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BioMedCentralPage1of6(pagenumbernotforcitationpurposes)BMCResearchNotesOpenAccessShortReportTheprevalenceofantimicrobialresistanceandcarriageofvirulencegenesinStaphylococcusaureusisolatedfromfoodhandlersinKuwaitCityrestaurantsEdetEUdo*1,SihamAl-Mufti2andMJohnAlbert1Address:1DepartmentofMicrobiology,FacultyofMedicine,KuwaitUniversity,Kuwaitand2PublicHealthLaboratory,MinistryofHealth,KuwaitEmail:EdetEUdo*-edet@hsc.
edu.
kw;SihamAl-Mufti-Sihmufti@kuwait.
net;MJohnAlbert-John@hsc.
edu.
kw*CorrespondingauthorAbstractBackground:Staphylococcusaureusisamajorcauseoffoodpoisoningduetotheirabilitytoproduceenterotoxinswhichifingestedinsufficientamountsresultsinsickness.
Foodhandlerscarryingenterotoxin-producingS.
aureusintheirnosesorhandscancontaminatefoodleadingtofoodpoisoning.
Wecharacterized200S.
aureusobtainedfromfoodhandlersindifferentrestaurantsforantibacterialresistanceandthecarriageofvirulencegenes.
Findings:SusceptibilitytoantibacterialagentswasdeterminedbydiskdiffusionandEtest.
PCRwasusedtodetectgenesforaccessorygeneregulator(agr);capsularpolysaccharide(cap)5and8,staphylococcalenterotoxins(SE),toxicshocksyndrometoxin-1(TSST-1)andPanton-Valentineleukocidin(PVL).
Isolatesweretypedusingpulsed-fieldgelelectrophoresis.
Intotal185(92.
5%)ofthe200isolatesexpressedresistancetoantibacterialagents.
TheywereresistanttopenicillinG(82.
0%),tetracycline(19.
0%),erythromycin(2.
5%),clindamycin(2.
0%),trimethoprim(7.
5%),kanamycin(2.
5%),streptomycin(1.
5%),ciprofloxacin(1.
5%),fusidicacid(1.
0%)andcadmiumacetate(68.
0%).
Seventy-six(38.
0%)and114(57.
0%)isolateshadtype5andtype8capsularpolysaccharidesrespectively.
TheagrtypesI,IIandIIIallelesweredetectedin50.
5%,20.
0%and23.
5%oftheisolatesrespectively.
TheycontainedgenesforSEI(38.
5%),SEG(24.
0%),SEC(23.
0%),SEB(12.
5%),SEH(21.
5%),SEA(11.
0),SED(1.
5%),SEE(1.
5%),TSST-1(4.
0%)andPVL(9.
0%).
Conclusion:ThisstudyrevealedahighprevalenceofantibacterialresistanceandvirulencedeterminantsinS.
aureusfromfoodhandlersinKuwaitrestaurantsjustifyingthescreeningoffoodhandlerstodetectandtreatcarriersandprotectrestaurantcustomersfromstaphylococcalfoodpoisoning.
BackgroundStaphylococcusaureuscancauselocalizedandinvasiveinfectionsinhumans.
Thisisattributedtoitsabilitytoproduceavarietyofvirulencefactorssuchascapsularpolysaccharides,staphylococcalenterotoxins(SEs),toxicshocksyndrometoxin1(TSST-1)[1,2],panton–valen-tineleukocidin(PVL)[3]andaccessorygeneregulators(agr)[1,4-6].
AlthoughS.
aureusisolatesproduceoneof11serotypesofcapsularpolysaccharides,mostclinicalisolatesbelongtoserotypes5and8[2].
Enterotoxin-pro-ducingS.
aureusarecommoncausesoffoodpoisoninginmanypartsoftheworld.
Theingestionofthepreformedtoxinsinfoodoftenleadstothedevelopmentoffoodpoi-soning.
Thesymptomstypicallyhavearapidonset(2–6Published:16June2009BMCResearchNotes2009,2:108doi:10.
1186/1756-0500-2-108Received:6November2008Accepted:16June2009Thisarticleisavailablefrom:http://www.
biomedcentral.
com/1756-0500/2/1082009Udoetal;licenseeBioMedCentralLtd.
ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.
org/licenses/by/2.
0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
BMCResearchNotes2009,2:108http://www.
biomedcentral.
com/1756-0500/2/108Page2of6(pagenumbernotforcitationpurposes)h)andmayincludenausea,vomiting,diarrheaandabdominalpain[1].
