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    <ArticleType>Research Article</ArticleType>
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      <Title language="en">Molecular detection of phenol-soluble modulin-mec (PSM-mec) in Staphylococcus aureus clinical isolates from Federal Medical Center Birnin Kebbi, North-West, Nigeria</Title>
      <TitleTranslated language="de">Molekulare Detektion von phenoll&#246;slichem Modulin-mec (PSM-mec) in klinischen Isolaten von Staphylococcus aureus vom Federal Medical Center Birnin Kebbi, Nordwest-Nigeria</TitleTranslated>
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        <PersonNames>
          <Lastname>Maishanu</Lastname>
          <LastnameHeading>Maishanu</LastnameHeading>
          <Firstname>Isah Musa</Firstname>
          <Initials>IM</Initials>
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        <Address>Kebbi State University of Science and Technology Aliero, along Jega Sokoto Road, 863104 Aliero, Nigeria; Phone &#43;234 706475551<Affiliation>Kebbi State University of Science and Technology Aliero, Nigeria</Affiliation><Affiliation>Ahmadu Bello University Zaria, Kaduna, Nigeria</Affiliation></Address>
        <Email>isatactics&#64;gmail.com</Email>
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          <Lastname>Gbonjubola</Lastname>
          <LastnameHeading>Gbonjubola</LastnameHeading>
          <Firstname>Adeshina O.</Firstname>
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          <Affiliation>Ahmadu Bello University Zaria, Kaduna, Nigeria</Affiliation>
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          <Affiliation>Ahmadu Bello University Zaria, Kaduna, Nigeria</Affiliation>
          <Affiliation>Ummaru Musa Yaradua University Katsina, Nigeria</Affiliation>
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          <Lastname>Olayinka</Lastname>
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          <Firstname>Busayo O.</Firstname>
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          <Affiliation>Ahmadu Bello University Zaria, Kaduna, Nigeria</Affiliation>
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          <Corporatename>German Medical Science GMS Publishing House</Corporatename>
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        <Address>D&#252;sseldorf</Address>
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    <SubjectGroup>
      <SubjectheadingDDB>610</SubjectheadingDDB>
      <Keyword language="en">Staphylococcus aureus</Keyword>
      <Keyword language="en">phenol soluble modulin-mec</Keyword>
      <Keyword language="en">panton valentine leucocidin</Keyword>
      <Keyword language="en">virulence genes</Keyword>
      <Keyword language="de">Staphylococcus aureus</Keyword>
      <Keyword language="de">Phenol-l&#246;sliches Modulin-Mec</Keyword>
      <Keyword language="de">Panton-Valentine-Leukocidin</Keyword>
      <Keyword language="de">Virulenzgene</Keyword>
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      <DatePublished>20250306</DatePublished>
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    <Language>engl</Language>
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      <AltText language="en">This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.</AltText>
      <AltText language="de">Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).</AltText>
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      <Journal>
        <ISSN>2196-5226</ISSN>
        <Volume>20</Volume>
        <JournalTitle>GMS Hygiene and Infection Control</JournalTitle>
        <JournalTitleAbbr>GMS Hyg Infect Control</JournalTitleAbbr>
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    <ArticleNo>09</ArticleNo>
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    <Abstract language="de" linked="yes"><Pgraph><Mark1>Ziel:</Mark1> Diese Studie wurde durchgef&#252;hrt, um Virulenzgene zu isolieren und zu erkennen, die mit klinischen<Mark2> S. aureus</Mark2>-Isolaten des Federal Medical Center Birnin Kebbi assoziiert sind. </Pgraph><Pgraph><Mark1>Methode:</Mark1> 120 <Mark2>S. aureus</Mark2>-Isolate wurden aus Urin, Sputum, Blut und Wunden gewonnen. <Mark2>S. aureus</Mark2> wurde ph&#228;notypisch mithilfe des Microgen Staph ID-Systems identifiziert. Die Gene PSM-mec und PVL wurden mithilfe der Polymerase-Kettenreaktion (PCR) nachgewiesen. </Pgraph><Pgraph><Mark1>Ergebnisse:</Mark1> Es wurden 48 <Mark2>S. aureus</Mark2>-Isolate gewonnen (Wundabstrich 21, Blut 7, Urin 15 und Sputum 5). Von 14 mittels PCR untersuchten <Mark2>S. aureus</Mark2> war das am h&#228;ufigsten vorkommende Gen PSM-mec (42,8&#37;),  w&#228;hrend das PVL-Gen in 21,4&#37; nachgewiesen wurde. </Pgraph><Pgraph><Mark1>Schlussfolgerung:</Mark1> Die PCR-Technik muss unbedingt verwendet werden, da sie f&#252;r die Erkennung von <Mark2>S. aureus</Mark2>-Virulenzfaktoren hochspezifische und genaue Ergebnisse liefert und die Erkennung von PSM-mec und PVL neue Targets f&#252;r antimikrobielle Wirkstoffe darstellen kann.</Pgraph></Abstract>
    <Abstract language="en" linked="yes"><Pgraph><Mark1>Aim:</Mark1> This study was carried out to isolate and detect virulence genes associated with <Mark2>Staphylococcus (S.) aureus</Mark2> clinical isolates from the Federal Medical Center Birnin Kebbi, Nigeria. </Pgraph><Pgraph><Mark1>Methods:</Mark1> To obtain <Mark2>S. aureus</Mark2> isolates, samples were taken from urine, sputum, blood and wound sources. <Mark2>S. aureus</Mark2> was phenotypically identified using Microgen staph ID system and PSM-mec and PVL genes were detected using polymerase chain reaction (PCR). </Pgraph><Pgraph><Mark1>Results:</Mark1> A total of 48 non-duplicate <Mark2>S. aureus</Mark2> isolates were obtained (21 from wound swabs, 7 from blood, 15 from urine, and 5 from sputum). From the 14 <Mark2>S. aureus</Mark2> isolates examined by PCR, the most abundant gene was <Mark2>PSM-mec</Mark2> (42.8&#37;), while the PVL was the least abundant with 21.4&#37;.</Pgraph><Pgraph><Mark1>Conclusion:</Mark1> Because it gives highly specific and accurate results, it is essential to use the PCR technique to detect <Mark2>S. aureus</Mark2> virulence determinants as well as PSM-mec and PVL as targets for antimicrobial agents. </Pgraph></Abstract>
