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Molecular characterization of methicillin-resistant Panton-valentine leukocidin positive staphylococcus aureus clones disseminating in Tunisian hospitals and in the community

Ben Jomàa-Jemili Mariem1, Teruyo Ito23*, Meng Zhang2, Jingxun Jin2, Shanshuang Li2, Boutiba-Ben Boubaker Ilhem14, Hammami Adnan5, Xiao Han2 and Keiichi Hiramatsu23

Author Affiliations

1 Laboratoire de recherche Résistance aux antimicrobiens, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

2 Department of Infection Control Science, Juntendo University, Tokyo, Japan

3 Department of Bacteriology, Juntendo University, Tokyo, Japan

4 Department of Microbiology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia

5 Department of Bacteriology, Habib Borguiba Hospital of Sfax, Tunis, Tunisia

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BMC Microbiology 2013, 13:2  doi:10.1186/1471-2180-13-2

Published: 7 January 2013



The spread of MRSA strains at hospitals as well as in the community are of great concern worldwide. We characterized the MRSA clones isolated at Tunisian hospitals and in the community by comparing them to those isolated in other countries.


We characterized 69 MRSA strains isolated from two Tunisian university hospitals between the years 2004-2008. Twenty-two of 28 (79%) community-associated MRSA (CA-MRSA) strains and 21 of 41 (51%) healthcare-associated MRSA (HA-MRSA) strains were PVL-positive. The PVL-positive strains belonged to predicted founder group (FG) 80 in MLST and carried either type IVc SCCmec or nontypeable SCCmec that harbours the class B mec gene complex. In contrast, very diverse clones were identified in PVL-negative strains: three FGs (5, 15, and 22) for HA-MRSA strains and four FGs (5, 15, 45, and 80) for CA-MRSA strains; and these strains carried the SCCmec element of either type I, III, IVc or was nontypeable. The nucleotide sequencing of phi7401PVL lysogenized in a CA-MRSA strain JCSC7401, revealed that the phage was highly homologous to phiSA2mw, with nucleotide identities of more than 95%. Furthermore, all PVL positive strains were found to carry the same PVL phage, since these strains were positive in two PCR studies, identifying gene linkage between lukS and mtp (major tail protein) and the lysogeny region, both of which are in common with phi7401PVL and phiSa2mw.


Our experiments suggest that FG80 S. aureus strains have changed to be more virulent by acquiring phi7401PVL, and to be resistant to β-lactams by acquiring SCCmec elements. These novel clones might have disseminated in the Tunisian community as well as at the Tunisian hospitals by taking over existing MRSA clones.