Clinical and Demographic Correlates of MRSA and mecA-Positive Isolates in a Tertiary Hospital, Tehran: A Cross-Sectional Study
MRSA and mecA-Positive Isolates in Tehran: A Cross-Sectional Study
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Abstract
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections, with the mecA gene serving as a key marker of resistance. This study investigates the clinical and demographic factors associated with MRSA and mecA carriage in a tertiary hospital in Tehran to inform targeted infection control strategies.
Method: This cross-sectional study included 125 hospitalized patients with Staphylococcus aureus infections from a tertiary hospital in Tehran. Clinical and demographic data were collected via structured questionnaires and medical records, and MRSA/mecA status was determined using phenotypic methods and real-time PCR, with associations analyzed using chi-square and Fisher’s exact tests in SPSS v18.
Result : MRSA was identified in 40.8% of Staphylococcus aureus isolates, with no significant association found with age or sex. Prolonged hospitalization, immunocompromised status, and frequent antibiotic use were significantly associated with MRSA infection (p < 0.05), while a lower prevalence was observed among patients with infected wounds.
Conclusion: This study highlights a high prevalence of MRSA in a Tehran tertiary hospital, with prolonged hospitalization, immunocompromised status, and antibiotic overuse identified as key risk factors. Targeted infection control strategies integrating clinical risk assessment and microbiological surveillance are recommended to mitigate MRSA transmission.
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2. Abebe AA, Birhanu AG. Methicillin resistant Staphylococcus aureus: molecular mechanisms underlying drug resistance development and novel strategies to combat. Infect Drug Resist 2023; 14(16):7641-62.
3. World Health Organization. New Report Calls for Urgent Action to Avert Antimicrobial Resistance Crisis. Available online: https://www.who.int/news/item/29-04-2019 (accessed on 29 April 2020).
4. Matsuhashi M, Song MD, Ishino F, et al. Molecular cloning of the gene of a penicillin-binding protein supposed to cause high resistance to beta-lactam antibiotics in Staphylococcus aureus. J Bacteriol 1986; 167:975-80.
5. Rosado PC, Marques MM, Justino GC. Targeting MRSA penicillin-binding protein 2a: structural insights, allosteric mechanisms, and the potential of adjuvant inhibitors. Biochem Pharmacol 2025; 239:117048.
6. Wang H, Kim S, Kim J, et al. Multiplex Real-Time PCR Assay for Rapid Detection of Methicillin-Resistant Staphylococci Directly from Positive Blood Cultures. J Clin Microbiol 2014; 52:1911-12.
7. Azimian A, Najar-Pirayeh S, Mirab-Samiee S, et al. Occurrence of methicillin resistant Staphylococcus aureus (MRSA) among clinical samples in tehran-iran and its correlation with polymorphism of specific accessory gene regulator (AGR) groups. Braz J Microbiol 2012; 43(2):779-85.
8. Askari E, Soleymani F, Arianpoor A, et al. Epidemiology of mecA-Methicillin Resistant Staphylococcus aureus (MRSA) in Iran: A Systematic Review and Meta-analysis. Iran J Basic Med Sci 2012; 15(5):1010-9.
9. Qodrati M, SeyedAlinaghi S, Dehghan Manshadi SA, et al. Antimicrobial susceptibility testing of Staphylococcus aureus isolates from patients at a tertiary hospital in Tehran, Iran, 2018-2019. Eur J Med Res 2022; 27(1):152
10. Fatholahzadeh B, Emaneini M, Gilbert G, et al. Staphylococcal cassette chromosome mec (SCCmec) analysis and antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) isolates in Tehran, Iran. Microb Drug Resist 2008; 14(3):217-20.
11. Rajabiani A, Kamrani F, Boroumand MA, et al. mecA-mediated Resistance in Staphylococcus aureus in a Referral Hospital, Tehran, Iran. Jundishapur J Microbiol 2014; 7(4):e9181.