    <TextBlock name="Introduction" linked="yes">
      <MainHeadline>Introduction</MainHeadline><Pgraph>Being one of the &#8220;ESKAPE&#8221; organisms, <Mark2>Staphylococcus (S.) aureus</Mark2> poses an increasing hazard to human health due to its ability to produce a range of serious nosocomial infections <TextLink reference="1"></TextLink>. The relationship among bacterial evolution, host factors, and virulence determinants has been the focus of recent clinical research <TextLink reference="2"></TextLink>, <TextLink reference="3"></TextLink>. The virulence determinants found in <Mark2>Staphylococcus aureus</Mark2> comprise staphylokinase, hyaluronidase, lipase, nuclease, hemolysin, leukocidin, and invasive proteases. Leukocidin induces inflammatory reactions by disrupting skin, mucosal cells, and, among the host blood cells, leukocytes <TextLink reference="4"></TextLink>. The genes that codes for leukocidin are PSM-mec, <TextGroup><PlainText>luk-F&#47;</PlainText></TextGroup>-S-PV, lukE, lukM, and PSM-&#945;. Due to the presence or lack of mobile genetic elements (MGEs), which are made up of genes encoding for toxins and other virulence factors, the organism&#8217;s potential for virulence varies greatly amongst isolates. Antibiotic resistance determinants and virulence factors proliferate as a result of the rich diversification of the naturally adapted mobile genetic element <Mark2>Staphylococcus</Mark2> cassette chromosome mec (SCCmec), which is responsible for the stable maintenance of the core genome environment. Unlike several other bacterial pathogens, which frequently depend on just one or a few toxins to cause illness, <Mark2>S. aureus</Mark2> generates an incredible variety of virulence factors. These comprise a wide range of protein and non-protein components that facilitate host colonization during infection, as well as an abundance of toxins and immune evasion mechanisms. <Mark2>Staphylococcal</Mark2> cassette chromosome mec (<Mark2>SCCmec</Mark2>) elements contain PSM-mec, as well as regulatory factors, recombinase genes, mecA, and other resistance genes <TextLink reference="5"></TextLink>, <TextLink reference="6"></TextLink>. The sole known virulence determinant associated with these determinants is the PSM-mec. It has been discovered in <Mark2>S. aureus</Mark2> SCCmec types II, III, and VIIIK <TextLink reference="7"></TextLink>. Multiple cell surface and secreted virulence factors mediate the pathogenesis of <Mark2>S. aureus</Mark2>. One such virulence factor is called Panton-Valentine leukocidin (PVL), an extracellular protein with dermonecrotic and leucocidal properties, which is expressed by the genes luk-S-PV and luk-F-PV. It is cytotoxic to macrophages, monocytes, and neutrophils in mammals. Community-acquired methicillin-susceptible <Mark2>S. aureus</Mark2> (CA-MSSA) and community-acquired MRSA (CA-MRSA) strains can both produce the toxin. In addition to causing SSTIs, <Mark2>PVL</Mark2>-positive strains have been connected to purpura fulminans, necrotizing pneumonia, bacteremia, and septic arthritis, among other serious diseases <TextLink reference="8"></TextLink>. Detecting PSM-mec and PVL genes in <Mark2>S. aureus</Mark2> clinical isolates from the Federal Medical Centre Birnin Kebbi was the aim of the current investigation.</Pgraph></TextBlock>
    <TextBlock name="Materials and methods" linked="yes">
      <MainHeadline>Materials and methods</MainHeadline><SubHeadline>Collection and authentication of bacterial isolates </SubHeadline><Pgraph>A total of 120 presumptive staphylococcal isolates were collected from wound swabs, urine, blood and sputum. Following conventional microbiological protocols, the isolates were cultivated and identified using the Microgen Staph ID system (.Microgen bioproducts Ltd, UK).  </Pgraph><SubHeadline>DNA extraction </SubHeadline><Pgraph>Each sample was grown for an entire night at 33&#176;C for 24 hrs on Mueller-Hinton agar plates. After that, 3 ml of sterile lysogeny broth medium were used to placed each single bacterial colony (Oxoid, Hampshire, UK), which was then cultured for eight hours at 33&#176;C with vigorous shaking. Next, DNA was extracted using the Hipure Bacterial DNA Kit (Magen, Guangzhou, China) in compliance with the manufacturer&#8217;s instructions.</Pgraph><SubHeadline>Amplification of virulence genes using PCR </SubHeadline><Pgraph>PCR was used to amplify PSM-mec and PVL, as previously reported by Jiang <TextLink reference="9"></TextLink> in 14 isolates of <Mark2>S. aureus</Mark2>. Table 1 <ImgLink imgNo="1" imgType="table" /> lists the target genes, primer sequences, and target segment of the PCR products. The PCR techniques were performed in a final volume of 25 &#181;L of reaction mixture that contained 50 ng of genomic DNA, 20 pmol of each primer, and 12.5 &#181;L of 2&#215;Taq PCR Master Mix (Tiangen Biotech, China: 0.1 U of Taq polymerase&#47;&#181;L, 0.5 mM dNTP each, 20 mM Tris-HCl&#47;pH 8.3, 100 mM KCl, 3 mM MgCl<Subscript>2</Subscript>). The denaturation process was completed in 3 minutes at 94&#176;C, followed by 30 cycles of 30 seconds each at 94&#176;C for denaturation, 30 seconds of annealing at 55&#176;C 1 minute of primer extension at 72&#176;C, and 5 minutes of final extension at 72&#176;C.</Pgraph><SubHeadline>Statistical analysis </SubHeadline><Pgraph>The statistical software for social sciences (SPSS) version 21 was used to analyze the data. The analysis employed descriptive statistics such as percentages.</Pgraph></TextBlock>
    <TextBlock name="Results" linked="yes">
      <MainHeadline>Results</MainHeadline><Pgraph>Forty-eight (48)<Mark2> S. aureus</Mark2> isolates were obtained during the course of a 6-month study period. The majority of <Mark2>S. aureus</Mark2> isolates were from wound (43.7&#37;), urine (31.25&#37;) and blood (12.5&#37;) while sputum was (10.4&#37;). A breakdown of the prevalence of (17.5&#37;) in wound samples was recorded as shown in (Table 2 <ImgLink imgNo="2" imgType="table" />). </Pgraph><Pgraph>The prevalence of PVL and PSM-mec genes in 14 of the <Mark2>S. aureus</Mark2> isolates was 21.4&#37; (3&#47;14) and 42.8&#37; (6&#47;14), respectively. The highest proportion of PSM-mec genes was detected in the <Mark2>S. aureus</Mark2> isolates from wound swabs, followed by urine, while PVL genes were also detected in mostly in wound swabs, followed by blood (Figure 1 <ImgLink imgNo="1" imgType="figure" />).</Pgraph></TextBlock>
