The Evolution and Transmission of HA-MRSA ST239 through Hospitals in Turkey and Intercontinental Spread

  • Mona Aldeljawi

Student thesis: Doctoral ThesisPhD


Next-generation sequencing technology provides high-resolution data for epidemiological surveillance of bacterial pathogens on local and global scales. This approach has been used for many species including Methicillin Resistant Staphylococcus aureus (MRSA). In this thesis I demonstrate the utility of these data for understanding the spread of the globally disseminated clone MRSA ST239. I focus both on local and national-level epidemiology through sequence data of 71 isolates recovered from four hospitals representing three cities in Turkey; Istanbul (x2). Ankara and Izmir. I analyse whole genome sequence data from a further 33 ST239 isolates from global sources. These data were combined with previously published data for phylogenetic analysis based only on the core genome. I demonstrate how transmission events can be inferred from this approach on multiple levels; within hospital, between hospitals and between countries. The data pointed to a European origin of ST239, and independent introductions from Europe to Turkey, South America and East Asia. I also demonstrate how whole genome sequence data can be used to develop bespoke PCR assays, based on phage variation, for rapid local epidemiology. Finally, I consider how the sequence data might be used to explain variation in virulence potential, and describe the distribution and transfer of an important phage-borne virulence determinant, sasX, within Europe. Finally, I identified a single isolate with very strong biofilm forming ability likely due to the over-expression of the important adhesion SasG.
Date of Award20 Aug 2015
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorEdward Feil (Supervisor) & Ruth Massey (Supervisor)


  • MRSA
  • ST239
  • Whole Genome Sequencing
  • SasG
  • Next Generation Sequencing
  • HA-MRSA (ST 239)
  • NGS
  • Dokuz Eylül hospital
  • intercontinental transmission
  • Hacettepe hospital
  • Cerrahpasa hospital
  • Marmara hospital
  • Turkey

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