Nasalandhandcarriageofenterotox-igenicS.
aureusbyfoodhandlersisanimportantsourceofstaphylococcalfoodcontaminationinrestaurantsandfastfoodoutlets[7].
ThereforeitisimportanttodetectS.
aureuscarriageamongfoodhandlerstopreventpossiblefoodcontaminationbythemresultinginfoodpoisoning.
Foodpoisoningoutbreaksresultinhugefinanciallossestorestaurants,inadditiontothelossofreputationandconfidenceamongthepublic.
Staphylococcalfood-bornediseasesareestimatedtocause6–81millionillnessesandupto9000deaths,andaccountsfor14–20%ofout-breaksinvolvingcontaminatedfoodintheUSA[8].
MostofthestudiesonS.
aureusassociatedwithfoodpoi-soninghavefocusedonscreeningoftheisolatesforenter-otoxins[1,9-13]withonlysparsedataonthecarriageofothervirulencefactorsandantimicrobialresistanceamongS.
aureusobtainedfromfoodhandlers[14-17]especiallyintheArabianGulfcountries.
Althoughwepre-viouslystudiedtheprevalenceofstaphylococcalentero-toxinsinS.
aureusisolatedfromfoodhandlersinKuwaitcity[10],theirsusceptibilitytoantibacterialagentswerenotinvestigated.
Thereforeinthepresentstudy,wechar-acterizedS.
aureusisolatedfromfoodhandlersinKuwaitCityrestaurantsfortheirsusceptibilitytoantibacterialagentsandthecarriageofvirulenceassociatedgenes.
MethodsS.
aureusisolatesIntotal,200S.
aureusisolateswererecoveredfromfoodhandlersworkingin50KuwaitCityrestaurantsfrom2003to2005.
Theyconsistedof133(102isolatesfromnasaland31handswabs)of500swabsfrom250adultmaleworkersin50restaurants,duringscreeningoffoodhan-dlersasdemandedbytheCityCouncil,yieldingacarriagerateof53.
2%.
TheKuwaitMunicipalCouncilmandatedacompulsoryscreeningofrestaurantworkerstodetectS.
aureuscarriers.
Onlyonesamplewasinvestigatedfromthesamefoodhandler.
Thestudyalsoincluded67isolatesobtainedfrom31stoolsamples,9throatswabsand27nasalsamplesobtainedfromfoodhandlersduringrou-tineinvestigationsofsuspectedcasesoffoodpoisoningindifferentrestaurants.
Bacteriawereisolatedandidentifiedusingstandardbacteriologicalmethodsincludingculturalcharacteristics,Gramstain,catalase,tubecoagulaseandDNasetests[10].
Theisolateswerepreservedinskimmedmilkat-80°C.
SusceptibilitytoantibacterialagentsSusceptibilitytoantimicrobialagentswasdeterminedbythediskdiffusionmethod[18]Diskscontainingcad-miumacetate(50μg),propamidineisethionate(100μg),andmercuricchloride(109μg)werepreparedinthelab-oratory[19].
Azonediameterof6–10mmindicatedresistancetocadmiumacetate,propamidineisethionateandmercuricchloride.
Theminimuminhibitoryconcen-trations(MICs)ofmethicillin,vancomycinandteico-planinweredeterminedwithEteststrips(ABBiodisk,Solna,Sweden)accordingtothemanufacturer'sinstruc-tions.
S.
aureusstrainATCC25923wasusedforqualitycontrol.
IsolationofDNAforPCRamplificationDNAforPCRwasextractedasdescribedpreviously[3].
TheextractedDNAwasusedforPCRimmediatelyorstoredat4°Candusedwithinthreemonths.
Detectionofgenesforstaphylococcalenterotoxin(SE)andtoxicshocksyndrometoxin(TSST-1)PCRamplificationwasperformedforgenesencodingsta-phylococcalenterotoxinsSEA(sea),SEB(seb),SEC(sec),SED(sed),SEE(see),SEG(seg),SEH(seh),andSEI(sei)andtoxicshocksyndromegeneTSST-1(tst)withprimerspub-lishedpreviously[13,20]inthreemultiplex(MT)assaysasfollows:MT1(sec,seiandsed),MT2(seg,sehandsee)andMT3(sea,sebandtst).
Basedonoptimizationexperi-ments,theprimerconcentrationsusedwere0.
1μMforsea,sec,andtst,and0.