    <TextBlock name="Discussion" linked="yes">
      <MainHeadline>Discussion</MainHeadline><Pgraph>In the community, hospital, and environmental settings, virulence factors are an essential component of pathogenic invasion that results in staphylococcal infection. Global reports indicate that <Mark2>S. aureus</Mark2> possesses a rich diversity of virulence-associated genes <TextLink reference="10"></TextLink>, <TextLink reference="11"></TextLink>. The virulence analysis was focused on detecting PVL and PSM-mec genes. Research has shown that the prevalence of PVL in <Mark2>S. aureus</Mark2> isolates derived from clinical specimens varies greatly between nations, with prevalences as high as 57&#37; observed in isolates from west African countries and 9.7&#37; in England <TextLink reference="12"></TextLink>, <TextLink reference="13"></TextLink>. We investigated the prevalence of PVL genes in 14 clinical samples that tested positive for <Mark2>S. aureus</Mark2>. A prevalence of 33.0&#37; was detected out of the 14 <Mark2>S. aureus</Mark2> isolates that underwent investigation for the PVL gene. This is substantially greater than what was found in some studies conducted in Nigeria, with 10.7&#37; <TextLink reference="14"></TextLink>, 11.2&#37; <TextLink reference="15"></TextLink>, <TextLink reference="16"></TextLink> and 13&#37; <TextLink reference="17"></TextLink>, but was similar to others, e. g, in Jos Nigeria with 31.3&#37; <TextLink reference="18"></TextLink>, 34&#37; in Southwest Nigeria <TextLink reference="19"></TextLink> and 39.35&#37; at Obafemi Awolowo University <TextLink reference="20"></TextLink>. In contrast, our results were lower than in Maiduguri, Nigeria, which had 52.1&#37; <TextLink reference="21"></TextLink>, Gambiya 61&#37; <TextLink reference="22"></TextLink>, Sudan 58&#37; <TextLink reference="23"></TextLink>, Iran 56&#37; <TextLink reference="24"></TextLink> and India 61&#37; <TextLink reference="25"></TextLink>. </Pgraph><Pgraph>The virulence factor PSM-mec belongs to the class of amphipathic, alpha-helical peptide poisons known as phenol-soluble modulins (PSM). All known PSMs are core-genome encoded, with the exception of the PSM-mec, which is present in specific subtypes of SCCmec methicillin-resistant mobile genetic elements, discovered in methicillin-resistant <Mark2>S. aureus</Mark2>. According to Wang et al. <TextLink reference="25"></TextLink>, the alpha-type phenol-soluble modulins (PSMs), which are novel cytolytic peptides, are encoded in an operon present in every strain of <Mark2>S. aureus</Mark2> that has been sequenced. Recent studies suggest that PSM synthesis is inhibited by the transcription and translation products of PSM-mec, which are present in the HA-MRSA mobile genetic elements SCCmec-II and -III <TextLink reference="26"></TextLink>. Queck et al. <TextLink reference="27"></TextLink> discovered that PSM-mec had a positive impact on the pathogenicity of the HA-MRSA strain MSA890. Also, the translational product of PSM-mec was found to be more prevalent than that of other PSMs. In the present study, only 42.8&#37; of the 14 MRSA isolates that underwent PCR analysis carried the PSM-mec gene. The majority of HA-MRSA carries the PSM-mec gene, which is present in type-II and type-III SCCmec and regulates <Mark2>S. aureus</Mark2> pathogenicity <TextLink reference="28"></TextLink>. The<Mark2> S. aureus</Mark2> PSM-mec gene, which is necessary for MRSA colonization and pathogenesis, is still not well understood. Given the essential roles of the PVL and PSM-mec genes, these virulence factors may be potential candidates for consideration in vaccines that combat MRSA strains. </Pgraph></TextBlock>
    <TextBlock name="Conclusions" linked="yes">
      <MainHeadline>Conclusions</MainHeadline><Pgraph><Mark2>S. aureus</Mark2> isolated from clinical samples in Nigeria possessed the PSM-mec and PVL genes. An understanding of the links between virulence and resistance would help to lessen the impact of <Mark2>S. aureus</Mark2> infections, given the high prevalence of infections produced by this pathogen and its significance in human medicine. To obtain deeper insight into the various virulence and resistance mechanisms employed by this pathogen and their interactions, additional research is required.</Pgraph></TextBlock>
    <TextBlock name="Notes" linked="yes">
      <MainHeadline>Notes</MainHeadline><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph><SubHeadline>Ethical approval </SubHeadline><Pgraph>Ethical clearance was obtained from the ethical committee of Federal Medical Center Birnin Kebbi, Nigeria to enable collection of Staphylococcal clinical isolates from medical microbiology unit of the hospital.</Pgraph><SubHeadline>Funding</SubHeadline><Pgraph>None. </Pgraph><SubHeadline>Acknowledgments</SubHeadline><Pgraph>We are very grateful to members of staff of Microbiology unit, Federal Medical Center Birnin Kebbi and that of Central Research Laboratory, Department of Veterinary Microbiology Usman Dan Fodio University Sokoto for their cooperation and assistance during the study.</Pgraph></TextBlock>
    <References linked="yes">
      <Reference refNo="1">
        <RefAuthor>Tommasi R</RefAuthor>
        <RefAuthor>Brown DG</RefAuthor>
        <RefAuthor>Walkup GK</RefAuthor>
        <RefAuthor>Manchester JI</RefAuthor>
        <RefAuthor>Miller AA</RefAuthor>
        <RefTitle>ESKAPEing the labyrinth of antibacterial discovery</RefTitle>
        <RefYear>2015</RefYear>
        <RefJournal>Nat Rev Drug Discov</RefJournal>
        <RefPage>529-42</RefPage>
        <RefTotal>Tommasi R, Brown DG, Walkup GK, Manchester JI, Miller AA. ESKAPEing the labyrinth of antibacterial discovery. Nat Rev Drug Discov. 2015 Aug;14(8):529-42. DOI: 10.1038&#47;nrd4572</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1038&#47;nrd4572</RefLink>
      </Reference>