12. Chabok SY, Hemmati H, Amiri Z, et al. Assessment of screening tests for methicillin-resistant Staphylococcus aureus in patients undergoing surgery by molecular (PCR) and culturing methods. J Guilan Univ Med Sci 2012; 81(25):45-52.
13. Hardy K, Price C, Szczepura A, et al. Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study. Clin Microbiol Infect 2010; 16(4):333-9.
14. Dadashi M, Nasiri MJ, Fallah F, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Iran: A systematic review and meta-analysis. J Glob Antimicrob Resist 2018; 12:96-103.
15. Jalali R, Mohammadi M, Vaisi-Raygani A, et al. Prevalence of methicillin-resistant Staphylococcus aureus in Iranian medical centers staff: a systematic review, meta-analysis and meta-regression. Lancet Infect Dis 2020.
16. Goudarzi M, Goudarzi H, Sá Figueiredo AM, et al. Molecular characterization of methicillin resistant Staphylococcus aureus strains isolated from intensive care units in Iran: ST22-SCCmec IV/t790 Emerges as the Major Clone. PLosOne 2016; 11(5):e0155529.
17. Ghasemian A, Mirzaee M. Methicillin resistant Staphylococcus aureus (MRSA) strains and the staphylococcal cassette chromosome mec types in Iran. Infect Epidemiol Med 2016; 2(3):31-4.
18. Abdollahi A, Kouhpaye SA, Najafipour S, et al. Frequency of drug resistance and staphylococcal chromosomal cassette mec (SCCmec) Genotype in methicillin-resistant Staphylococcus aureus strains. Sci Res J Alborz Med Sci 2012; 1(1):47-52 (In Persian).
19. Rahimipour F, Roudbari F, Azimian A, et al. Prevalence of Staphylococcus aureus with reduced susceptibility against vancomycin in clinical samples isolated from Mashhad hospitals during 2014. J North Khorasan Univ Med Sci 2015; 7(2):309-18. (In Persian).
20. Quero S, Serras-Pujol M, Párraga-Niño N, et al. Methicillin-resistant and methicillin-sensitive Staphylococcus aureus in pork industry workers, Catalonia, Spain. One Health 2023; 16:100538.
21. Ajao AO, Harris AD, Johnson JK, et al. Association between methicillin-resistant Staphylococcus aureus colonization and infection may not differ by age group. Infect Control Hosp Epidemiol 2013; 34(1):93-5.
22. Kupfer M, Jatzwauk L, Monecke S, et al. MRSA in a large German University Hospital: Male gender is a significant risk factor for MRSA acquisition. GMS Krankenhhyg Interdiszip 2010; 5(2):Doc11.
23. Asensio A, Guerrero A, Quereda C, et al. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996; 17(1):20-8.
24. Pius T, Danladi Makeri IR, Tamale A. Methicillin-resistant Staphylococcus aureus among patients with skin and soft tissue infections: a cross-sectional study at a tertiary hospital in Bushenyi, Western Uganda. Open Access Library J 2023; 10(5):141-50.
25. Chen Y, Yang J, Wang Y, et al. Community-associated methicillin-resistant Staphylococcus aureus infection of diabetic foot ulcers in an eastern diabetic foot center in a tertiary hospital in China. BMC Infect Dis 2023; 23(1):652.
26. Raphulu P, Wadula J, Moore DP, et al. The clinical spectrum of Staphylococcus aureus infections in children admitted to Chris Hani Baragwanath Academic Hospital, South Africa: a retrospective, descriptive study. South African J Child Health 2023; 17(2):71-5.
27. Rhodes NJ, Rohani R, Yarnold PR, et al. Machine learning to stratify methicillin-resistant Staphylococcus aureus risk among hospitalized patients with community-acquired pneumonia. Antimicrob Agents Chemother 2023; 67(1):e01023-22.
28. Abdollahi A, Kouhpaye SA, Najafipour S, et al. Frequency of drug resistance and staphylococcal chromosomal cassette mec (SCCmec) Genotype in methicillin-resistant Staphylococcus aureus strains. Sci Res J Alborz Med Sci 2012;1(1):47-52. (In Persian).
