1
|
Camacho-Cruz J, Gutiérrez IF, Brand-López K, Sosa-Rodríguez YA, Vásquez-Hoyos P, Gómez-Cortés LC, Romero-Higuera LN, Rojas-Rojas DP, Ortiz-Mendez CA, Camacho-Moreno G, Wilches-Cuadros MA, Hernandez-Vargas JC, Velandia-Páez JP, Mancera-Gutiérrez LA, Palacios-Ariza MA, Beltrán-Higuera SJ. Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics: Multicenter Cohort Study Conducted in Bogotá, Colombia, 2014-2018. Pediatr Infect Dis J 2022; 41:12-19. [PMID: 34889869 PMCID: PMC8658953 DOI: 10.1097/inf.0000000000003349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia. METHODS Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI. RESULTS Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar. CONCLUSIONS MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.
Collapse
Affiliation(s)
- Jhon Camacho-Cruz
- From the Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Sociedad de Cirugía de Bogotá-Hospital de San José
- Departamento de Pediatría, Clínica Pediátrica, Clínica Colsanitas SA
- Facultad de Medicina, Fundación Universitaria Sanitas
| | - Iván Felipe Gutiérrez
- Division of Pediatric Infectious Diseases, Clínica Santa María del Lago, Clínica Colsanitas SA
- Facultad de Medicina, Fundación Universitaria Sanitas
- Colsubsidio Investiga Research Group, Clínica Infantil Colsubsidio
| | | | | | - Pablo Vásquez-Hoyos
- Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Sociedad de cirugía de Bogotá-Hospital de San José and Universidad Nacional de Colombia
| | | | | | - Diana Paola Rojas-Rojas
- Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José
| | - Cesar Alfredo Ortiz-Mendez
- Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Sociedad de cirugía de Bogotá-Hospital de San José
| | - Germán Camacho-Moreno
- Division of Pediatric Infectious Diseases, Hospital Infantil Universitario de San José and Universidad Nacional de Colombia
| | | | | | | | | | | | | |
Collapse
|
2
|
Champion AE, Goodwin TA, Brolinson PG, Werre SR, Prater MR, Inzana TJ. Prevalence and characterization of methicillin-resistant Staphylococcus aureus isolates from healthy university student athletes. Ann Clin Microbiol Antimicrob 2014; 13:33. [PMID: 25085442 PMCID: PMC4362218 DOI: 10.1186/s12941-014-0033-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has been increasing in the general population, and there is concern that close or physical contact, such as in professional and collegiate sports, may increase spread of MRSA. We sought to determine the prevalence of MRSA colonization of male and female athletes from 9 different sports at a major, Division I University during a 12-week period, and determine the USA and SCCmec type from select isolates. METHODS Swabs for culture of MRSA were obtained from nasal, axillary, and inguinal sites from healthy, asymptomatic student athletes and support staff each week for 12 weeks. Select MRSA isolates were typed by pulsed field gel electrophoresis (PFGE), and the genes encoding for MecA, cassette chromosome recombinase (Ccr), and several toxins were determined by multiplex polymerase chain reaction (PCR). Discrepant results were clarified by multi-locus sequence typing (MLST) and spa typing. RESULTS Thirty-five percent (78/223) of test subjects were positive for MRSA during the study period, resulting in isolation of 139 MRSA isolates. However, 47% (37/78) of MRSA-positive participants carried MRSA in axillary or inguinal sites, but not in the anterior nares. There was significant correlation between MRSA carriage and participation in wrestling (76%, 19/25; adjusted odds ratio 29.7, 95% CI 5.8-151.5) and baseball (44%, 17/39; adjusted odds ratio 4.4, 95% CI 1.1- 17.4), compared with a staff prevalence of 18.1% (4/22), but other factors were not examined. Multiplex PCR analysis indicated that of the 32 isolates examined 26 could be typed, and all of these carried the SCCmec type IV cassette. PFGE typing identified USA types 300, 400, 500, 700, and 800. However, one isolate was not a known USA type, but was identified as a novel ST951 by MLST, and as spa type t216. Of the strains typed from the same individual, there was consistency, but also variation and alternation of the SCCmec and spa types isolated from individual subjects. Various staphylococcal toxin genes were identified in 31 of the 32 isolates analyzed. CONCLUSIONS Colonization by MRSA was greater in some student athletes than the average carriage rate for the general population, and only 53% of MRSA carriers were identified by nasal cultures. Carriage of MRSA clones on the same individual and transmission to contacts could vary over time, indicating colonization can be a dynamic process that may be difficult to control.
