AUTHOR=McTavish Sharla M. , Snow Sarah J. , Cook Ellie C. , Pichon Bruno , Coleman Sarah , Coombs Geoffrey W. , Pang Stanley , Arias Cesar A. , Díaz Lorena , Boldock Emma , Davies Steve , Udukala Mangala , Kearns Angela Marie , Siribaddana Sisira , de Silva Thushan I. 

TITLE=Genomic and Epidemiological Evidence of a Dominant Panton-Valentine Leucocidin-Positive Methicillin Resistant Staphylococcus aureus Lineage in Sri Lanka and Presence Among Isolates From the United Kingdom and Australia

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=9

YEAR=2019

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2019.00123

DOI=10.3389/fcimb.2019.00123

ISSN=2235-2988

ABSTRACT=<p><bold>Objective:</bold> To undertake the first detailed genomic analysis of methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) isolated in Sri Lanka.</p><p><bold>Methods:</bold> A prospective observational study was performed on 94 MRSA isolates collected over a 4 months period from the Anuradhapura Teaching Hospital, Sri Lanka. Screening for <italic>mec</italic>A, <italic>mec</italic>C, and the Panton-Valentine leucocidin (PVL)-associated <italic>lukS-PV/lukF-PV</italic> genes and molecular characterization by <italic>spa</italic> typing was undertaken. Whole genome sequencing (WGS) and phylogenetic analysis was performed on selected multilocus sequence type (MLST) clonal complex 5 (CC5) isolates from Sri Lanka, England, Australia, and Argentina.</p><p><bold>Results:</bold> All 94 MRSA harbored the <italic>mecA</italic> gene. Nineteen <italic>spa</italic> types belonging to nine MLST clonal complexes were identified. Where origin of the sample was recorded, most isolates were from skin and soft tissue infections (70/91; 76.9%), with fewer causing bacteremia (16/91; 17.6%), empyema (3/91; 3.3%) and osteomyelitis (2/91; 2.2%). Sixty two (65.9%) isolates were PVL positive with the majority (56 isolates; 90.3%) belonging to a dominant CC5 lineage. This lineage, PVL-positive ST5-MRSA-IVc, was associated with both community and hospital-onset infections. Based on WGS, representative PVL-positive ST5-MRSA-IVc isolates from Sri Lanka, England and Australia formed a single phylogenetic clade, suggesting wide geographical circulation.</p><p><bold>Conclusions:</bold> We present the most detailed genomic analysis of MRSA isolated in Sri Lanka to date. The analysis identified a PVL-positive ST5-MRSA-IVc that is prevalent among MRSA causing clinical infections in Sri Lanka. Furthermore, this clone was also found among isolates from the United Kingdom and Australia.</p>