Emergence and characterization of Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus infections in Canary Islands, Spain, 20032008
Abstract number: P1043
Cañas-Pedrosa A., Horcajada I., Artiles F., Vindel A., Lafarga B.
Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged rapidly in the United States and is now emerging in Europe. In this study we assessed the prevalence, microbiological characteristics, molecular epidemiology and outcomes of Panton-Valentine leukocidin-positive (PVL-positive) CA-MRSA infections in Gran Canaria over the last 6 years.
Methods: Patients with PVL-positive CA-MRSA infections between January 2003 and December 2008, were eligible for inclusion in this study. The PVL genes (lukS-PV and lukF-PV), mecA gene and arcA region of ACME gene were detected by PCR. SCCmec types, SCCmec IV subtypes and agr type were determined by using multiplex PCRs. Strains were genotyped by pulse field gel electrophoresis (PFGE) after SmaI digested, spa typing and assigned to clonal complexes (CCs).
Results: A total of 560 new MRSA cases (1 per patient) were found from 2003 to 2008. Of the MRSA cases, 2.7% (18) were PVL-positive CA-MRSA. The female-to-male ratio was 0.29 and the mean age was 20 years (range, 154). The proportions of PVL-positive CA-MRSA cases were less than 2% from 2003 to 2006, 3.6% in 2007 and 15% in 2008. In total, 22% (4/18) of the patients were of non-Spanish origin (Ecuador, Colombia and Filipinas). Skin and soft tissue infections (SSTIs) were predominant (16 cases [88%]), followed by invasive infections (arthritis and osteomyelitis) (2 cases [12%]). In 13 (82%) cases, SSTI was associated with an abscess. In total, 82% (13/16) of the isolates genotyped were identified as spa-CC008-SCCmec IV, agr I allele. Of these 13, three (23%) were found to be USA-300, ACME+, SCCmec IVa, spa type t008, and 10 (70%) had a USA300-like PFGE pulsotype, SCCmec IVc, spa type t008 (8) and t024 (2). Two isolates (12%) were t019/ST30-SCCmec IVc, agr III allele (South Pacific clone) and one isolate (6%) was t311/ST5-SCCmec IVa, agr II allele (paediatric clone).
Conclusions: Our results show an increase in the incidence of PVL-positive CA-MRSA in 2008. PVL-positive CA-MRSA predominantly caused SSTI in children, and abscesses were the most frequently encountered indication. Well-known CA-MRSA strains, such as, CC8:ST8-IV (USA300), CC30:ST30-IV (South Pacific CA-MRSA) and CC5:ST5-IV (paediatric clone) were found. However, CC80: ST80-IV (European CA-MRSA) was not present. Clinical and microbiological evidence suggests import and subsequent transmission as the most likely sources of many of the new CA-MRSA cases.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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