SAINS MALAYSIANA

Sains Malaysiana 55(8)(2026): 1337-1349

http://doi.org/10.17576/jsm-2026-5508-09

Prevalence Assessment of the mecC Gene Among MRSA Clinical Isolates in a Malaysian Teaching Hospital

(Penilaian Kelaziman Gen mecC dalam Kalangan Pencilan Klinikal MRSA di Sebuah Hospital Pengajar di Malaysia)

WEI XUAN CHANG¹, KON KEN WONG¹, SHARIFAH AZURA SALLEH², HUI-MIN NEOH³ & MUTTAQILLAH NAJIHAN ABDUL SAMAT^1,*

¹Department of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia

²Infection Control Unit, Hospital Canselor Tuanku Muhriz UKM, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia

³UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia

Received: 16 March 2026/Accepted: 17 August 2026

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) resistance is predominantly mediated by the mecA gene; a novel homologue, mecC, has emerged among livestock-associated MRSA, and to date no data exist on the prevalence of human mecC-MRSA in Malaysia. This retrospective cross-sectional study aimed to determine the prevalence of mecC gene carriage and characterise the antimicrobial susceptibility profiles of 89 archived clinical MRSA isolates from 2023, using conventional PCR for gene detection and the VITEK 2 system for antimicrobial susceptibility testing. All isolates were mecA-positive, and none carried mecC. High resistance rates were observed against ciprofloxacin (89.9%, MIC₉₀ ≥8 µg/mL), levofloxacin (88.8%, MIC₉₀ ≥8 µg/mL), moxifloxacin (88.8%, MIC₉₀ 4 µg/mL), erythromycin (66.3%, MIC₉₀ ≥8 µg/mL) and clindamycin (65.2%, MIC₉₀ ≤0.25 µg/mL). All isolates remained susceptible to vancomycin (MIC₉₀ 1 µg/mL), linezolid (MIC₉₀ 2 µg/mL), quinupristin/dalfopristin (MIC₉₀ ≤0.25 µg/mL), tigecycline (MIC₉₀ 0.25 µg/mL), nitrofurantoin (MIC₉₀ 32 µg/mL) and rifampicin (MIC₉₀ ≤0.5 µg/mL). Susceptibility to trimethoprim/sulphamethoxazole and tetracycline was 95.5% (MIC₉₀ ≤10 µg/mL and ≤1 µg/mL, respectively). One mecA-positive isolate was susceptible to oxacillin (MIC 0.5 µg/mL) and negative on cefoxitin screening, consistent with the oxacillin-susceptible MRSA (OS-MRSA) phenotype. This study confirms mecA as the sole methicillin-resistance determinant in this hospital; the absence of mecC likely reflects limited livestock exposure in this urban population, although surveillance in agricultural regions remains warranted. The detection of OS-MRSA highlights the limitations of relying solely on phenotypic screening and supports incorporating molecular assays to prevent misclassification.

Keywords: mecA; mecC; microbial sensitivity tests; MRSA; prevalence

Abstrak

Rintangan Staphylococcus aureus rintang metisilin (MRSA) lazimnya dimediasi oleh gen mecA; gen baharu, mecC, turut dikenal pasti memberikan rintangan metisilin, khususnya dalam MRSA berkait ternakan dan setakat ini tiada data kelaziman mecC-MRSA pada manusia di Malaysia. Kajian keratan rentas retrospektif ini bertujuan untuk menentukan kelaziman pembawaan gen mecC serta mencirikan profil kerentanan antibiotik dalam kalangan 89 pencilan MRSA klinikal terarkib pada tahun 2023, menggunakan amplifikasi PCR konvensional untuk pengesanan gen dan sistem VITEK 2 untuk ujian kerentanan antibiotik. Kesemua pencilan didapati positif mecA dan tiada yang membawa mecC. Kadar kerintangan tinggi diperhatikan terhadap siprofloksasin (89.9%, MIC₉₀ ≥8 µg/mL), levofloksasin (88.8%, MIC₉₀ ≥8 µg/mL), moksifloksasin (88.8%, MIC₉₀ 4 µg/mL), eritromisin (66.3%, MIC₉₀ ≥8 µg/mL) dan klindamisin (65.2%, MIC₉₀ ≤0.25 µg/mL). Kesemua pencilan kekal rentan terhadap vankomisin (MIC₉₀ 1 µg/mL), linezolid (MIC₉₀ 2 µg/mL), kinupristin/dalfopristin (MIC₉₀ ≤0.25 µg/mL), tigesiklin (MIC₉₀ 0.25 µg/mL), nitrofurantoin (MIC₉₀ 32 µg/mL) dan rifampisin (MIC₉₀ ≤0.5 µg/mL). Kerentanan terhadap trimetoprim/sulfametoksazol dan tetrasiklin adalah 95.5% (MIC₉₀ ≤10 µg/mL dan ≤1 µg/mL). Satu pencilan positif mecA rentan terhadap oksasilin (MIC 0.5 µg/mL) dan negatif dalam saringan sefoksitin, selaras dengan fenotip MRSA rentan oksasilin (OS-MRSA). Kajian ini mengesahkan mecA sebagai penentu tunggal kerintangan metisilin dalam kalangan MRSA klinikal di hospital ini; ketiadaan mecC mungkin mencerminkan pendedahan ternakan yang terhad dalam populasi bandar, walaupun pemantauan di kawasan pertanian tetap diperlukan. Pengesanan OS-MRSA menekankan keterbatasan penggunaan kaedah saringan fenotip semata-mata serta menyokong penggabungan ujian molekul bagi mengelakkan salah pengelasan.

Kata kunci: Kelaziman; mecA; mecC; MRSA; ujian kepekaan mikrob

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*Corresponding author; email: muttaqillah@hctm.ukm.edu.my