1 Mayo Clinic, Division of Infectious Diseases, Department of Internal Medicine, Rochester, Minnesota, USA.
2 American University of Beirut Medical Center, Division of Infectious Diseases, Department of Internal Medicine, Beirut, Lebanon.
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data suggest a high burden of methicillin-resistant staphylococcus
aureus (MRSA) in Arab countries of the Middle East and North Africa
(MENA). To review the MRSA rates and molecular epidemiology in this
region, we used PubMed search engine to identify relative articles
published from January 2005 to December 2019. Great heterogeneity in
reported rates was expectedly seen. Nasal MRSA colonization ranged from
2%-16% in Gulf Cooperation Council (GCC), 1-9% in the Levant, and
0.2%-9% in North African Arab states. Infective MRSA rates ranged from
9%-38% in GCC, 28%-67% in the Levant, and 28%-57% in North African
states. Studies demonstrated a wide clonal diversity in the MENA. The
most common molecular types belonged to 5 clonal complexes (CC) known
to spread worldwide: CC5, CC8, CC22, CC30, and CC80. The most prevalent
strains had genotypes related to the European community-acquired MRSA
(CA-MRSA), Brazilian/Hungarian hospital-acquired MRSA (HA-MRSA),
UK-EMRSA-15 HA-MRSA, and USA300 CA-MRSA. Finally, significant
antimicrobial resistance was seen in the region with variation in
patterns depending on location and clonal type. For a more accurate
assessment of MRSA epidemiology and burden, the Arab countries need to
implement national surveillance systems.
|Table 1. Major MRSA Clones Encountered Globally.|
ResultsMRSA colonization in the MENA region:
|Figure 1. Reported Rates of MRSA
Colonization in the MENA Region. MRSA carriage rate reported as % of
total nasal/pharyngeal swabs growing MRSA (i.e., total MRSA/total
swabs). The reported rates in the figure are for the total number of
subjects from all cited studies per country.
KSA [12-19]; Kuwait ; Oman [21,22]; Gaza and West Bank [23-25]; Jordan [26,27]; Lebanon [28,29]; Iraq ; Egypt [12,31-33]; Algeria [34,35]; Tunisia .
|Table 2. Reported Rates of MRSA Colonization in the MENA Region Stratified based on Cohorts.|
Figure 2. Reported Rates of Methicillin-resistance among Staphylococcus aureus from Clinical Specimen in the MENA Region. The figure demonstrates rates as percent of all clinical S. aureus isolates derived from all studies per country showing methicillin resistance (total MRSA/total S. aureus derived from clinical specimen).
KSA [37-40] UAE  Oman [42,43] Qatar [11,44] Gaza Jordan [46,47] Lebanon [48-50] Iraq [51-53] Egypt [54-57] Algeria[58-62] Tunisia [63-65]
|Table 3. Stratification of clinical isolates based on epidemiological criteria.|
|Table 4. Molecular Typing of Colonizing MRSA Isolates in the MENA Region.|
|Table 5. Molecular Typing of Infective MRSA Isolates in the MENA Region.|
|Table 6. Percent susceptibility of total MRSA isolates. Susceptibility presented as total # isolates susceptible/total isolates tested (% susceptible).|
|Supplementary Table 1. The table presents the relative global frequencies of spa types. Only those >/= 0.5% are reported here. Data is adopted from http://www.spaserver.ridom.de. It also lists the Arab countries that reported these spa types based on our review of literature.|
|Supplementary Table 2. Reported Rates of Methicillin-Resistance among Staphylococcus aureus from clinical specimen in MENA Region. MRSA rates presented as total MRSA/total S. aureus isolates. All isolates were from various clinical samples unless otherwise specified. Numerical values are rounded to the nearest whole digit.|
|Supplementary Table 3. Molecular Typing of Colonizing MRSA Strains in the MENA Region. Numerical values are rounded to the nearest whole digit.|
|Supplementary Table 4.Molecular Typing of Infective MRSA Isolates in the MENA Region.|
|Supplementary Table 5. Antimicrobial Susceptibility Profile of MRSA Isolates in the Arab World. Presented values are percentages of tested isolates. Infective isolates are labeled as CO-MRSA or HO-MRSA when specified by the cited study, otherwise they are labeled as Not specified.|
|Supplementary Figure 1. Illustrates how different typing techniques can be grouped together into a clonal complex.|