PVL positive strains might therefore have emerged elsewhere and spread in the community and at hospitals. It is interesting that the PVL-negative MRSA selleck screening library clones were the same MRSA strains isolated in other countries. Two other CA-MRSA isolates belonged to ST5-MRSA-IV which is one of predominant clones in the Netherlands [34]. Concerning the HA-MRSA, the agr group I was BAY 80-6946 predominant, as reported previously in Tunisian MRSA [27]. The predominance of a group I background was also reported in United States and in Korea [35, 36]. Similar results

were obtained in European countries such as Germany and Belgium [36]. Three isolates belonged to the clone ST241-SCCmecIII. Two belonged to the ST247-SCCmecI (Iberian) clone, which is one of predominant clones in Poland [37]. Two other isolates belonged to ST239-SCCmecIII (Hungarian) clone, which is predominant in Turkey [38]. Conclusion Tunisian PVL positive MRSA strains carried the PVL phage, which was highly homologous to phiSa2mw, but distinct in two ORFs. They belonged to FG80 and agr group Anlotinib in vivo III, and carried type IVc or nontypeable SCCmec. Such strains disseminated in the community and might have spread at the Tunisian hospitals by taking over existing

MRSA clones, e.g., CC8-SCCmecI and CC8-SCCmecIII. Methods Bacterial strains One hundred and fifty-four non-replicated HA-MRSA strains were isolated from 1999 through 2008 at Charles Nicolle Hospital of Tunis. Among them, 41 strains isolated from 2004 through 2008 were chosen based on their resistance profiles. HA-MRSA strains were isolated from mucous pus and blood cultures, puncture fluids, urine, and biomaterials of inpatients. A total of 28 non-replicated CA-MRSA strains were isolated from January 2004 through June 2008 in two Tunisian hospitals (Charles Nicolle Hospital and Habib Bourguiba Hospital). CA-MRSA strains were isolated from the specimens

of the patients with MRSA infections who had not been recently (¬within the past year) hospitalized or undergone a medical procedure (such as dialysis, surgery, catheterization). The CA-MRSA strains were generally recovered from mucous pus, puncture fluids, urine and biomaterials from outpatients. Some MRSA strains GNAT2 isolated from patients within 48 h of hospitalization, e.g., after surgery, in the intensive care unit, in the departments of nephrology, otorhinolaryngology and gynecology, were also included. Strain identification The isolates were identified by the conventional methods (Gram-positive cocci, catalase positive, mannitol fermenting and DNase-positive) and were confirmed to be S. aureus by their ability to coagulate rabbit plasma (bioMérieux, Marcy l’Etoile, France) and to produce clumping factor (Staphyslide test, bioMérieux). The biotypes were determined using Api20 Staph (bioMérieux, Marcy l’Etoile, France).