Strain typing and characterization of virulence genes in clinical Staphylococcus aureus isolates from Kenya

Abstract

Staphylococcusaureus strain typing is an important surveillance tool as particular strains have been associated with virulence and community and hospital acquired MRSA outbreaks globally. This study sought to determine the circulating strain types of S.aureus in Kenya and establish the virulence genes among the strains. Clinical S.aureus isolates from 3 hospitals in Kenya were sequenced on the Illumina Miseq and genomes assembled and annotated on PATRIC. Results demonstrated great diversity among the isolates with identification of 6 distinct CC (8,22,15,80,121,152), 8 ST types (8, 15, 22,80,121,152,241, 1633) and 8 spa types (t005, t037, t064, t084, t233, t2029, t272,t355). Novel STs (4705, 4707) and a novel spa type (t17826) were identified. The most prominent clonal complex was CC 152 comprised of only MSSA. A majority of MRSA isolates (3/4) typed to ST 241, CC8. One MRSA isolate typed to a novel ST 4705. All isolates were screened for a panel of 56 known virulence genes (19 adhesins, 9 hemolysins, 5 immune evasion proteins, 6 exo-enzymes and 19 toxins). 9 toxin genes were detected among the isolates with CC8 isolates having the highest numbers of toxin genes. An MSSA isolate (CC8) from a severe burn infection had the highest number of toxin genes (5). All MRSA isolates (CC8) had only 2 toxins, SEK and SEQ, whereas a majority of the MSSA isolates either had 0 or [≥]2 toxins. SEK+SEQ and TSST-1+SEB+SEL toxin combinations were observed among patients whose disease resulted in hospitalization, an indicator of severe infections. This study confirms the highly heterogeneous S.aureus population in Kenya. MSSA appear to have the potential of accumulating more toxin genes than MRSA. This co-occurrence of major toxin genes, some associated with MRSA, highlights the potential risks of outbreaks of highly virulent MRSA infections which would pose treatment challenges.