Collapse
Affiliation(s)
- Anna E Champion
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA.
| | - Thomas A Goodwin
- Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - P Gunnar Brolinson
- Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - Stephen R Werre
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA.
| | - M Renee Prater
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA. .,Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - Thomas J Inzana
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA. .,Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Life Sciences 1, 970 Washington St. SW, Blacksburg, VA, 24061, USA.
| |
Collapse
|
3
|
Gelatti LC, Bonamigo RR, Inoue FM, Carmo MSD, Becker AP, Castrucci FMDS, Pignatari ACC, d' Azevedo PA. Community-acquired methicillin-resistant Staphylococcus aureus carrying SCCmec type IV in southern Brazil. Rev Soc Bras Med Trop 2013; 46:34-8. [DOI: 10.1590/0037-868213022013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/30/2011] [Indexed: 11/21/2022] Open
|
4
|
Jiménez JN, Ocampo AM, Vanegas JM, Rodríguez EA, Garcés CG, Patiño LA, Ospina S, Correa MM. Characterisation of virulence genes in methicillin susceptible and resistant Staphylococcus aureus isolates from a paediatric population in a university hospital of Medellín, Colombia. Mem Inst Oswaldo Cruz 2012; 106:980-5. [PMID: 22241120 DOI: 10.1590/s0074-02762011000800013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 08/31/2011] [Indexed: 11/22/2022] Open
Abstract
Virulence and antibiotic resistance are significant determinants of the types of infections caused by Staphylococcus aureus and paediatric groups remain among the most commonly affected populations. The goal of this study was to characterise virulence genes of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains isolated from a paediatric population of a Colombian University Hospital during 2009. Sixty MSSA and MRSA isolates were obtained from paediatric patients between zero-14 years. We identified the genes encoding virulence factors, which included Panton-Valentine leucocidine (PVL), staphylococcal enterotoxins A-E, exfoliative toxins A and B and toxic shock syndrome toxin 1. Typing of the staphylococcal chromosome cassette mec (SCCmec) was performed in MRSA strains. The virulence genes were more diverse and frequent in MSSA than in MRSA isolates (83% vs. 73%). MRSA strains harboured SCCmec types IVc (60%), I (30%), IVa (7%) and V (3%). SCCmec type IVc isolates frequently carried the PVL encoding genes and harboured virulence determinants resembling susceptible strains while SCCmec type I isolates were often negative. PVL was not exclusive to skin and soft tissue infections. As previously suggested, these differences in the distribution of virulence factor genes may be due to the fitness cost associated with methicillin resistance.
Collapse
|
5
|
Lee BY, Ufberg PJ, Bailey RR, Wiringa AE, Smith KJ, Nowalk AJ, Higgins C, Wateska AR, Muder RR. The potential economic value of a Staphylococcus aureus vaccine for neonates. Vaccine 2010; 28:4653-60. [PMID: 20472028 PMCID: PMC2896294 DOI: 10.1016/j.vaccine.2010.04.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 04/10/2010] [Accepted: 04/23/2010] [Indexed: 11/24/2022]
Abstract
The continuing morbidity and mortality associated with Staphylococcus aureus (S. aureus) infections, especially methicillin-resistant S. aureus (MRSA) infections, have motivated calls to make S. aureus vaccine development a research priority. We developed a decision analytic computer simulation model to determine the potential economic impact of a S. aureus vaccine for neonates. Our results suggest that a S. aureus vaccine for the neonatal population would be strongly cost-effective (and in many situations dominant) over a wide range of vaccine efficacies (down to 10%) for vaccine costs (or=1%).
