## 4 Discussion
isolates in under 2 min, indicating that it has several advantages over traditional diagnostic techniques, such as saving time, being more cost-effective, and being >99% more sensitive [59]. Prior studies also reported similar results in which 93-100% of _S. aureus_ isolates could be correctly identified using MALDI-TOF MS with high score values [17; 60; 61]. In all of these studies, there is no indication of the _S. aureus_ subspecies, but considering the clinical origin of the isolates, it is reasonable to assume that all were _S. aureus_ subsp. aureus. The efficacy of the MALDI-TOF MS approach to successfully differentiate MRSA and MSSA strains was demonstrated in this investigation through the identification of distinct new peaks. Earlier research has also suggested unique MRSA peaks, but a systematic discrimination strategy focusing on these peaks in hospital studies remains unavailable. Furthermore, the observed peaks have a variety of patterns [17; 55; 62; 63] or are only relevant to a subset of MRSA strains [64; 65]. The discriminating techniques discussed here, on the other hand, offer great reliability and predictive ability, and can be used in ordinary clinical settings. Despite phenotypic and MALDI-TOF MS techniques being used for the identification of MRSA, the identification of _mecA_ currently plays a crucial role as a confirmatory method of MRSA. Because of its precision and accuracy, real-time PCR amplification of _mecA_ to confirm MRSA has been deemed the gold standard approach [2; 66]. In this investigation, 22 of the isolated bacteria screened positive for _mecA_. Despite the fact that two strains were morphologically tolerant to cefoxitin, there was no evidence of _mecA_ amplification, suggesting that it could be carrying another gene, such as _mecC_, instead of _mecA_[67]. The _MecA_ gene has been found in cefoxitin-sensitive bacteria, which contradicts this finding [68]. This discrepancy between genotypic approaches could be due to differences in culture conditions, temperature, culture media composition, inoculum volume, growth conditions, or the medical team's physical expertise [69]. The existence of _PVL_ is one of the characteristics that contributes to _S. aureus_ virulence by causing excessive inflammatory reactions and tissue destruction, and ultimately, overriding the host's defenses [70]. The _PVL_ gene, on the other hand, is less common throughout the world, with important spatial variability in frequency (5% in France; 4.9% in the United Kingdom) [71]. _PVL_ screening was unsuccessful in this investigation, even when employing standard and real-time PCR procedures. _PVL_-positive isolates have indeed been reported to be less common within DFI strains [71]. Additional explanations could be that our investigation had a small sample size, and some specimens were acquired from healthcare supplies, despite the fact that this gene has mostly been found in domestic animals [72]. For better control of DFIs, awareness of the isolates' local antimicrobial sensitivity profiles is critical. Antimicrobial drugs such as linezolid, nitrofurantoin, quinupristin-dalforgistin, tigecycline, and vancomycin demonstrated 100% sensitivity to MRSA in this study. These results are in accordance with earlier investigations [35; 73; 74]. Numerous worldwide surveys, nonetheless, have found a rise in vancomycin-resistant _S. aureus_ and _E. faecalis_ strains [34; 38]. Even though MRSA strains are completely responsive to vancomycin, treatment failure, according to [PERSON] and [PERSON] [75], is not unheard of. A vancomycin prescription necessitates cautious drug-level monitoring due to the possibility of neurotoxic effects. As a result, prudent administration of this antibiotic is essential to prevent the emergence of vancomycin-resistant strains in Saudi Arabia in the future. [PERSON] et al. [76] found 100% sensitivity to cotrimoxazole in _S. aureus_ and 100% tolerance to ciprofloxacin.