29. Rahimipour F, Roudbari F, Azimian A, et al. Prevalence of Staphylococcus aureus with reduced susceptibility against vancomycin in clinical samples isolated from Mashhad hospitals during 2014. J North Khorasan Univ Med Sci 2015; 7(2):309-18. Persian.
30. Tacconelli E, De Angelis G, Cataldo MA, et al. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008; 61(1):26-38.
31. Monnet DL. Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use: possible implications for control. Infect Control Hosp Epidemiol 1998; 19(8):552-9.
32. Lawes T, Lopez-Lozano JM, Nebot CA, et al. Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis 2015; 15(12):1438-49.
33. Kardas-Sloma L, Boëlle PY, Opatowski L, et al. Impact of antibiotic exposure patterns on selection of community-associated methicillin-resistant Staphylococcus aureus in hospital settings. Antimicrob Agents Chemother 2011; 55(10):4888-95.
34. Pius T, Danladi Makeri IR, Tamale A. Methicillin-resistant Staphylococcus aureus among patients with skin and soft tissue infections: a cross-sectional study at a tertiary hospital in Bushenyi, Western Uganda. Open Access Library J 2023; 10(5):141-50.
35. Hossein Hasanpour A, Sepidarkish M, Mollalo A, et al. The global prevalence of methicillin-resistant Staphylococcus aureus colonization in residents of elderly care centers: a systematic review and meta-analysis. Antimicrob Res Infect Cont 2023; 12(2):132-140.
36. Kmiha S, Jouini A, Zerriaa N, et al. Methicillin-resistant Staphylococcus aureus strains isolated from burned patients in a Tunisian hospital: molecular typing, virulence genes, and antimicrobial resistance. Antibiotics 2023;12(6):1030.
37. Koupahi H, Honarmand Jahromy S, Mardani M, et al. Detection of methicillin resistant Staphylococcus aureus (MRSA) by CHROMagar versus cefoxitin disk diffusion method. Iran J Med Microbiol 2023; 17(2):251-5.
38. Zarkesh-Esfahani FS, Ghandehari F, Nasr-Esfahani B, et al. Frequency of methicillin-resistant Staphylococcus aureus strains isolated from patients of a teaching hospital in Isfahan. J Isfahan Med School 2021; 39(643):730-6.
2. Abebe AA, Birhanu AG. Methicillin resistant Staphylococcus aureus: molecular mechanisms underlying drug resistance development and novel strategies to combat. Infect Drug Resist 2023; 14(16):7641-62.
3. World Health Organization. New Report Calls for Urgent Action to Avert Antimicrobial Resistance Crisis. Available online: https://www.who.int/news/item/29-04-2019 (accessed on 29 April 2020).
4. Matsuhashi M, Song MD, Ishino F, et al. Molecular cloning of the gene of a penicillin-binding protein supposed to cause high resistance to beta-lactam antibiotics in Staphylococcus aureus. J Bacteriol 1986; 167:975-80.
5. Rosado PC, Marques MM, Justino GC. Targeting MRSA penicillin-binding protein 2a: structural insights, allosteric mechanisms, and the potential of adjuvant inhibitors. Biochem Pharmacol 2025; 239:117048.
6. Wang H, Kim S, Kim J, et al. Multiplex Real-Time PCR Assay for Rapid Detection of Methicillin-Resistant Staphylococci Directly from Positive Blood Cultures. J Clin Microbiol 2014; 52:1911-12.
7. Azimian A, Najar-Pirayeh S, Mirab-Samiee S, et al. Occurrence of methicillin resistant Staphylococcus aureus (MRSA) among clinical samples in tehran-iran and its correlation with polymorphism of specific accessory gene regulator (AGR) groups. Braz J Microbiol 2012; 43(2):779-85.