      <Reference refNo="2">
        <RefAuthor>Ghaznavi-Rad E</RefAuthor>
        <RefAuthor>Nor Shamsudin M</RefAuthor>
        <RefAuthor>Sekawi Z</RefAuthor>
        <RefAuthor>Khoon LY</RefAuthor>
        <RefAuthor>Aziz MN</RefAuthor>
        <RefAuthor>Hamat RA</RefAuthor>
        <RefAuthor>Othman N</RefAuthor>
        <RefAuthor>Chong PP</RefAuthor>
        <RefAuthor>van Belkum A</RefAuthor>
        <RefAuthor>Ghasemzadeh-Moghaddam H</RefAuthor>
        <RefAuthor>Neela V</RefAuthor>
        <RefTitle>Predominance and emergence of clones of hospital-acquired methicillin-resistant Staphylococcus aureus in Malaysia</RefTitle>
        <RefYear>2010</RefYear>
        <RefJournal>J Clin Microbiol</RefJournal>
        <RefPage>867-72</RefPage>
        <RefTotal>Ghaznavi-Rad E, Nor Shamsudin M, Sekawi Z, Khoon LY, Aziz MN, Hamat RA, Othman N, Chong PP, van Belkum A, Ghasemzadeh-Moghaddam H, Neela V. Predominance and emergence of clones of hospital-acquired methicillin-resistant Staphylococcus aureus in Malaysia. J Clin Microbiol. 2010 Mar;48(3):867-72. DOI: 10.1128&#47;JCM.01112-09</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1128&#47;JCM.01112-09</RefLink>
      </Reference>
      <Reference refNo="3">
        <RefAuthor>Xu S</RefAuthor>
        <RefAuthor>Fu Z</RefAuthor>
        <RefAuthor>Zhou Y</RefAuthor>
        <RefAuthor>Liu Y</RefAuthor>
        <RefAuthor>Xu X</RefAuthor>
        <RefAuthor>Wang M</RefAuthor>
        <RefTitle>Mutations of the Transporter Proteins GlpT and UhpT Confer Fosfomycin Resistance in</RefTitle>
        <RefYear>2017</RefYear>
        <RefJournal>Front Microbiol</RefJournal>
        <RefPage>914</RefPage>
        <RefTotal>Xu S, Fu Z, Zhou Y, Liu Y, Xu X, Wang M. Mutations of the Transporter Proteins GlpT and UhpT Confer Fosfomycin Resistance in. Front Microbiol. 2017;8:914. DOI: 10.3389&#47;fmicb.2017.00914</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3389&#47;fmicb.2017.00914</RefLink>
      </Reference>
      <Reference refNo="4">
        <RefAuthor>Boan P</RefAuthor>
        <RefAuthor>Tan HL</RefAuthor>
        <RefAuthor>Pearson J</RefAuthor>
        <RefAuthor>Coombs G</RefAuthor>
        <RefAuthor>Heath CH</RefAuthor>
        <RefAuthor>Robinson JO</RefAuthor>
        <RefTitle>Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study</RefTitle>
        <RefYear>2015</RefYear>
        <RefJournal>BMC Infect Dis</RefJournal>
        <RefPage>10</RefPage>
        <RefTotal>Boan P, Tan HL, Pearson J, Coombs G, Heath CH, Robinson JO. Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study. BMC Infect Dis. 2015 Jan;15:10. DOI: 10.1186&#47;s12879-014-0742-6</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1186&#47;s12879-014-0742-6</RefLink>
      </Reference>
      <Reference refNo="5">
        <RefAuthor>Chatterjee SS</RefAuthor>
        <RefAuthor>Chen L</RefAuthor>
        <RefAuthor>Joo HS</RefAuthor>
        <RefAuthor>Cheung GY</RefAuthor>
        <RefAuthor>Kreiswirth BN</RefAuthor>
        <RefAuthor>Otto M</RefAuthor>
        <RefTitle>Distribution and regulation of the mobile genetic element-encoded phenol-soluble modulin PSM-mec in methicillin-resistant Staphylococcus aureus</RefTitle>
        <RefYear>2011</RefYear>
        <RefJournal>PLoS One</RefJournal>
        <RefPage>e28781</RefPage>
        <RefTotal>Chatterjee SS, Chen L, Joo HS, Cheung GY, Kreiswirth BN, Otto M. Distribution and regulation of the mobile genetic element-encoded phenol-soluble modulin PSM-mec in methicillin-resistant Staphylococcus aureus. PLoS One. 2011;6(12):e28781. DOI: 10.1371&#47;journal.pone.0028781</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1371&#47;journal.pone.0028781</RefLink>
      </Reference>
      <Reference refNo="6">
        <RefAuthor>Peschel A</RefAuthor>
        <RefAuthor>Otto M</RefAuthor>
        <RefTitle>Phenol-soluble modulins and staphylococcal infection</RefTitle>
        <RefYear>2013</RefYear>
        <RefJournal>Nat Rev Microbiol</RefJournal>
        <RefPage>667-73</RefPage>
        <RefTotal>Peschel A, Otto M. Phenol-soluble modulins and staphylococcal infection. Nat Rev Microbiol. 2013 Oct;11(10):667-73. DOI: 10.1038&#47;nrmicro3110</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1038&#47;nrmicro3110</RefLink>
      </Reference>
      <Reference refNo="7">
        <RefAuthor>Kaito C</RefAuthor>
        <RefAuthor>Saito Y</RefAuthor>
        <RefAuthor>Ikuo M</RefAuthor>
        <RefAuthor>Omae Y</RefAuthor>
        <RefAuthor>Mao H</RefAuthor>
        <RefAuthor>Nagano G</RefAuthor>
        <RefAuthor>Fujiyuki T</RefAuthor>
        <RefAuthor>Numata S</RefAuthor>
        <RefAuthor>Han X</RefAuthor>
        <RefAuthor>Obata K</RefAuthor>
        <RefAuthor>Hasegawa S</RefAuthor>
        <RefAuthor>Yamaguchi H</RefAuthor>
        <RefAuthor>Inokuchi K</RefAuthor>
        <RefAuthor>Ito T</RefAuthor>
        <RefAuthor>Hiramatsu K</RefAuthor>
        <RefAuthor>Sekimizu K</RefAuthor>
        <RefTitle>Mobile genetic element SCCmec-encoded psm-mec RNA suppresses translation of agrA and attenuates MRSA virulence</RefTitle>
        <RefYear>2013</RefYear>
        <RefJournal>PLoS Pathog</RefJournal>
        <RefPage>e1003269</RefPage>
        <RefTotal>Kaito C, Saito Y, Ikuo M, Omae Y, Mao H, Nagano G, Fujiyuki T, Numata S, Han X, Obata K, Hasegawa S, Yamaguchi H, Inokuchi K, Ito T, Hiramatsu K, Sekimizu K. Mobile genetic element SCCmec-encoded psm-mec RNA suppresses translation of agrA and attenuates MRSA virulence. PLoS Pathog. 2013;9(4):e1003269. DOI: 10.1371&#47;journal.ppat.1003269</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1371&#47;journal.ppat.1003269</RefLink>
      </Reference>
      <Reference refNo="8">
        <RefAuthor>He C</RefAuthor>
        <RefAuthor>Xu S</RefAuthor>
        <RefAuthor>Zhao H</RefAuthor>
        <RefAuthor>Hu F</RefAuthor>
        <RefAuthor>Xu X</RefAuthor>
        <RefAuthor>Jin S</RefAuthor>
        <RefAuthor>Yang H</RefAuthor>
        <RefAuthor>Gong F</RefAuthor>
        <RefAuthor>Liu Q</RefAuthor>
        <RefTitle>Leukotoxin and pyrogenic toxin Superantigen gene backgrounds in bloodstream and wound Staphylococcus aureus isolates from eastern region of China</RefTitle>
