, Mendez Alvarez S. Tracking methicillin-resistant Staphylococcus aureus clones during a five-year period (1998 to 2002) in a Spanish hospital. J Clin Microbiol 2004; 42: 4649-4656.
36. Chung M, Dickinson G, De Lencastre H, Tomasz A. International clones of methicillin-resistant Staphylococcus aureus in two hospitals in Miami, Florida. J Clin Microbiol 2004; 42: 542-547.
37. Berglund C, Soderquist B. The origin of a methicillin-resistant Staphylococcus aureus isolate at a neonatal ward in Sweden-possible horizontal transfer of a staphylococcal cassette chromosome mec between methicillin-resistant Staphylococcus haemolyticus and Staphylococcus aureus. Clin Microbiol Infect 2008; 14: 1048-1056.
38. Ruppe E, Barbier F, Mesli Y, Maiga A, Cojocaru R, Benkhalfat M, et al. Diversity of staphylococcal cassette chromosome mec structures in methicillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus strains among outpatients from four countries. Antimicrob Agents Chemother 2009; 53: 442-449.
39. Bhutia KO, Singh T, Adhikari L, Biswas S. Molecular characterization of community- & hospital-acquired methicillin-resistant & methicillin-sensitive Staphylococcus aureus isolates in Sikkim. Indian J Med Res 2015; 142: 330-335.
40. Nagasundaram N , Sistla S. Existence of multiple SCCmec elements in clinical isolates of methicillin-resistant Staphylococcus aureus. J Med Microbiol 2019; 68: 720-727.
41. Bimanand L, Taherikalani M, Jalilian FA, Sadeghifard N, Ghafourian S, Mahdavi Z, et al. Association between biofilm production, adhesion genes and drugs resistance in different SCCmec types of methicillin resistant Staphylococcus aureus strains isolated from several major hospitals of Iran. Iran J Basic Med Sci 2018; 21: 400-403.
42. Murugesan S, Perumal N, Mahalingam SP, Dilliappan SK , Krishnan P. Analysis of antibiotic resistance genes and its associated SCCmec types among nasal carriage of methicillin resistant coagulase negative staphylococci from community settings, Chennai, Southern India. J Clin Diagn Res 2015; 9: DC01-5.
43. Bouchami O, Achour W, Mekni MA, Rolo J , Hassen AB. Antibiotic resistance and molecular characterization of clinical isolates of methicillin-resistant coagulase-negative staphylococci isolated from bacteremic patients in oncohematology. Folia Microbiol (Praha) 2011; 56:122-130.
44. Ito T, Kuwahara-Arai K, KatayamaY, Uehara Y, Han X, Kondo Y, et al. Staphylococcal cassette chromosome mec (SCCmec) analysis of MRSA. Methods Mol Biol 2014; 1085: 131-148.
45. International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC). Classification of staphylococcal cassette chromosome mec (SCCmec): guidelines for reporting novel SCCmec elements. Antimicrob Agents Chemother 2009; 53: 4961-4967.
46. Bouchami O, Hassen AB, De Lencastre H , Miragaia M. High prevalence of mec complex C and ccrC is independent of SCCmec type V in Staphylococcus haemolyticus. Eur J Clin Microbiol Infect Dis 2012; 31: 605-614.
| Files | ||
| Issue | Vol 14 No 1 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v14i1.8802 | |
| Keywords | ||
| Methicillin resistant Staphylococcus aureus; Antimicrobial; Resistance; Molecular typing; Cassette chromosome recombinase | ||
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How to Cite
1.
Youssef C, Kadry A, El-Ganiny A. Investigating the relation between resistance pattern and type of Staphylococcal cassette chromosome mec (SCCmec) in methicillin-resistant Staphylococcus aureus. Iran J Microbiol. 2022;14(1):56-66.
