Microbiological virulence determinants and surgical outcomes in Staphylococcus aureus-infected diabetic foot ulcers: Clinical significance of mecA and pvl genes | ||
| Microbes and Infectious Diseases | ||
| Articles in Press, Accepted Manuscript, Available Online from 07 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/mid.2025.421962.3194 | ||
| Authors | ||
| Mai Mwafy1; AbdelRahman Nagy2; Esraa A. Mohamed* 1 | ||
| 1Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Egypt | ||
| 2Vascular and Endovascular Surgery Department, Faculty of Medicine, Tanta University, Egypt | ||
| Abstract | ||
| Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of diabetic foot infections, often complicating healing and surgical outcomes. While the roles of the mecA and Panton–Valentine leucocidin (pvl) genes in antimicrobial resistance and virulence are well recognized, relatively few studies have explored their combined clinical relevance in diabetic foot ulcers (DFUs), particularly in relation to surgical planning and healing outcomes. Objectives: To determine the prevalence of mecA and pvl genes in MRSA isolates from DFUs and to assess their associations with ulcer severity, surgical intervention type, and healing outcomes. Methods: A cross-sectional study of 202 DFU patients was conducted over six months at a tertiary hospital in Egypt. Clinical, microbiological, as well as PCR detection of mecA and pvl genes were conducted. Surgical outcomes were stratified by intervention type, and healing was monitored prospectively. Results: Among 58 Staphylococcus aureus isolates, 37 (63.8%) were MRSA, with mecA and pvl detected in 83.8% and 35.1%, respectively. mecA positivity was associated with longer ulcer duration (P=0.01) but not healing rates. pvl-positive MRSA correlated with higher Wagner grades (P=0.04), greater need for major debridement (P=0.05), and lower healing rates (P=0.001). All pvl-positive cases required major debridement. Regression analysis identified pvl expression and polymicrobial infection as independent predictors of delayed healing. Conclusions: pvl expression was associated with greater ulcer severity, more extensive surgical intervention, and impaired healing, whereas mecA predicted chronicity. Incorporating molecular detection of these genes into routine assessment may help guide surgical decision-making in MRSA-infected DFUs. | ||
| Keywords | ||
| Diabetic foot infections (DFIs); Panton-Valentine leukocidin; MRSA; PCR; Wagner classification | ||
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