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Unveiling the spectrum of vancomycin resistance in Staphylococcus aureus from Hospital-acquired urinary tract infections (HA-UTI) in cardiac patients

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Abstract

Background

Patients with cardiac disease are highly susceptible to hospital-acquired urinary tract infections (HA-UTI) due to immunosuppression, invasive procedures, and prolonged hospitalization. Although Enterobacteriaceae are frequent pathogens, the contribution of vancomycin-resistant Staphylococcus aureus (VRSA) remains unexplored. Among 11 known glycopeptide resistance genes (vanA, vanB, vanD, vanF, vanI, vanM, vanC, vanE, vanG, vanL, and vanN), vanA and vanB are most commonly reported. However, the diversity of other van genes and their interplay with antimicrobial resistance (AMR) and virulence determinants are poorly characterized.

Methods and results

Between March 2020 and April 2022, 189 cardiac ward patients were screened for VRSA-associated HA-UTI. The presence of van genes, efflux pump genes (norA, norB, sepA, mepA, mdeA), and virulence genes (hla, sea, icaA, fnbA) was determined using singleplex PCR, correlation analysis, and qRT-PCR for expression profiling. Antimicrobial susceptibility was assessed via disk diffusion, minimum inhibitory concentration (MIC), hierarchical clustering, and multiple antibiotic resistance indexing. 55% of VRSA isolates harboured limited van gene diversity, with vanA predominant. These isolates exhibited extensive AMR, high vancomycin MICs (> 256 µg/mL), and multidrug resistance. Co-occurrence of efflux pump genes (norA + norB, norB + norC, sepA + norB) and virulence genes (hla + sea, icaA + fnbA) showed significant positive correlations. All isolates were susceptible to linezolid and chloramphenicol.

Conclusion

vanA-mediated resistance in VRSA from HA-UTI is strongly associated with efflux pump activity and virulence gene expression. Integrative genomic and transcriptomic approaches are essential for deciphering these networks, guiding precision therapeutics, and strengthening infection control measures.

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Data availability

All data analyzed in this study were obtained from the corresponding author upon request.

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Funding

This study did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Muhammad Umer Asghar

    Present address: Department of Biology, University of Ottawa, Ottawa, Canada

Authors and Affiliations

  1. National Probiotic Lab, National Institute for Biotechnology and Genetic Engineering- College (NIBGE-C), Faisalabad, 38000, Pakistan

    Muhammad Umer Asghar, Muhammad Tariq & Arsalan Haseeb Zaidi

  2. Pakistan Institute of Engineering & Applied Sciences (PIEAS), 45650, Nilore Islamabad (ICT), Pakistan

    Muhammad Umer Asghar, Muhammad Tariq & Arsalan Haseeb Zaidi

  3. Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad, 3802, Pakistan

    Muhammad Umer Asghar & Kabeer Haneef

  4. School of Life Sciences, Institute for Immunology, Tsinghua University, Beijing, 100084, China

    Kabeer Haneef

  5. Chinese Institute for Brain Research (CIBR), Beijing, 102206, China

    Kabeer Haneef

  6. Department of Gynecology and Obstetrics, District Headquarters Hospital (DHQH), Toba Tek Singh, 36050, Pakistan

    Aisha Asghar

  7. Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, 54000, Pakistan

    Aisha Asghar

  8. Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, 54590, Pakistan

    Noor Ul Ain

  9. Centre for Clinical Microbiology, University college London (UCL), London, UK

    Noor Ul Ain

Authors
  1. Muhammad Umer Asghar
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Contributions

Muhammad Umer Asghar: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing. Muhammad Tariq: Supervision. Arsalan Haseeb Zaidi: Supervision. Kabeer Haneef: Writing, review, and editing. Aisha Asghar: Writing - review & editing. Noor Ul Ain: Investigation, Writing, review, and editing.

Corresponding authors

Correspondence to Muhammad Umer Asghar or Noor Ul Ain.

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All the authors have reviewed and approved the final manuscript.

Competing interests

The authors declare no competing interests.

Ethical approval

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The direct involvement of patients was not included because only medical data were used. This study was approved by the Institutional Ethical Review Committee of the Faisalabad Institute of Cardiology (FIC) (approval no. 17–2019/DME/FIC/FSD). As this study involved retrospective medical data, the requirement for informed consent was waived by the Institutional Ethical Review Committee of the FIC.

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Asghar, M.U., Tariq, M., Zaidi, A.H. et al. Unveiling the spectrum of vancomycin resistance in Staphylococcus aureus from Hospital-acquired urinary tract infections (HA-UTI) in cardiac patients. Mol Biol Rep 52, 1001 (2025). https://doi.org/10.1007/s11033-025-11117-7

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