8. Askari E, Soleymani F, Arianpoor A, et al. Epidemiology of mecA-Methicillin Resistant Staphylococcus aureus (MRSA) in Iran: A Systematic Review and Meta-analysis. Iran J Basic Med Sci 2012; 15(5):1010-9.
9. Qodrati M, SeyedAlinaghi S, Dehghan Manshadi SA, et al. Antimicrobial susceptibility testing of Staphylococcus aureus isolates from patients at a tertiary hospital in Tehran, Iran, 2018-2019. Eur J Med Res 2022; 27(1):152
10. Fatholahzadeh B, Emaneini M, Gilbert G, et al. Staphylococcal cassette chromosome mec (SCCmec) analysis and antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) isolates in Tehran, Iran. Microb Drug Resist 2008; 14(3):217-20.
11. Rajabiani A, Kamrani F, Boroumand MA, et al. mecA-mediated Resistance in Staphylococcus aureus in a Referral Hospital, Tehran, Iran. Jundishapur J Microbiol 2014; 7(4):e9181.
12. Chabok SY, Hemmati H, Amiri Z, et al. Assessment of screening tests for methicillin-resistant Staphylococcus aureus in patients undergoing surgery by molecular (PCR) and culturing methods. J Guilan Univ Med Sci 2012; 81(25):45-52.
13. Hardy K, Price C, Szczepura A, et al. Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study. Clin Microbiol Infect 2010; 16(4):333-9.
14. Dadashi M, Nasiri MJ, Fallah F, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Iran: A systematic review and meta-analysis. J Glob Antimicrob Resist 2018; 12:96-103.
15. Jalali R, Mohammadi M, Vaisi-Raygani A, et al. Prevalence of methicillin-resistant Staphylococcus aureus in Iranian medical centers staff: a systematic review, meta-analysis and meta-regression. Lancet Infect Dis 2020.
16. Goudarzi M, Goudarzi H, Sá Figueiredo AM, et al. Molecular characterization of methicillin resistant Staphylococcus aureus strains isolated from intensive care units in Iran: ST22-SCCmec IV/t790 Emerges as the Major Clone. PLosOne 2016; 11(5):e0155529.
17. Ghasemian A, Mirzaee M. Methicillin resistant Staphylococcus aureus (MRSA) strains and the staphylococcal cassette chromosome mec types in Iran. Infect Epidemiol Med 2016; 2(3):31-4.
18. Abdollahi A, Kouhpaye SA, Najafipour S, et al. Frequency of drug resistance and staphylococcal chromosomal cassette mec (SCCmec) Genotype in methicillin-resistant Staphylococcus aureus strains. Sci Res J Alborz Med Sci 2012; 1(1):47-52 (In Persian).
19. Rahimipour F, Roudbari F, Azimian A, et al. Prevalence of Staphylococcus aureus with reduced susceptibility against vancomycin in clinical samples isolated from Mashhad hospitals during 2014. J North Khorasan Univ Med Sci 2015; 7(2):309-18. (In Persian).
20. Quero S, Serras-Pujol M, Párraga-Niño N, et al. Methicillin-resistant and methicillin-sensitive Staphylococcus aureus in pork industry workers, Catalonia, Spain. One Health 2023; 16:100538.
21. Ajao AO, Harris AD, Johnson JK, et al. Association between methicillin-resistant Staphylococcus aureus colonization and infection may not differ by age group. Infect Control Hosp Epidemiol 2013; 34(1):93-5.
22. Kupfer M, Jatzwauk L, Monecke S, et al. MRSA in a large German University Hospital: Male gender is a significant risk factor for MRSA acquisition. GMS Krankenhhyg Interdiszip 2010; 5(2):Doc11.
23. Asensio A, Guerrero A, Quereda C, et al. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996; 17(1):20-8.
24. Pius T, Danladi Makeri IR, Tamale A. Methicillin-resistant Staphylococcus aureus among patients with skin and soft tissue infections: a cross-sectional study at a tertiary hospital in Bushenyi, Western Uganda. Open Access Library J 2023; 10(5):141-50.
