Hostname: page-component-7dd5485656-2pp2p Total loading time: 0 Render date: 2025-11-02T10:15:53.004Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical and Laboratory Features of Community-Associated Methicillin-Resistant Staphylococcus aureus: Is It Really New?

Published online by Cambridge University Press:  21 June 2016

Leonard B. Johnson ,
Sajjad Saeed ,
Joan Pawlak ,
Odette Manzor  and
Louis D. Saravolatz
Leonard B. Johnson*
Affiliation:
Department of Internal Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Sajjad Saeed
Affiliation:
Department of Internal Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Joan Pawlak
Affiliation:
Department of Internal Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Odette Manzor
Affiliation:
Department of Internal Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Louis D. Saravolatz
Affiliation:
Department of Internal Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
*
St. John Hospital and Medical Center, 19251 Mack Avenue, Suite 340, Grosse Pointe Woods, MI 48236 (leonard.johnson@stjohn.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To review the epidemiologic and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Detroit, Michigan, to assess the risk factors for infection and the response to therapy.

Design.

Prospective clinical and laboratory study of 2003-2004 CA-MRSA isolates. Molecular features were compared with CA-MRSA isolates from 1980.

Setting.

A 600-bed urban academic medical center.

Patients.

Twenty-three patients with CA-MRSA infections from 2003-2004 were evaluated. In addition, laboratory analysis was performed on 13 CA-MRSA isolates from 1980.

Main Outcome Measures.

Laboratory analysis of isolates included antimicrobial susceptibility testing, pulsed-field genotyping, testing for Panton-Valentine leukocidin (PVL) genes, and staphylococcal cassette chromosome mec typing.

Results.

Patients were predominantly young African American males and presented with skin and soft-tissue infections. All isolates were resistant to erythromycin and highly susceptible to other agents. Patients were generally treated successfully with combination incision and drainage and systemic antibiotics. Among the 23 isolates, 20 (87%) were the same strain. This strain carried the staphylococcal cassette chromosome mec type IV and PVL genes and is genetically identical to USA 300. Thirteen isolates of patients from our community who presented with CA-MRSA infections in 1980 represented a single clone that is unique compared with the 2003-2004 isolates. This strain carried staphylococcal cassette chromosome mec type IVA but did not carry the PVL genes.

Conclusions.