        <RefYear>2018</RefYear>
        <RefJournal>BMC Infect Dis</RefJournal>
        <RefPage>395</RefPage>
        <RefTotal>He C, Xu S, Zhao H, Hu F, Xu X, Jin S, Yang H, Gong F, Liu Q. Leukotoxin and pyrogenic toxin Superantigen gene backgrounds in bloodstream and wound Staphylococcus aureus isolates from eastern region of China. BMC Infect Dis. 2018 Aug;18(1):395. DOI: 10.1186&#47;s12879-018-3297-0</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1186&#47;s12879-018-3297-0</RefLink>
      </Reference>
      <Reference refNo="9">
        <RefAuthor>Jiang B</RefAuthor>
        <RefAuthor>Yin S</RefAuthor>
        <RefAuthor>You B</RefAuthor>
        <RefAuthor>Gong Y</RefAuthor>
        <RefAuthor>Huang G</RefAuthor>
        <RefAuthor>Yang Z</RefAuthor>
        <RefAuthor>Zhang Y</RefAuthor>
        <RefAuthor>Chen Y</RefAuthor>
        <RefAuthor>Chen J</RefAuthor>
        <RefAuthor>Yuan Z</RefAuthor>
        <RefAuthor>Hu X</RefAuthor>
        <RefAuthor>Peng Y</RefAuthor>
        <RefTitle>Antimicrobial resistance and virulence genes profiling of methicillin-resistant Staphylococcus aureus isolates in a burn center: A 5-year study</RefTitle>
        <RefYear>2018</RefYear>
        <RefJournal>Microb Pathog</RefJournal>
        <RefPage>176-9</RefPage>
        <RefTotal>Jiang B, Yin S, You B, Gong Y, Huang G, Yang Z, Zhang Y, Chen Y, Chen J, Yuan Z, Hu X, Peng Y. Antimicrobial resistance and virulence genes profiling of methicillin-resistant Staphylococcus aureus isolates in a burn center: A 5-year study. Microb Pathog. 2018 Jan;114:176-9. DOI: 10.1016&#47;j.micpath.2017.11.020</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;j.micpath.2017.11.020</RefLink>
      </Reference>
      <Reference refNo="29">
        <RefAuthor>Grace JU</RefAuthor>
        <RefAuthor>Obaro S</RefAuthor>
        <RefAuthor>Olayinka B</RefAuthor>
        <RefAuthor>Onaolapo J</RefAuthor>
        <RefAuthor>Hassan-Hanga F</RefAuthor>
        <RefAuthor>Munir H</RefAuthor>
        <RefTitle></RefTitle>
        <RefYear>2019</RefYear>
        <RefBookTitle>Staphylococcus epidermidis in Bloodstream Infection: The Clinical Implication in Paediatric Care;</RefBookTitle>
        <RefPage></RefPage>
        <RefTotal>Grace JU, Obaro S, Olayinka B, Onaolapo J, Hassan-Hanga F, Munir H et al. Staphylococcus epidermidis in Bloodstream Infection: The Clinical Implication in Paediatric Care. 2019. DOI: 10.13140&#47;RG.2.2.26861.13289</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.13140&#47;RG.2.2.26861.13289</RefLink>
      </Reference>
      <Reference refNo="30">
        <RefAuthor>Le Thomas I</RefAuthor>
        <RefAuthor>Mariani-Kurkdjian P</RefAuthor>
        <RefAuthor>Collignon A</RefAuthor>
        <RefAuthor>Gravet A</RefAuthor>
        <RefAuthor>Clermont O</RefAuthor>
        <RefAuthor>Brahimi N</RefAuthor>
        <RefAuthor>Gaudelus J</RefAuthor>
        <RefAuthor>Aujard Y</RefAuthor>
        <RefAuthor>Navarro J</RefAuthor>
        <RefAuthor>Beaufils F</RefAuthor>
        <RefAuthor>Bingen E</RefAuthor>
        <RefTitle>Breast milk transmission of a Panton-Valentine leukocidin-producing Staphylococcus aureus strain causing infantile pneumonia</RefTitle>
        <RefYear>2001</RefYear>
        <RefJournal>J Clin Microbiol</RefJournal>
        <RefPage>728-9</RefPage>
        <RefTotal>Le Thomas I, Mariani-Kurkdjian P, Collignon A, Gravet A, Clermont O, Brahimi N, Gaudelus J, Aujard Y, Navarro J, Beaufils F, Bingen E. Breast milk transmission of a Panton-Valentine leukocidin-producing Staphylococcus aureus strain causing infantile pneumonia. J Clin Microbiol. 2001 Feb;39(2):728-9. DOI: 10.1128&#47;JCM.39.2.728-729.2001</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1128&#47;JCM.39.2.728-729.2001</RefLink>
      </Reference>
      <Reference refNo="10">
        <RefAuthor>Sabouni F</RefAuthor>
        <RefAuthor>Mahmoudi S</RefAuthor>
        <RefAuthor>Bahador A</RefAuthor>
        <RefAuthor>Pourakbari B</RefAuthor>
        <RefAuthor>Sadeghi RH</RefAuthor>
        <RefAuthor>Ashtiani MT</RefAuthor>
        <RefAuthor>Nikmanesh B</RefAuthor>
        <RefAuthor>Mamishi S</RefAuthor>
        <RefTitle>Virulence Factors of Staphylococcus aureus Isolates in an Iranian Referral Children&#39;s Hospital</RefTitle>
        <RefYear>2014</RefYear>
        <RefJournal>Osong Public Health Res Perspect</RefJournal>
        <RefPage>96-100</RefPage>
        <RefTotal>Sabouni F, Mahmoudi S, Bahador A, Pourakbari B, Sadeghi RH, Ashtiani MT, Nikmanesh B, Mamishi S. Virulence Factors of Staphylococcus aureus Isolates in an Iranian Referral Children&#39;s Hospital. Osong Public Health Res Perspect. 2014 Apr;5(2):96-100. DOI: 10.1016&#47;j.phrp.2014.03.002</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;j.phrp.2014.03.002</RefLink>
      </Reference>
      <Reference refNo="11">
        <RefAuthor>13 Chen X</RefAuthor>
        <RefAuthor>Wu Z</RefAuthor>
        <RefAuthor>Zhou Y</RefAuthor>
        <RefAuthor>Zhu J</RefAuthor>
        <RefAuthor>Li K</RefAuthor>
        <RefAuthor>Shao H</RefAuthor>
        <RefAuthor></RefAuthor>
        <RefTitle>Molecular and virulence characteristics of methicillin-resistant Staphylococcus aureus in burn patients</RefTitle>
        <RefYear>2017</RefYear>
        <RefJournal>Front Lab Med</RefJournal>
        <RefPage>43-7</RefPage>
        <RefTotal>13 Chen X, Wu Z, Zhou Y, Zhu J, Li K, Shao H, et al. Molecular and virulence characteristics of methicillin-resistant Staphylococcus aureus in burn patients. Front Lab Med. 2017;1(1):43-7. DOI: 10.1016&#47;j.flm.2017.02.010</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;j.flm.2017.02.010</RefLink>
      </Reference>
      <Reference refNo="12">
        <RefAuthor>Breurec S</RefAuthor>
        <RefAuthor>Fall C</RefAuthor>
        <RefAuthor>Pouillot R</RefAuthor>
        <RefAuthor>Boisier P</RefAuthor>
        <RefAuthor>Brisse S</RefAuthor>
        <RefAuthor>Diene-Sarr F</RefAuthor>
        <RefAuthor>Djibo S</RefAuthor>
        <RefAuthor>Etienne J</RefAuthor>
        <RefAuthor>Fonkoua MC</RefAuthor>
        <RefAuthor>Perrier-Gros-Claude JD</RefAuthor>
        <RefAuthor>Ramarokoto CE</RefAuthor>