2μMforseb,see,sed,segandseh.
Amplificationscomprisedanactivationstepat95°Cfor15minfollowedby37cyclesof94°Cfor2min,51°Cfor1minand72°Cfor1minwithafinalextensionat72°Cfor7min.
ControlstrainsusedwereS.
aureus;ATCC13565(SEA),ATCC14458(SEB),ATCC23235(SED),ATCC27664(SEE),ATCC51811(SEH),WBG525(SEC,TSST-1),C90(SEI)[16],C29(SEG).
The16SrRNAprimers,5'-GGAGGAAGGTGGGGATGACG-3'and5'-ATGGTGTGACGGGCGGTGTG-3'[21]wereusedasinternalcontrols.
Alltestswereconsideredpositiveifthepositivecontrolsandtheinternalcontrolsyieldedtheexpectedresults.
NegativecontrolsforallPCRconsistedofthePCRmixeswithouttemplateDNA.
PCRproducts(5μl)wereloadedin2.
0%(w/v)molecularbiologygradeagarose(BioRad,Hercules,USA)gels.
PCRproductswereanalyzedbyagarosegelelectrophoresis.
Detectionofgenesforaccessorygeneregulators(agr),capsularpolysaccharides(cap)andPanton-ValentineLeucocidin(lukS-lukF)AllisolatesweretestedforthepresenceofgenesforPVL,agrtypesI,II,IIIandIVandcaptype5andtype8inPCRassaysasdescribedpreviously[3,22,23].
The16SrRNAprimer[21]wasusedasinternalcontrolinPCRamplifica-tions.
Pulsed-fieldgelelectrophoresis(PFGE)Counter-clampedhomogeneouselectricfield(CHEF)electrophoresisofSmaI-digestedchromosomalDNAwasperformedasdescribedpreviously[19].
BMCResearchNotes2009,2:108http://www.
biomedcentral.
com/1756-0500/2/108Page3of6(pagenumbernotforcitationpurposes)StatisticsDifferencesinthedistributionofvirulencedeterminantsbetweengroupswereassessedbyChisquaretest.
AP-valueof=0.
05wasconsideredsignificant.
ResultsOnehundredandeightyfive(92.
5%)ofthe200S.
aureusisolateswereresistanttoantibacterialagents.
Themajor-ity,164(82.
0%)and136(68.
0%)ofthemwereresistanttopenicillinGandcadmiumacetaterespectively.
Forty-twoisolates(21.
0%)wereresistanttotetracycline,15iso-lates(7.
5%)wereresistanttotrimethoprimandsixiso-lates(3%)wereresistanttokanamycin.
Fiveandfourisolateswereresistanttoerythromycinandstreptomycinrespectively.
Twoisolateswereresistanttofusidicacidandonlyoneisolatewasresistanttomethicillinandgen-tamicin.
Theywereallsusceptibletomupirocin,rifampicin,vancomycin,teicoplaninandlinezolid.
Sixty-fivepercentofthemwereresistanttotwoormoreantibac-terialagentsand23%weremultiresistantwithresistancetothreeormoreclassesofantibacterialagents.
ThedistributionofgenesforcapsulartypesandagrallotypesissummarizedinTable1.
Whereas114isolateshadgeneforcap8,76isolateshadgeneforcap5.
Tenisolatesyieldedneg-ativeresultsforbothcapsularpolysaccharides.
Onlyoneagrtypewasdetectedineachisolate.
Onehundredandoneiso-lateswereagrtypeI,47isolatesweretypeIII,and40isolatesweretypeII.
NonewaspositiveforagrtypeIV.
Twelveiso-latesyieldednegativeresultsforthefouragrtypestested.
ThedistributionofgenesforSE,TSST-1andPVLissum-marizedinFigure1andTable2.
Intotal,142(71.
0%)iso-lateswerepositiveforSE,8(4.
0%)werepositiveforTSST-1and,18isolates,includingtheonlyMRSAisolate,werepositiveforPVL.
GeneforSEIwasthemostcommonSEgene.
Itwasdetectedin77isolates.
FiftyisolatescontainedsingleSEgenes,54isolatescarriedtwoSEgenes,28and10isolatescontainedthreeandfourSEgenesrespectively.
Thecharacteristicsofthe18lukS-lukFpositiveisolatesarepresentedinTable3.
Theyhaddifferentresistancepat-terns,belongedtodifferentagrandcaptypesandhar-boreddifferentSEgenesbutnonecarriedgeneforTSST-1.