Collapse
Affiliation(s)
- Bruce Y Lee
- Applied Modeling, Public Health Computational and Operations Research (PHICOR), Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Marçal FJB, Cortez DAG, Ueda-Nakamura T, Nakamura CV, Filho BPD. Activity of the extracts and neolignans from Piper regnellii against methicillin-resistant Staphylococcus aureus (MRSA). Molecules 2010; 15:2060-9. [PMID: 20428025 PMCID: PMC6257403 DOI: 10.3390/molecules15042060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/21/2010] [Accepted: 03/23/2010] [Indexed: 11/21/2022] Open
Abstract
Piper regnellii (Miq.) C. DC. var. pallescens (C. DC.) Yunck (Piperaceae) is a medicinal plant traditionally used in Brazil to treat infectious diseases. The extracts obtained of the leaves from P. regnellii were investigated for their antibacterial activities against methicillin-resistant Staphylococcus aureus (MRSA). The ethyl acetate extract presented a good activity against MRSA, with minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of 16 μg/mL. Based on this finding, the ethyl acetate extract was fractionated by silica gel column chromatography into nine fractions. The hexane fraction was active against MRSA (MIC at 4 μg/mL). Further column chromatography separation of the hexane fraction afforded the pure compound eupomatenoid-5. The structure of the compound was established by spectral data (1H and 13C NMR HSQC, HMBC, gNOE, IR and MS). Eupomatenoid-5 was the only compound active on the bacterium. The antibacterial property of P. regnellii extract provides preliminary scientific validation for the traditional medicinal use of this plant. The active compound eupomatenoid-5 should be further studied in animal models to verify in vivo efficacy and toxicity.
Collapse
Affiliation(s)
- Flaviano João Basilio Marçal
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, Brazil; E-Mail: (F.J.B.M.)
| | | | - Tânia Ueda-Nakamura
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, Av. Colombo, 5790, 87020-900, Maringá, Brazil; E-Mails: (T.U.N.); (C.V.N)
| | - Celso Vataru Nakamura
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, Av. Colombo, 5790, 87020-900, Maringá, Brazil; E-Mails: (T.U.N.); (C.V.N)
| | - Benedito Prado Dias Filho
- Departamento de Ciências Básicas da Saúde, Universidade Estadual de Maringá, Av. Colombo, 5790, 87020-900, Maringá, Brazil; E-Mails: (T.U.N.); (C.V.N)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +55 44 32614136; Fax: +55 44 4109
| |
Collapse
|
7
|
Staphylococcus aureus vaccine for orthopedic patients: an economic model and analysis. Vaccine 2010; 28:2465-71. [PMID: 20064479 DOI: 10.1016/j.vaccine.2009.12.075] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 12/19/2009] [Accepted: 12/25/2009] [Indexed: 01/08/2023]
Abstract
To evaluate the potential economic value of a Staphylococcus aureus vaccine for pre-operative orthopedic surgery patients, we developed an economic computer simulation model. At MRSA colonization rates as low as 1%, a $50 vaccine was cost-effective [<or=$50,000 per quality-adjusted life year (QALY) saved] at vaccine efficacy >or=30%, and a $100 vaccine at vaccine efficacy >or=70%. High MRSA prevalence (>or=25%) could justify a vaccine price as high as $1000. Our results suggest that a S. aureus vaccine for the pre-operative orthopedic population would be very cost-effective over a wide range of MRSA prevalence and vaccine efficacies and costs.
