Molecular Characterization of Methicillin-Susceptible and -Resistant Staphylococcus aureus Harboring Panton Valentine Leukocidin-Encoding Bacteriophages in a Tertiary Care Hospital in Myanmar

Panton Valentine leukocidin (PVL) is a pore-forming toxin encoded by genes on bacteriophages distributed to Staphylococcus aureus, associated with its increased virulence to humans. In this study, molecular epidemiological characteristics were investigated for 239 clinical isolates of S. aureus collected in a tertiary care hospital in Yangon, Myanmar, particularly with regard to methicillin resistance and PVL genes. Methicillin-resistant S. aureus (MRSA) accounted for 13.8% (33/239) and possessed mostly types IV- and V-SCCmec, while types III- and IX-SCCmec were identified in a few isolates. PVL genes were detected in 66.7% and 28.6% in MRSA and methicillin-susceptible S. aureus (MSSA), respectively. Among PVL-positive MRSA, ST772/SCCmec-V isolates (i.e., Bengal Bay clone) were predominant (73%, 16/22), and harbored PVL gene-encoding bacteriophage phi Sa119. Furthermore, two ST8-MRSA-SCCmec-IVa isolates harbored type-I arginine catabolic mobile element and phi Sa2usa: these isolates were considered the USA300 clone first identified in Myanmar. phi PVL was the most frequent PVL phage among MSSA (56%, 33/59), and distributed to various genotypes, with ST88 and ST121 being dominant. In contrast, phi Sa2usa and phi Sa119 were also detected in MSSA with genotypes other than ST8 or ST772, suggesting the spread of these PVL phages to MSSA. The present study revealed potentially high prevalence of PVL phages among diverse clones of MRSA and MSSA in Myanmar.