WhentypedbyPFGEtodetermineiftheywererelated,theyyieldedeightPFGEpatternsdesignatedtypesAtoH(Figure2,Table3).
Eightisolatesobtainedfromstool,handandnasalsampleshadthesamePFGEpattern(typeA)and10isolatesbelongedtosevenPFGEpatterns.
Whentheisolatesobtainedduringthescreeningexercise(screeningsamples)werecomparedwiththoseobtainedduringroutineinvestigationoffoodpoisoningcases(rou-tinesamples),theresultswerenotsignificantlydifferentforthedistributionofgenesforagrandcapsularpolysac-charides(datanotshown).
Similarly,72.
9%ofthescreen-ingsampleisolates(97/133)and67.
1%(45/67)oftheroutinesamplesisolatescontainedgenesforSEsshowingnosignificantdifferenceinthedistributionofgenesforSEbetweenthetwosetsofisolates(Pvalue=0.
50).
Further-moretstwasdetectedin5.
2%(7/133)ofthescreeningsamplesisolatesandin1.
5%(1/67)oftheroutinesampleisolates(Pvalue=0.
4)DiscussionThisstudyhasdemonstratedahighprevalenceofantibac-terialresistanceanddiversityinthecarriageofvirulencegenesinS.
aureusobtainedfromfoodhandlersemployedinrestaurantsinKuwaitCity.
Ourresultsthat92.
5%oftheisolatesexpressedresistancetoantibacterialagentsissimilartotheprevalenceofantibacterialresistanceinmethicillin-susceptibleS.
aureusobtainedfrompatientsinKuwaithospitals[24]andtothatfoundinS.
aureusiso-latesfromfoodhandlersinChile[11]andBotswana[17].
Althoughonlyoneisolatewasmethicillin-resistant,thefindingissignificantbecausefoodhandlerscarryingMRSAhadinitiatedoutbreaksinhospitalsintheNether-lands[14],USA[25]andBrazil[15].
Asfoodhandlersrepresentasectionofthehealthypopulationinthecom-Table1:Distributionofgenesforvirulencefactorsin200S.
aureusisolatedfromfoodhandlers.
Number(%)ofisolatespositiveforvirulencegenesSourcesofS.
aureus(#)SEcap5cap8agrIagrIIagrIIIlukS-lukFtstNose(129)93(72.
1)49(38.
0)72(55.
8)67(51.
9)24(18.
6)28(21.
7)11(8.
5)7(5.
4)Stool(31)21(67.
7)15(48.
4)15(48.
4)17(54.
8)6(19.
3)7(22.
5)4(12.
9)1(3.
2)Hands(31)22(70.
9)9(29.
0)21(67.
7)13(41.
9)6(19.
3)11(34.
0)3(9.
7)NDThroats(9)6(66.
6)3(33.
3)6(66.
6)4(44.
4)4(44.
4)1(11.
1)NDNDTotal(200)142(71.
0)76(38.
0)114(57.
0)101(50.
5)40(20.
0)47(23.
5)18(9.
0)8(4.
0)Abbreviations:cap,genesforcapsularpolysaccharide,agr,genesforaccessorygeneregulator,luKS-lukFgenesforPVL,tst,genesforTSST-1.
ND,NotdetectedBMCResearchNotes2009,2:108http://www.
biomedcentral.
com/1756-0500/2/108Page4of6(pagenumbernotforcitationpurposes)munity,besidesworkinginrestaurants,thedetectionofhighprevalenceofantibioticresistanceinS.
aureusiso-latedfromthemalsohighlightsthegrowingproblemofantibioticresistanceinthecommunity.
TheabilityofS.
aureustocolonizeorinfectitshostisrelatedtoitsabilitytoexpressvirulencefactorsthatfacili-tatetheiradherencetosurfaces,causedamageoritsabilitytoevadehost'simmunesystem[1,2].
Ourisolatescarriedgenesforarangeofvirulencefactorsincludingthreeofthefouraccessorygeneregulatorsthatregulatestaphylococcalvirulencefactors[6].
Ourresultthat50.
5%oftheisolateswereagrtypeIconcurswithresultsofotherstudiesthatthemajorityofS.
aureusfromclinicalsourcesbelongtoagrtypeI[4,23].