25. Chen Y, Yang J, Wang Y, et al. Community-associated methicillin-resistant Staphylococcus aureus infection of diabetic foot ulcers in an eastern diabetic foot center in a tertiary hospital in China. BMC Infect Dis 2023; 23(1):652.
26. Raphulu P, Wadula J, Moore DP, et al. The clinical spectrum of Staphylococcus aureus infections in children admitted to Chris Hani Baragwanath Academic Hospital, South Africa: a retrospective, descriptive study. South African J Child Health 2023; 17(2):71-5.
27. Rhodes NJ, Rohani R, Yarnold PR, et al. Machine learning to stratify methicillin-resistant Staphylococcus aureus risk among hospitalized patients with community-acquired pneumonia. Antimicrob Agents Chemother 2023; 67(1):e01023-22.
28. Abdollahi A, Kouhpaye SA, Najafipour S, et al. Frequency of drug resistance and staphylococcal chromosomal cassette mec (SCCmec) Genotype in methicillin-resistant Staphylococcus aureus strains. Sci Res J Alborz Med Sci 2012;1(1):47-52. (In Persian).
29. Rahimipour F, Roudbari F, Azimian A, et al. Prevalence of Staphylococcus aureus with reduced susceptibility against vancomycin in clinical samples isolated from Mashhad hospitals during 2014. J North Khorasan Univ Med Sci 2015; 7(2):309-18. Persian.
30. Tacconelli E, De Angelis G, Cataldo MA, et al. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008; 61(1):26-38.
31. Monnet DL. Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use: possible implications for control. Infect Control Hosp Epidemiol 1998; 19(8):552-9.
32. Lawes T, Lopez-Lozano JM, Nebot CA, et al. Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis 2015; 15(12):1438-49.
33. Kardas-Sloma L, Boëlle PY, Opatowski L, et al. Impact of antibiotic exposure patterns on selection of community-associated methicillin-resistant Staphylococcus aureus in hospital settings. Antimicrob Agents Chemother 2011; 55(10):4888-95.
34. Pius T, Danladi Makeri IR, Tamale A. Methicillin-resistant Staphylococcus aureus among patients with skin and soft tissue infections: a cross-sectional study at a tertiary hospital in Bushenyi, Western Uganda. Open Access Library J 2023; 10(5):141-50.
35. Hossein Hasanpour A, Sepidarkish M, Mollalo A, et al. The global prevalence of methicillin-resistant Staphylococcus aureus colonization in residents of elderly care centers: a systematic review and meta-analysis. Antimicrob Res Infect Cont 2023; 12(2):132-140.
36. Kmiha S, Jouini A, Zerriaa N, et al. Methicillin-resistant Staphylococcus aureus strains isolated from burned patients in a Tunisian hospital: molecular typing, virulence genes, and antimicrobial resistance. Antibiotics 2023;12(6):1030.
37. Koupahi H, Honarmand Jahromy S, Mardani M, et al. Detection of methicillin resistant Staphylococcus aureus (MRSA) by CHROMagar versus cefoxitin disk diffusion method. Iran J Med Microbiol 2023; 17(2):251-5.
38. Zarkesh-Esfahani FS, Ghandehari F, Nasr-Esfahani B, et al. Frequency of methicillin-resistant Staphylococcus aureus strains isolated from patients of a teaching hospital in Isfahan. J Isfahan Med School 2021; 39(643):730-6.
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| Issue | Vol 14 No 1 (2026) | |
| Section | Original Articles | |
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| Clinical Demographic Correlates mecA-Positive MRSA Isolates. | ||
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How to Cite
1.
Bashi Zadeh Fakhar H, Shahidi PS, Jalalian M, Rangraz S. Clinical and Demographic Correlates of MRSA and mecA-Positive Isolates in a Tertiary Hospital, Tehran: A Cross-Sectional Study. J Med Bacteriol. 2026;14(1):1-10.