        <RefAuthor>Randrianirina F</RefAuthor>
        <RefAuthor>Thiberge JM</RefAuthor>
        <RefAuthor>Zriouil SB</RefAuthor>
        <RefAuthor> Working Group on Staphylococcus aureus InfectionsGarin B</RefAuthor>
        <RefAuthor>Laurent F</RefAuthor>
        <RefTitle>Epidemiology of methicillin-susceptible Staphylococcus aureus lineages in five major African towns: high prevalence of Panton-Valentine leukocidin genes</RefTitle>
        <RefYear>2011</RefYear>
        <RefJournal>Clin Microbiol Infect</RefJournal>
        <RefPage>633-9</RefPage>
        <RefTotal>Breurec S, Fall C, Pouillot R, Boisier P, Brisse S, Diene-Sarr F, Djibo S, Etienne J, Fonkoua MC, Perrier-Gros-Claude JD, Ramarokoto CE, Randrianirina F, Thiberge JM, Zriouil SB; Working Group on Staphylococcus aureus InfectionsGarin B, Laurent F. Epidemiology of methicillin-susceptible Staphylococcus aureus lineages in five major African towns: high prevalence of Panton-Valentine leukocidin genes. Clin Microbiol Infect. 2011 Apr;17(4):633-9. DOI: 10.1111&#47;j.1469-0691.2010.03320.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1469-0691.2010.03320.x</RefLink>
      </Reference>
      <Reference refNo="13">
        <RefAuthor>Shallcross LJ</RefAuthor>
        <RefAuthor>Williams K</RefAuthor>
        <RefAuthor>Hopkins S</RefAuthor>
        <RefAuthor>Aldridge RW</RefAuthor>
        <RefAuthor>Johnson AM</RefAuthor>
        <RefAuthor>Hayward AC</RefAuthor>
        <RefTitle>Panton-Valentine leukocidin associated staphylococcal disease: a cross-sectional study at a London hospital, England</RefTitle>
        <RefYear>2010</RefYear>
        <RefJournal>Clin Microbiol Infect</RefJournal>
        <RefPage>1644-8</RefPage>
        <RefTotal>Shallcross LJ, Williams K, Hopkins S, Aldridge RW, Johnson AM, Hayward AC. Panton-Valentine leukocidin associated staphylococcal disease: a cross-sectional study at a London hospital, England. Clin Microbiol Infect. 2010 Nov;16(11):1644-8. DOI: 10.1111&#47;j.1469-0691.2010.03153.x</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1111&#47;j.1469-0691.2010.03153.x</RefLink>
      </Reference>
      <Reference refNo="14">
        <RefAuthor>O&#8217;Malley SM</RefAuthor>
        <RefAuthor>Emele FE</RefAuthor>
        <RefAuthor>Nwaokorie FO</RefAuthor>
        <RefAuthor>Idika N</RefAuthor>
        <RefAuthor>Umeizudike AK</RefAuthor>
        <RefAuthor>Emeka-Nwabunnia I</RefAuthor>
        <RefAuthor>Hanson BM</RefAuthor>
        <RefAuthor>Nair R</RefAuthor>
        <RefAuthor>Wardyn SE</RefAuthor>
        <RefAuthor>Smith TC</RefAuthor>
        <RefTitle>Molecular typing of antibiotic-resistant Staphylococcus aureus in Nigeria</RefTitle>
        <RefYear>2015</RefYear>
        <RefJournal>J Infect Public Health</RefJournal>
        <RefPage>187-93</RefPage>
        <RefTotal>O&#8217;Malley SM, Emele FE, Nwaokorie FO, Idika N, Umeizudike AK, Emeka-Nwabunnia I, Hanson BM, Nair R, Wardyn SE, Smith TC. Molecular typing of antibiotic-resistant Staphylococcus aureus in Nigeria. J Infect Public Health. 2015;8(2):187-93. DOI: 10.1016&#47;j.jiph.2014.08.001</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;j.jiph.2014.08.001</RefLink>
      </Reference>
      <Reference refNo="15">
        <RefAuthor>Babatunde OJ</RefAuthor>
        <RefAuthor>Ogundare AO</RefAuthor>
        <RefAuthor>Adebolu TT</RefAuthor>
        <RefTitle>Antibacterial activities of Polyalthia longifolia leaf extracts on multiple antibiotic-resistant bacteria isolated from hospital fomites in Akure, Nigeria</RefTitle>
        <RefYear>2023</RefYear>
        <RefJournal>Nusantara Biosci</RefJournal>
        <RefPage></RefPage>
        <RefTotal>Babatunde OJ, Ogundare AO, Adebolu TT. Antibacterial activities of Polyalthia longifolia leaf extracts on multiple antibiotic-resistant bacteria isolated from hospital fomites in Akure, Nigeria. Nusantara Biosci. 2023;15(2). DOI: 10.13057&#47;nusbiosci&#47;n150203</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.13057&#47;nusbiosci&#47;n150203</RefLink>
      </Reference>
      <Reference refNo="16">
        <RefAuthor>Abdullahi IN</RefAuthor>
        <RefAuthor>Issaoui R</RefAuthor>
        <RefAuthor>Usman Y</RefAuthor>
        <RefTitle>Prevalence and genetic lineages of nasal colonization and urinary tract infection among people living with HIV&#47;AIDS in Nigeria: A systematic review</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>IJID Reg</RefJournal>
        <RefPage>17-24</RefPage>
        <RefTotal>Abdullahi IN, Issaoui R, Usman Y. Prevalence and genetic lineages of nasal colonization and urinary tract infection among people living with HIV&#47;AIDS in Nigeria: A systematic review. IJID Reg. 2022 Sep;4:17-24. DOI: 10.1016&#47;j.ijregi.2022.05.009</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1016&#47;j.ijregi.2022.05.009</RefLink>
      </Reference>
      <Reference refNo="17">
        <RefAuthor>Orji OL</RefAuthor>
        <RefAuthor>Olayinka BO</RefAuthor>
        <RefAuthor>Afolabi B</RefAuthor>
        <RefAuthor>Ejikeugwu Chika P</RefAuthor>
        <RefAuthor>Nwakaeze EA</RefAuthor>
        <RefTitle>Molecular detection of panton-valentine leucocidin (PVL) toxins in clinical isolates of Staphylococcus aureus from Maitama district hospital</RefTitle>
        <RefYear>2016</RefYear>
        <RefJournal>J Med Microb Diagn</RefJournal>
        <RefPage>3</RefPage>
        <RefTotal>Orji OL, Olayinka BO, Afolabi B, Ejikeugwu Chika P, Nwakaeze EA. Molecular detection of panton-valentine leucocidin (PVL) toxins in clinical isolates of Staphylococcus aureus from Maitama district hospital. J Med Microb Diagn. 2016; 5:3. DOI: 10.4172&#47;2161-0703.1000240</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.4172&#47;2161-0703.1000240</RefLink>
      </Reference>
      <Reference refNo="18">
        <RefAuthor>Essien UC</RefAuthor>
        <RefAuthor>Boswihi SS</RefAuthor>
        <RefAuthor>Agbakoba NR</RefAuthor>
        <RefAuthor>Udo EE</RefAuthor>
        <RefTitle>Description of Methicillin-Susceptible Staphylococcus aureus Clonal Complex 30 Related to the Pandemic Phage Type 80&#47;81 Isolated from Patients in Three Tertiary Hospitals in Jos, North Central Nigeria</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>Med Princ Pract</RefJournal>