Similarly,ourresultsthat57%oftheiso-latesbelongedtoserotype8and38%belongedtosero-type5areinagreementwithpreviousstudiesthatshowedthatthemajorityofS.
aureusobtainedfromclinicalsam-plesbelongedtocapsularpolysaccharideserotypes5or8[2,23].
WithregardstothecarriageofSEdeterminants,theresultsofthisstudydifferfromthatofapreviousstudyinKuwait[10].
The71.
0%prevalenceofSEgenesinthisstudywaslowerthanthe86.
6%prevalencedetectedpreviouslyinS.
aureusfromfoodhandlersinKuwaitrestaurants[10].
However,itwassimilartotheprevalenceof74.
1%obtainedfromS.
aureusisolatedfromfoodpoisoningcasesinTaiwan[26]andhigherthantheprevalenceofSEreportedinS.
aureusfromfoodhandlersinChile[19%,[11]]andfromhumans,foodandanimalsourcesinMalaysia[20.
8%,[27]].
Inaddition,thedemonstrationofSEIasthemostcommonSEgeneinthisstudycontrastedwiththeresultsofapreviousstudyofSEinS.
aureusiso-latedfromfoodhandlersinKuwaitrestaurants[10]andotherstudies[9,11,12]whereSEAwasthemostcommonSE.
Furthermore,whereas64.
7%oftheSEpositiveiso-latesinthisstudycarriedgenesfortwotofourSEs,only8.
6%ofS.
aureusinthepreviousstudyfromKuwaitcar-riedmorethanoneSEgene[10].
Thisisconsistentwithrecentreportsintheliteraturethatalsodocumentthecar-riageofmultipleSEgeneinenterotoxigenicS.
aureus[9,12,13].
ThedetectionofmultipleSEgenesinrecentS.
aureusisolatescouldbeduetotheimprovementindetec-tionmethodsfollowingtheapplicationofPCRtechnol-ogyandthediscoveryofnewSEgeneswhichwerenottestedinthepreviousstudy.
Itcouldalsobeduetofre-quenthorizontaltransmissionofphage-mediatedtoxingenesamongthestaphylococcalpopulations[21].
Distributionoftoxinsin200S.
aureusisolatedfromfoodhandlersFigure1Distributionoftoxinsin200S.
aureusisolatedfromfoodhandlers.
38.
51112.
5232421.
51.
51.
549051015202530354045SEISEASEBSECSEGSEHSEESEDTSST-1PVLToxinsPrevalence%Table2:Enterotoxingeneprofilesofthe142enterotoxin-positiveS.
aureusfromfoodhandlers.
Enterotoxinprofiles1SaureusisolateswithsingleSEgenes(50)sea(6),seb(9),sec(13),seg(9),seh(6),sei(7)2S.
aureusisolateswithtwoSEgenes(54)seg,sei(13);seh,sei(17);sea,sec(4);sec,seg(4);sec,seh(4);seb,seg(3);sea,sei(2);seb,sei(2);seg,sed(1);seb,sec(1);sec,sei(1);see,sei(1);seb,see(1).
3.
S.
aureusisolateswiththreeSEgenes(28)sec,seg,sei(9);sec,seh,sei(5);sea,seg,sei(4);seb,seg,sei(3);sea,seh,sei(3);seb,seh,sei(2);;sec,sed;seg(1);seb,sec,seg(1).
4S.
aureusisolateswithfourSEgenes(10)sea,sec,seg,sei(3);sea,sec,seh,sei(1);seb,seg,seh,sei(1);seb,seg,seh,sei(1);seb,see,seh,sei(1);sea,seg,seh,sei(1);sea,sec,sed,seh(1);seb,sec,seh,sei(1).
PFGEofrepresentativesof18PVLpositiveS.
aureusfromfoodhandlersFigure2PFGEofrepresentativesof18PVLpositiveS.
aureusfromfoodhandlers.
LanesA:PFGEtypeA,LaneA1:PFGEtypeA1,LaneB:PFGEtypeB,LaneB1:PFGEtypeB1,LaneC:PFGEtypeC,LaneC1:PFGEtypeC1,LaneD:PFGEtypeD,LaneE:PFGEtypeE,LaneG:PFGEtypeG,LaneH:PFGEtypeH.
BMCResearchNotes2009,2:108http://www.
biomedcentral.
com/1756-0500/2/108Page5of6(pagenumbernotforcitationpurposes)PVLiswidelydistributedamongsomeclonesofcommu-nity-associatedMRSA(CA-MRSA)isolatedinKuwaitandothercountries[3,28,29]andwasthoughttocontributetotheincreasedvirulenceofCA-MRSAisolates[3,28].
