Maalej SM, Trabelsi JJ, Claude-alexandre G, Boutiba I, Mastouri M, et al. (2019) Antimicrobial Susceptibility and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in Tunisia: Results of a Multicenter Study. J Infect Dis Epidemiol 5:071.


© 2019 Maalej SM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ORIGINAL ARTICLE | OPEN ACCESS DOI: 10.23937/2474-3658/1510071

Antimicrobial Susceptibility and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in Tunisia: Results of a Multicenter Study

Senda Mezghani Maalej1,*, Jihene Jdidi Trabelsi2, Gustave Claude-alexandre3,4, Ilhem Boutiba5, Maha Mastouri6, Sophia Besbes7, Farouk Barguellil8, Frederic Laurent3,4 and Adnene Hammami1

1Laboratory of Microbiology, Habib Bourguiba Hospital, Sfax, Tunisia

2Epidemiology Department, Hedi Chaker Hospital, Sfax, Tunisia

3Department of Clinical Microbiology, Hospices Civils de Lyon, Lyon, France

4National Reference Center for Staphylococci, International Center of Infectious Research, INSERM U1111, CNRS UMR5308, University of Lyon 1, ENS de Lyon, Lyon, France

5Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia

6Laboratory of Microbiology, Fattouma Bourguiba Hospital, Monastir, Tunisia

7Laboratory of Microbiology, Institute Kassab, Tunis, Tunisia

8Laboratory of Microbiology, Military Hospital, Tunis, Tunisia



Methicillin resistant Staphylococcus aureus (MRSA) as a major cause of infections in hospital and community settings is a global health concern. The purpose of this study was to determine the antimicrobial susceptibility and the molecular characteristics of MRSA strains causing community-acquired (CA) and hospital-acquired (HA) infections in Tunisia.


A total of 135 non-duplicate MRSA strains were consecutively collected from five Tunisian hospitals. Antimicrobial susceptibility was done by disc diffusion method and by MIC. The presence of pvl (Panton Valentine Leukocidin) and tst-1 (toxic shock syndrome toxin 1) Genes were determined by PCR method. Strains were typed by agr, SCCmec typing, PFGE and spa typing.


Forty-nine strains (36.3%) were CA. HA strains showed significantly higher rates of resistance than the CA strains. One HA strain was resistant to teicoplanin (MIC = 4 µgml-1). The pvl gene was detected in 83.7% and 32.6% of CA and HA strains, respectively. Only eight strains were tst-1 positive. PFGE revealed 61 pulsotypes among HA strains and 20 pulsotypes among CA strains. Twenty-four spa types were identified. spa type t044 was the most common, representing 69.4% and 25.6% among CA and HA strains respectively. Most of t044 strains was pvl-positive, harbored agr3 and SCCmec IV and were resistant to kanamycin, tetracycline and fusidic acid. t037, agr1 and SCCmec III was the most prevalent among HA-MRSA.


Genetically diverse MRSA strains were circulating in our hospitals with relatively high prevalence of spa type t044 and t037. Regular surveillance studies on MRSA are needed to monitor the evolution of antimicrobial susceptibility, to better elucidate the distribution of existing MRSA clones and to detect the emergence of new MRSA clones.