In our community, CA-MRSA is largely due to a single clone with a type IV mec gene and PVL gene. The type IV staphylococcal cassette chromosome mec type can be demonstrated in CA-MRSA isolates from a remote period, suggesting that earlier outbreaks were not related to healthcare exposure.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 2 , February 2006 , pp. 133 - 138
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Colley, EW, McNicol, MW, Bracken, PM. Methicillin-resistant staphylococci in a general hospital. Lancet 1965; 191:595–597.CrossRefGoogle Scholar
2.Barrett, FF, McGehee, RF Jr, Finland, M. Methicillin resistant Staphylococcus aureus at Boston City Hospital: bacteriologic and epidemiologic observations. N Engl J Med 1968; 27:441–448.CrossRefGoogle Scholar
3.Saravolatz, LD, Markowitz, N, Arking, L, Pohlod, D, Fisher, E. Methicillin-resistant Staphylococcus aureus: epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982; 96:11–16.Google Scholar
4.Saravolatz, LD, Pohlod, DJ, Arking, LM. Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks. Ann Intern Med 1982; 97:325–329.CrossRefGoogle ScholarPubMed
5.Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279:593–598.Google Scholar
6.Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired MRSA—Minnesota and North Dakota, 1997-1999. MMWR Morb Mortal Wkly Rep 1999; 48:707–710.Google Scholar
7.Collignon, P, Gosbell, I, Vickery, A, Nimmo, G, Stylianopoulos, T, Gottlieb, T. Community-acquired methicillin-resistant Staphylococcus aureus in Australia. Lancet 1998; 352:145–146.Google Scholar
8.Salmenlinna, S, Lyytikainen, O, Vuopio-Varkila, J. Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 2002; 8:602–607.CrossRefGoogle ScholarPubMed
9.Chambers, HF. The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 2001; 7:178–182.Google Scholar
10.Mongkolrattanothai, K, Boyle, S, Kahana, MD, Daum, RS. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. Clin Infect Dis 2003; 37:1050–1058.CrossRefGoogle ScholarPubMed
11.Centers for Disease Control and Prevention. Community-associated methicillin-resistant Staphylococcus aureus infections in Pacific Islanders—Hawaii, 2001-2003. MMWR Morb Mortal Wkly Rep 2004; 53:767–770.Google Scholar
12.Groom, AV, Wolsey, DH, Naimi, TS, et al. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001; 286:1201–1205.CrossRefGoogle Scholar
13.Naimi, TS, LeDell, KH, Boxrud, DJ, et al. Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota, 1996-1998. Clin Infect Dis 2001; 33:990–996.Google Scholar
14.Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of community-and health-care associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976–2984.Google Scholar
15.Daum, RS, Ito, T, Hiramatsu, K, et al. A novel methicillin-resistance cassette in community-acquired methicillin-resistant staphylococcus aureus isolates of diverse genetic backgrounds. J Infect Dis 2002; 186:1344–1347.Google Scholar
16.Dufour, P, Gillet, Y, Bes, M, et al. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine Leukocidin. Clin Infect Dis 2002; 35:819–824.Google Scholar
17.Wang, CC, Lo, WT, Chu, ML, Siu, LK. Epidemiological typing of community-acquired methicillin-resistant Staphylococcus aureus isolates from children in Taiwan. Clin Infect Dis 2004; 39:481–487.Google Scholar
18.NCCLS. Performance Standards for Antimicrobial Susceptibility Testing; Fourteenth International Supplement. Wayne, PA: NCCLS; 2004.Google Scholar
19.Matushek, MG, Bonten, MJM, Hayden, MK. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol 1996; 34:2598–2600.Google Scholar
20.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33:2233–2239.Google Scholar
21.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003; 41:5113–5120.Google Scholar
22.Oliveira, DC, de Lencastre, H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2002; 46: 2155–2161.Google Scholar
23.Okuma, K, Iwakawa, K, Turnidge, JD, et al. Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002; 40:4289–4294.Google Scholar
24.Enright, MC, Day, NPJ, Davies, CE, Peacock, SJ, Spratt, BG. Multilocus sequence typing for the characterization of methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) clones of Staphylococcus aureus. J Clin Microbiol 2000; 38:1008–1015.Google Scholar
25.Levine, DP, Cushing, RD, Jui, J, Brown, WJ. Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit Medical Center. Ann Intern Med 1982; 97:330–338.CrossRefGoogle ScholarPubMed
26.Baggett, HC, Hennessy, TW, Leman, R, et al. An outbreak of community-onset methicillin-resistant Staphylococcus aureus infections skin infections in southwestern Alaska. Infect Control Hosp Epidemiol 2003; 24:397–402.Google Scholar
27.Saiman, L, O'Keefe, M, Graham, PL, et al. Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003; 37:1313–1319.Google Scholar
28.Pan, ES, Diep, BA, Carleton, HA, et al. Increasing prevalence of methicillin-resistant Staphylococcus aureus infection in California jails. Clin Infect Dis 2003; 37:1384–1388.Google Scholar
29.Baggett, HC, Hennessy, TW, Rudolph, K, et al. Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxin Panton-Valentine Leukocidin during a furunculosis outbreak in rural Alaska. J Infect Dis 2004; 189:1565–1573.Google Scholar
30.Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus skin or soft tissue infections in a state prison—Mississippi, 2000. MMWR Morb Mortal Wkly Rep 2001; 50:919–922.Google Scholar
31.Adcock, PM, Paster, D, Medley, F, Patterson, JE, Murphy, TV. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1998; 178:577–580.Google Scholar
32.Carleton, HA, Diep, BA, Charlebois, ED, Sensabaugh, GF, Perdreau-Remington, F. Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis 2004; 190:1730–1738.Google Scholar
33.Hiramatsu, K, Okuma, K, Ma, XX, et al. New trends in Staphylococcus aureus infections: glycopeptide resistance in hospitals and methicillin resistance in the community. Curr Opin Infect Dis 2002; 15:407–413.Google Scholar
34.Lina, G, Piemont, Y, Godail-Gamot, MB, et al. Involvement of Panton-Valentine Leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128–1132.Google Scholar
35.Markowitz, N, Quinn, EL, Saravolatz, LD. Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection. Ann Intern Med 1992; 117:390–398.Google Scholar
36.Gorak, EJ, Yamada, SM, Brown, JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999; 29:797–800.Google Scholar
37.Lee, MC, Rios, AM, Aten, MF, et al. Management and outcome of children with skin and soft tissue abscess caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2004; 23:123–127.Google Scholar
38.Siberry, GK, Tekle, T, Carroll, K, Dick, J. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis 2003; 37:1257–1260.Google Scholar
39.Daum, TE, Schaberg, DR, Terpenning, MS, et al. Increasing resistance of Staphylococcus aureus to ciprofloxacin. Antimicrob Agents Chemother 1990;34:1862–1863.Google Scholar