Emerging insights into Panton-Valentine leukocidin-producing methicillin-resistant Staphylococcus aureus in Gulf Cooperation Council countries: A scoping review.

BACKGROUND: Panton-Valentine leukocidin (PVL)-producing methicillin-resistant Staphylococcus aureus (MRSA) is a growing public health concern in Gulf Cooperation Council (GCC) countries. PVL enhances MRSA virulence, contributing to severe skin and soft tissue infections and necrotizing pneumonia. OBJECTIVES: To review the prevalence, molecular characteristics, and antibiotic resistance patterns of PVL-positive MRSA strains in GCC countries, i.e., Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). METHODS: We conducted a scoping review of studies published between January 2020 and December 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were performed in PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar, targeting original research reporting PVL presence in clinical MRSA isolates from GCC countries. Data were extracted into standardized forms and organized in comparative tables. RESULTS: Fourteen original studies were included, primarily from Saudi Arabia, Kuwait, UAE, Bahrain, and Qatar. Across included studies, PVL prevalence among MRSA isolates varied widely, ranging from 0% to 62% depending on country, setting, and study design. Community-associated (CA) MRSA clones, such as ST80-IV, ST30-IV, and ST6-IV, predominated among PVL-positive strains, though PVL acquisition by hospital-associated (HA) lineages like ST22-IV and ST239-III was increasingly reported. PVL-positive strains exhibited resistance to fusidic acid, fluoroquinolones, and macrolides, but remained susceptible to vancomycin and linezolid. CONCLUSION: PVL-producing MRSA is a significant contributor to staphylococcal disease in the GCC, with prevalence in both community and hospital settings. The convergence of virulence and multidrug resistance among PVL-MRSA strains presents challenges for infection control. Strengthened regional surveillance, standardized molecular typing, and one-health-informed monitoring are needed.