        <RefPage>269-75</RefPage>
        <RefTotal>Essien UC, Boswihi SS, Agbakoba NR, Udo EE. Description of Methicillin-Susceptible Staphylococcus aureus Clonal Complex 30 Related to the Pandemic Phage Type 80&#47;81 Isolated from Patients in Three Tertiary Hospitals in Jos, North Central Nigeria. Med Princ Pract. 2022;31(3):269-75. DOI: 10.1159&#47;000524755</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1159&#47;000524755</RefLink>
      </Reference>
      <Reference refNo="19">
        <RefAuthor>Alli OA</RefAuthor>
        <RefAuthor>Ogbolu DO</RefAuthor>
        <RefAuthor>Shittu AO</RefAuthor>
        <RefAuthor>Okorie AN</RefAuthor>
        <RefAuthor>Akinola JO</RefAuthor>
        <RefAuthor>Daniel JB</RefAuthor>
        <RefTitle>Association of virulence genes with mecA gene in Staphylococcus aureus isolates from Tertiary Hospitals in Nigeria</RefTitle>
        <RefYear>2015</RefYear>
        <RefJournal>Indian J Pathol Microbiol</RefJournal>
        <RefPage>464-71</RefPage>
        <RefTotal>Alli OA, Ogbolu DO, Shittu AO, Okorie AN, Akinola JO, Daniel JB. Association of virulence genes with mecA gene in Staphylococcus aureus isolates from Tertiary Hospitals in Nigeria. Indian J Pathol Microbiol. 2015;58(4):464-71. DOI: 10.4103&#47;0377-4929.168875</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.4103&#47;0377-4929.168875</RefLink>
      </Reference>
      <Reference refNo="20">
        <RefAuthor>Kolawole DO</RefAuthor>
        <RefAuthor>Adeyanju A</RefAuthor>
        <RefAuthor>Schaumburg F</RefAuthor>
        <RefAuthor>Akinyoola AL</RefAuthor>
        <RefAuthor>Lawal OO</RefAuthor>
        <RefAuthor>Amusa YB</RefAuthor>
        <RefAuthor>K&#246;ck R</RefAuthor>
        <RefAuthor>Becker K</RefAuthor>
        <RefTitle>Characterization of colonizing Staphylococcus aureus isolated from surgical wards&#39; patients in a Nigerian university hospital</RefTitle>
        <RefYear>2013</RefYear>
        <RefJournal>PLoS One</RefJournal>
        <RefPage>e68721</RefPage>
        <RefTotal>Kolawole DO, Adeyanju A, Schaumburg F, Akinyoola AL, Lawal OO, Amusa YB, K&#246;ck R, Becker K. Characterization of colonizing Staphylococcus aureus isolated from surgical wards&#39; patients in a Nigerian university hospital. PLoS One. 2013;8(7):e68721. DOI: 10.1371&#47;journal.pone.0068721</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1371&#47;journal.pone.0068721</RefLink>
      </Reference>
      <Reference refNo="21">
        <RefAuthor>Okon KO</RefAuthor>
        <RefAuthor>Uba A</RefAuthor>
        <RefAuthor>Oyawoye OM</RefAuthor>
        <RefAuthor>Yusuf IZ</RefAuthor>
        <RefAuthor>Adesina OO</RefAuthor>
        <RefTitle>Prevalence and antibiotic susceptibility pattern of panton valentine leucocidin (PVL) positive Staphylococcus aureus strains from clinical specimens in Northeastern Nigeria</RefTitle>
        <RefYear>2012</RefYear>
        <RefJournal>Sierra Leone J Biomed Res</RefJournal>
        <RefPage>43-52</RefPage>
        <RefTotal>Okon KO, Uba A, Oyawoye OM, Yusuf IZ, Adesina OO. Prevalence and antibiotic susceptibility pattern of panton valentine leucocidin (PVL) positive Staphylococcus aureus strains from clinical specimens in Northeastern Nigeria. Sierra Leone J Biomed Res. 2012; 4(1):43-52.</RefTotal>
      </Reference>
      <Reference refNo="22">
        <RefAuthor>Darboe S</RefAuthor>
        <RefAuthor>Dobreniecki S</RefAuthor>
        <RefAuthor>Jarju S</RefAuthor>
        <RefAuthor>Jallow M</RefAuthor>
        <RefAuthor>Mohammed NI</RefAuthor>
        <RefAuthor>Wathuo M</RefAuthor>
        <RefAuthor>Ceesay B</RefAuthor>
        <RefAuthor>Tweed S</RefAuthor>
        <RefAuthor>Basu Roy R</RefAuthor>
        <RefAuthor>Okomo U</RefAuthor>
        <RefAuthor>Kwambana-Adams B</RefAuthor>
        <RefAuthor>Antonio M</RefAuthor>
        <RefAuthor>Bradbury RS</RefAuthor>
        <RefAuthor>de Silva TI</RefAuthor>
        <RefAuthor>Forrest K</RefAuthor>
        <RefAuthor>Roca A</RefAuthor>
        <RefAuthor>Lawal BJ</RefAuthor>
        <RefAuthor>Nwakanma D</RefAuthor>
        <RefAuthor>Secka O</RefAuthor>
        <RefTitle>Prevalence of Panton-Valentine Leukocidin (PVL) and Antimicrobial Resistance in Community-Acquired Clinical in an Urban Gambian Hospital: A 11-Year Period Retrospective Pilot Study</RefTitle>
        <RefYear>2019</RefYear>
        <RefJournal>Front Cell Infect Microbiol</RefJournal>
        <RefPage>170</RefPage>
        <RefTotal>Darboe S, Dobreniecki S, Jarju S, Jallow M, Mohammed NI, Wathuo M, Ceesay B, Tweed S, Basu Roy R, Okomo U, Kwambana-Adams B, Antonio M, Bradbury RS, de Silva TI, Forrest K, Roca A, Lawal BJ, Nwakanma D, Secka O. Prevalence of Panton-Valentine Leukocidin (PVL) and Antimicrobial Resistance in Community-Acquired Clinical in an Urban Gambian Hospital: A 11-Year Period Retrospective Pilot Study. Front Cell Infect Microbiol. 2019;9:170. DOI: 10.3389&#47;fcimb.2019.00170</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.3389&#47;fcimb.2019.00170</RefLink>
      </Reference>
      <Reference refNo="23">
        <RefAuthor>Osman NM</RefAuthor>
        <RefAuthor>Alrayah IE</RefAuthor>
        <RefAuthor>Mohamed YM</RefAuthor>
        <RefAuthor>Erag AE</RefAuthor>
        <RefAuthor>Eldirdery MM</RefAuthor>
        <RefAuthor>Salih MA</RefAuthor>
        <RefTitle>Molecular study of panton-valentine leukocidin genes among Staphylococcus aureus clinical isolates in Khartoum State, Sudan</RefTitle>
        <RefYear>2015</RefYear>
        <RefJournal>American J Microbiol Res</RefJournal>
        <RefPage>107-11</RefPage>
        <RefTotal>Osman NM, Alrayah IE, Mohamed YM, Erag AE, Eldirdery MM, Salih MA. Molecular study of panton-valentine leukocidin genes among Staphylococcus aureus clinical isolates in Khartoum State, Sudan. American J Microbiol Res. 2015; 3(3):107-11. DOI: 10.12691&#47;ajmr-3-3-2</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.12691&#47;ajmr-3-3-2</RefLink>
      </Reference>
      <Reference refNo="24">
        <RefAuthor>Nourbakhsh V</RefAuthor>
        <RefAuthor>Nourbakhsh F</RefAuthor>