How-ever,PVLhasrecentlyalsobeendetectedinhealthcare-associatedMRSAandinmethicillin-susceptibleS.
aureusfrompatients[29].
OurreportisthefirstinS.
aureusobtainedfromfoodhandlersinKuwaitandelsewhere.
Itsdetectionin9.
0%oftheisolatesinthisstudysupportsthesuggestionthatPVL-bearingphagesarewidespreadamongS.
aureusofdifferentgeneticbackgroundsandarenotaspe-cificcharacteristicofCA-MRSA[19,29].
Theobservationthateightofthe18lukS-lukFpositiveisolateshadsamePFGEpatternssuggestedatransmissionofacommonstrainamongtheseworkers.
ThedetectionofgenesforPVLinS.
aureusobtainedfromfoodhandlersisofpublichealthinterestsincethesefoodhandlerscanserveassourcesoftransmissionofPVLproducingS.
aureusinthecommunityespeciallyamongfamilymembers.
Giventhatthemajorityoftheisolatesinthisstudycon-tainedgenesforanarrayofvirulencefactors,theyarepotentialcausesofseriousS.
aureusinfections.
Thereforefoodhandlerscarryingthesestrainscancontaminatefoodthatcanleadtofoodpoisoning[7].
Thus,ourresultssup-portthecurrentpracticeofscreeningrestaurantworkerstoidentifyS.
aureuscarriersandreferringthemtotheappro-priatehealthauthoritiesfordecolonization.
AlthoughtheS.
aureuscarriagerateandtheirantibacterialresistanceinthisstudymaybesimilartothosefoundamonghealthyindividualsinthegeneralpopulation[30],itisimportanttodecontaminatefoodhandlerscarryingS.
aureusbecausetheirexposureto,andpossiblecontaminationoffoodpre-paredandservedinrestaurantsisapublichealthconcern.
Table3:Characteristicsof18S.
aureusisolatescontaininglukS-lukFIsolatesSourceResistancepatternagrclasscaptypeSEgenesPFGEpattern33NNosePc,Tc,Tp,CdIII8sea,seiA78NNoseMc,Pc,Km,Tc,Fd,CdIII8NDA157NNosePc,Km,SmIII8SegA342NNoseCdIII8SeiA1515NNoseCdIII8NDH42NNosePc,I5seb,seh,seiB46NNosePc,SmI5seh,seiC268NNoseCdI8NDC298NNosePcI5sehC489NNosePc,CdI5seh,sei.
E666NNosePc,Tc,Tp,CdI5sec,seg,sei.
G9SStoolPc,Tp,FdIII8sea,seh,seiA10SStoolPc,TpIII8sea,seg,seiA58SStoolPc,Tp,CdIII8sea,sec,seg,seiA76SStoolNoneIII8SebD4SHandCdIII8NDF515SHandPc,Tc,CdIII8seh,seiA666SHandPc,Tc,Tp,CdI5sec,seg,sei.
BAbbreviations:Cd,cadmiumacetate,Fd.
fusidicacid.
Km,kanamycin,Mc,methicillin,Pc,benzylpenicillin,Sm,streptomycin,Tc,tetracycline,Tp,trimethoprim,ND,notdetected,agr,accessorygeneregulatorclass,cap,capsularpolysaccharideserotypetype.
BMCResearchNotes2009,2:108http://www.
biomedcentral.
com/1756-0500/2/108Page6of6(pagenumbernotforcitationpurposes)ConclusionThisstudyhasprovidedupdateddataonthecarriageofSEandothervirulencegenes,andinitialinformationontheprevalenceofantibacterialresistanceinS.
aureusobtainedfromfoodhandlersinrestaurantsinKuwaitandintheGulfregion.
Ourresultsshouldcontributetobetterman-agementofS.
aureuscarriersamongthefoodhandlersandenhancethesafetyofrestaurantcustomers.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
Authors'contributionsAllauthorsconceivedthestudy.
SAMisolatedandper-formedinitialcharacterizationoftheisolates.
EEUandMJAperformedmolecularcharacterizationoftheisolates.
Allauthorsparticipatedinthepreparationofthemanu-script.
AcknowledgementsThisstudywassupportedbyKuwaitUniversityResearchGrantNo.
MI05/05.
WethankNadiaAlBania,B.
NoronhaandB.
Mathewfortechnicalassistance.
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