Collapse
|
8
|
Levenhagen KM. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging concern for physical therapists: discussion. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2008; 13:9-17. [PMID: 18288766 DOI: 10.1002/pri.392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Centers for Disease Control has identified community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) as an emerging worldwide public health risk. Healthcare professionals such as physical therapists can play an important role in the early detection, prevention and management of CA-MRSA. This discussion paper is a narrative overview of CA-MRSA's prevalence in at-risk groups, the distinguishing characteristics of hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and CA-MRSA infections, and treatments for HA-MRSA and CA-MRSA. Using the Guide to Physical Therapist Practice as a framework, this paper describes physical therapists' role in the detection, prevention and management of CA-MRSA infections and their role in community education about CA-MRSA.
Collapse
Affiliation(s)
- Kim M Levenhagen
- Department of Physical Therapy, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall, Room 1026, St. Louis, MO 63104, USA.
| |
Collapse
|
9
|
Coates ARM, Hu Y. Targeting non-multiplying organisms as a way to develop novel antimicrobials. Trends Pharmacol Sci 2008; 29:143-50. [PMID: 18262665 DOI: 10.1016/j.tips.2007.12.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 12/14/2007] [Accepted: 12/17/2007] [Indexed: 11/16/2022]
Abstract
Increasing resistance and decreasing numbers of antibiotics reaching the market point to a growing need for novel antibacterial drugs. Most antibiotics are very inefficient at killing non-multiplying bacteria, which live side by side with multiplying ones of the same strain in a clinical infection. Although non-multiplying bacteria do not usually cause disease, they can revert to the multiplying state that leads to overt disease, at which time resistance can emerge. Here we discuss the concept of developing antibacterial drugs by targeting non-multiplying organisms. We define non-multiplying bacteria, discuss the efficacy of existing antibiotics, and assess whether targeting these bacteria might lead to new antibiotics that will decrease the rate of emergence of resistance. Lastly, we review the potential of new molecular targets and live non-multiplying bacteria as possible routes for the development of novel antimicrobial drugs.
Collapse
Affiliation(s)
- Anthony R M Coates
- Medical Microbiology, Centre for Infection, Department of Cellular and Molecular Medicine, St George's, University of London, Cranmer Terrace, London, UK.
| | | |
Collapse
|
10
|
Emergency department management of community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Emerg Care 2008; 24:109-14; quiz 115-7. [PMID: 18277849 DOI: 10.1097/pec.0b013e318163df51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Staphylococcus aureus is a known cause of a variety of illnesses that present to the emergency department, including skin and soft tissue infections, pneumonia, and sepsis. Managing these conditions has become more difficult with the emergence of bacterial strains in the community that are resistant to traditional first-line antibiotics. Emergency care providers need to be aware of the increased prevalence of these resistant bacteria, to understand the characteristics of the infections with which they are associated, and to know the effective antibiotic options for treating these bacterial infections in the emergency department patient population.