        <RefAuthor>Tajbakhsh E</RefAuthor>
        <RefAuthor>Borooni S</RefAuthor>
        <RefAuthor>Daneshmand D</RefAuthor>
        <RefTitle>Characterization of Staphylococcus aureus isolated from wound infectious in diabetes clinic of Hazrat Fatemeh Zahra (SA) hospital</RefTitle>
        <RefYear>2018</RefYear>
        <RefJournal>Avicenna J Clin Microbiol Infect</RefJournal>
        <RefPage>67-70</RefPage>
        <RefTotal>Nourbakhsh V, Nourbakhsh F, Tajbakhsh E, Borooni S, Daneshmand D. Characterization of Staphylococcus aureus isolated from wound infectious in diabetes clinic of Hazrat Fatemeh Zahra (SA) hospital. Avicenna J Clin Microbiol Infect. 2018;5(3): 67-70. DOI: 10.34172&#47;ajcmi.2018.13</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.34172&#47;ajcmi.2018.13</RefLink>
      </Reference>
      <Reference refNo="25">
        <RefAuthor>Patil NR</RefAuthor>
        <RefAuthor>Ghorpade MV</RefAuthor>
        <RefTitle>Association of virulence factor (panton-valentine leukocidin) with meca gene in Staphylococcus aureus isolates in tertiary care hospital</RefTitle>
        <RefYear>2018</RefYear>
        <RefJournal>Asian J Pharm Clin Res</RefJournal>
        <RefPage>10.22159&#47;ajpcr.2018.v11i2</RefPage>
        <RefTotal>Patil NR, Ghorpade MV. Association of virulence factor (panton-valentine leukocidin) with meca gene in Staphylococcus aureus isolates in tertiary care hospital. Asian J Pharm Clin Res. 2018; 11(2): 113-6. DOI:10.22159&#47;ajpcr.2018.v11i2.19080</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.22159&#47;ajpcr.2018.v11i2.19080</RefLink>
      </Reference>
      <Reference refNo="26">
        <RefAuthor>Wang R</RefAuthor>
        <RefAuthor>Braughton KR</RefAuthor>
        <RefAuthor>Kretschmer D</RefAuthor>
        <RefAuthor>Bach TH</RefAuthor>
        <RefAuthor>Queck SY</RefAuthor>
        <RefAuthor>Li M</RefAuthor>
        <RefAuthor>Kennedy AD</RefAuthor>
        <RefAuthor>Dorward DW</RefAuthor>
        <RefAuthor>Klebanoff SJ</RefAuthor>
        <RefAuthor>Peschel A</RefAuthor>
        <RefAuthor>DeLeo FR</RefAuthor>
        <RefAuthor>Otto M</RefAuthor>
        <RefTitle>Identification of novel cytolytic peptides as key virulence determinants for community-associated MRSA</RefTitle>
        <RefYear>2007</RefYear>
        <RefJournal>Nat Med</RefJournal>
        <RefPage>1510-4</RefPage>
        <RefTotal>Wang R, Braughton KR, Kretschmer D, Bach TH, Queck SY, Li M, Kennedy AD, Dorward DW, Klebanoff SJ, Peschel A, DeLeo FR, Otto M. Identification of novel cytolytic peptides as key virulence determinants for community-associated MRSA. Nat Med. 2007 Dec;13(12):1510-4. DOI: 10.1038&#47;nm1656</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1038&#47;nm1656</RefLink>
      </Reference>
      <Reference refNo="27">
        <RefAuthor>Queck SY</RefAuthor>
        <RefAuthor>Khan BA</RefAuthor>
        <RefAuthor>Wang R</RefAuthor>
        <RefAuthor>Bach TH</RefAuthor>
        <RefAuthor>Kretschmer D</RefAuthor>
        <RefAuthor>Chen L</RefAuthor>
        <RefAuthor>Kreiswirth BN</RefAuthor>
        <RefAuthor>Peschel A</RefAuthor>
        <RefAuthor>Deleo FR</RefAuthor>
        <RefAuthor>Otto M</RefAuthor>
        <RefTitle>Mobile genetic element-encoded cytolysin connects virulence to methicillin resistance in MRSA</RefTitle>
        <RefYear>2009</RefYear>
        <RefJournal>PLoS Pathog</RefJournal>
        <RefPage>e1000533</RefPage>
        <RefTotal>Queck SY, Khan BA, Wang R, Bach TH, Kretschmer D, Chen L, Kreiswirth BN, Peschel A, Deleo FR, Otto M. Mobile genetic element-encoded cytolysin connects virulence to methicillin resistance in MRSA. PLoS Pathog. 2009 Jul;5(7):e1000533. DOI: 10.1371&#47;journal.ppat.1000533</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1371&#47;journal.ppat.1000533</RefLink>
      </Reference>
      <Reference refNo="28">
        <RefAuthor>Kaito C</RefAuthor>
        <RefAuthor>Saito Y</RefAuthor>
        <RefAuthor>Nagano G</RefAuthor>
        <RefAuthor>Ikuo M</RefAuthor>
        <RefAuthor>Omae Y</RefAuthor>
        <RefAuthor>Hanada Y</RefAuthor>
        <RefAuthor>Han X</RefAuthor>
        <RefAuthor>Kuwahara-Arai K</RefAuthor>
        <RefAuthor>Hishinuma T</RefAuthor>
        <RefAuthor>Baba T</RefAuthor>
        <RefAuthor>Ito T</RefAuthor>
        <RefAuthor>Hiramatsu K</RefAuthor>
        <RefAuthor>Sekimizu K</RefAuthor>
        <RefTitle>Transcription and translation products of the cytolysin gene psm-mec on the mobile genetic element SCCmec regulate Staphylococcus aureus virulence</RefTitle>
        <RefYear>2011</RefYear>
        <RefJournal>PLoS Pathog</RefJournal>
        <RefPage>e1001267</RefPage>
        <RefTotal>Kaito C, Saito Y, Nagano G, Ikuo M, Omae Y, Hanada Y, Han X, Kuwahara-Arai K, Hishinuma T, Baba T, Ito T, Hiramatsu K, Sekimizu K. Transcription and translation products of the cytolysin gene psm-mec on the mobile genetic element SCCmec regulate Staphylococcus aureus virulence. PLoS Pathog. 2011 Feb;7(2):e1001267. DOI: 10.1371&#47;journal.ppat.1001267</RefTotal>
        <RefLink>https:&#47;&#47;doi.org&#47;10.1371&#47;journal.ppat.1001267</RefLink>
      </Reference>
    </References>
    <Media>
      <Tables>
        <Table format="png">
          <MediaNo>1</MediaNo>
          <MediaID>1</MediaID>
          <Caption><Pgraph><Mark1>Table 1: The primers used and their nucleotide sequences</Mark1></Pgraph></Caption>
        </Table>
        <Table format="png">
          <MediaNo>2</MediaNo>
          <MediaID>2</MediaID>
          <Caption><Pgraph>Table 2: Prevalence of <Mark2>Staphylococcus aureus</Mark2> isolates by specimen</Pgraph></Caption>
        </Table>
        <NoOfTables>2</NoOfTables>
      </Tables>
      <Figures>
        <Figure width="367" height="453" format="png">
          <MediaNo>1</MediaNo>
          <MediaID>1</MediaID>
          <Caption><Pgraph><Mark1>Figure 1: Percentage of virulence genes in </Mark1><Mark1><Mark2>S aureus</Mark2></Mark1><Mark1> from various clinical specimens. (PVL&#61;panton valentine leucocidin, PSM-mec&#61;phenol soluble modulin-mec)</Mark1></Pgraph></Caption>
        </Figure>
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