Characterisation of a novel SCCmec VI element harbouring fusC in an emerging Staphylococcus aureus strain from the Arabian Gulf region

PLoS One. 2019 Nov 5;14(11):e0223985. doi: 10.1371/journal.pone.0223985. eCollection 2019.


Fusidic acid is a steroid antibiotic known since the 1960s. It is frequently used in topical preparations, i.e., ointments, for the treatment of skin and soft tissue infections caused by Staphylococcus aureus. There is an increasing number of methicillin-resistant S. aureus (MRSA) strains that harbour plasmid-borne fusB/far1 or fusC that is localised on SCC elements. In this study we examined a series of related CC30-MRSA isolates from the Arabian Gulf countries that presented with SCCmec elements and fusC, including a variant that-to the best of our knowledge-has not yet formally been described. It consisted of a class B mec complex and ccrA/B-4 genes. The fusidic acid resistance gene fusC was present, but contrary to the previously sequenced element of HDE288, it was not accompanied by tirS. This element was identified in CC30 MRSA from Kuwait, Saudi Arabia and the United Arab Emirates that usually also harbour the Panton-Valentin leukocidin (PVL) genes. It was also identified in CC8 and ST834 isolates. In addition, further CC30 MRSA strains with other SCCmec VI elements harbouring fusC were found to circulate in the Arabian Gulf region. It can be assumed that MRSA strains with SCCmec elements that include fusC have a selective advantage in both hospital and community settings warranting a review of the use of topical antibiotics and indicating the necessity of reducing over-the-counter sale of antibiotics, including fusidic acid, without prescription.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics
  • Drug Resistance, Bacterial / genetics
  • Fusidic Acid / pharmacology
  • Genes, Bacterial
  • Genetic Variation
  • Humans
  • Kuwait
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / genetics*
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Oligonucleotide Array Sequence Analysis
  • Plasmids / genetics
  • Saudi Arabia
  • United Arab Emirates


  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Fusidic Acid

Grants and funding

The project was partially funded by internal research grant from the College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, UAE (Ref#: MBRU-CM-RG2018-07). The Leibniz Society supported the open access publication of the present work. Agiomix FZ-LLC provided support in the form of salary for author JM. These funders did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.