Collapse
|
11
|
Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infections: implications for patients and practitioners. Am J Clin Dermatol 2008; 8:259-70. [PMID: 17902728 DOI: 10.2165/00128071-200708050-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Dermatologists and other healthcare providers need to be aware of the epidemiology, clinical features, management, and prevention of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection. Currently, infection caused by CAMRSA is considered to represent a worldwide epidemic and infectious skin lesions are a frequent occurrence. Athletes, certain ethnic populations, children, homeless persons, homosexual men, household members of infected people, HIV-infected patients, intravenous drug abusers, military personnel, newborns, pregnant and postpartum women, tattoo recipients, and urban dwellers of lower socioeconomic status in crowded living conditions are individuals at increased risk of developing CAMRSA infection. Although the observed incidence of cutaneous CAMRSA lesions in patients with atopic dermatitis or other conditions that are characterized by a non-intact skin barrier is less than that reported in other groups of people at risk for this skin infection, close surveillance for the emergence of CAMRSA skin infection in children and adults with atopic dermatitis and other patients whose skin barrier is disrupted is justified since colonization by S. aureus in these individuals represents a potential reservoir for CAMRSA. It is also important to note that infection-associated risk factors are absent in many individuals who develop cutaneous CAMRSA infection. CAMRSA skin lesions are pleomorphic. The most common presentations of CAMRSA infection are abscess, cellulitis, or both. These infectious lesions are not uncommonly misinterpreted by the patient as spider bites or insect bites. Other manifestations of cutaneous CAMRSA infection are impetigo, folliculitis, and paronychia. Incision and drainage of abscesses, systemic antibacterial therapy, and adjunctive topical antibacterial treatment are the essential components of management of CAMRSA skin infections. At the initial visit, a bacterial culture of the infectious lesion is recommended to confirm identification of the pathogen and to determine antimicrobial susceptibility. Subsequently, based upon the reported antibacterial sensitivity, alteration (if necessary) of the patient's empiric systemic antimicrobial treatment can be initiated. Direct skin-to-skin transmission of the causative bacteria, damage to the skin's surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of CAMRSA skin infection. The spread of cutaneous CAMRSA infection can potentially be prevented by incorporating personal, environmental, and healthcare measures that strive to eliminate the causes of acquisition and transmission of the bacteria.
Collapse
Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, University of Houston, Houston, Texas, USA.
| |
Collapse
|
12
|
Rossney AS, Shore AC, Morgan PM, Fitzgibbon MM, O'Connell B, Coleman DC. The emergence and importation of diverse genotypes of methicillin-resistant Staphylococcus aureus (MRSA) harboring the Panton-Valentine leukocidin gene (pvl) reveal that pvl is a poor marker for community-acquired MRSA strains in Ireland. J Clin Microbiol 2007; 45:2554-63. [PMID: 17581935 PMCID: PMC1951240 DOI: 10.1128/jcm.00245-07] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) carrying pvl is an emerging problem worldwide. CA-MRSA tends to harbor staphylococcal cassette chromosome mec type IV (SCCmec IV), to be non-multiantibiotic resistant, and to have different genotypes from the local hospital-acquired MRSA (HA-MRSA). However, in Ireland, 80% of HA-MRSA isolates have the non-multiantibiotic-resistant genotype ST22-MRSA-IV. This study investigated MRSA isolates from Ireland (CA-MRSA, health care-associated MRSA, and HA-MRSA) for the carriage of pvl and determined the genotypic characteristics of all pvl-positive isolates identified. All 1,389 MRSA isolates were investigated by antibiogram-resistogram typing and SmaI DNA macrorestriction analysis. pvl-positive isolates were further characterized by multilocus sequence typing and SCCmec, agr, and toxin gene typing. Twenty-five (1.8%) MRSA isolates belonging to six genotypes (ST30, ST8, ST22, ST80, ST5, and ST154) harbored pvl. Nineteen of these (76%) were CA-MRSA isolates, but a prospective study of MRSA isolates from 401 patients showed that only 6.7% (2/30) of patients with CA-MRSA yielded pvl-positive isolates. Thus, pvl cannot be used as a sole marker for CA-MRSA. Fifty-two percent of pvl-positive MRSA isolates were recovered from patients with skin and soft tissue infections; thirty-six percent were from patients of non-Irish ethnic origin, reflecting the increasing heterogeneity of the Irish population due to immigration. All 25 pvl-positive isolates carried SCCmec IV; 14 (56%) harbored SCCmec IV.1 or IV.3, and the remaining 11 isolates could not be subtyped. This study demonstrates that pvl is not a reliable marker for CA-MRSA in Ireland and reveals the emergence and importation of diverse genotypes of pvl-positive MRSA in Ireland.
Collapse
Affiliation(s)
- Angela S Rossney
- National MRSA Reference Laboratory, St. James's Hospital, James's St., Dublin 8, Ireland
| | | | | | | | | | | |
Collapse
|