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Emergence of SCCmec type IV and SCCmec type V methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leukocidin genes in a large academic teaching hospital in central Switzerland: external invaders or persisting circulators?
J Clin Microbiol 2010; 48(3):720-7JC

Abstract

The hospital epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has changed in the past few years due to the encroachment of community-associated MRSA (CA-MRSA) strains into health care settings. MRSA strains that were isolated during a 2-year period from patients of the Luzerner Kantonsspital were analyzed to elucidate their epidemiology. Moreover, extended surveillance of individuals who were contacts of those patients was carried out for 6 months to identify the routes of spread and to assess the quality of the infection control measures used in our setting. Patient data were collected to distinguish CA-MRSA strains from health care-associated MRSA (HA-MRSA) strains by epidemiological criteria, as defined by the Centers for Disease Control and Prevention (CDC). On the basis of the CDC definition, the majority of the strains were considered to be HA-MRSA. However, 87% of them belonged to staphylococcal cassette chromosome mec (SCCmec) types IV and V, which are traditionally associated with CA-MRSA. Surprisingly, classical nosocomial SCCmec types I and II represented a minority, whereas SCCmec type III was completely absent. By PFGE analysis, four predominant clonal lineages and 21 highly variable sporadic genotypes were detected. Twenty-eight percent of the MRSA strains studied carried the genes encoding the Panton-Valentine leukocidin (PVL), of which 21% and 83% were associated with SCCmec types IV and V, respectively. Among 289 contact individuals screened for MRSA carriage throughout the extended surveillance, a single secondary patient was discovered. The possibility of nosocomial transmission could be excluded. The high proportions of SCCmec type IV and V strains as well as PVL-positive strains suggest strong infiltration of CA-MRSA into our institution. Moreover, the low endemic prevalence of MRSA demonstrates that current infection control measures are sufficient to limit its spreading and the emergence of large epidemic outbreaks.

Authors+Show Affiliations

Department of Medical Microbiology, Center for Laboratory Medicine, Luzerner Kantonsspital, Lucerne 16, CH 6000, Switzerland. giovalsesia@alumni.ethz.chNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20042625

Citation

Valsesia, Giorgia, et al. "Emergence of SCCmec Type IV and SCCmec Type V Methicillin-resistant Staphylococcus Aureus Containing the Panton-Valentine Leukocidin Genes in a Large Academic Teaching Hospital in Central Switzerland: External Invaders or Persisting Circulators?" Journal of Clinical Microbiology, vol. 48, no. 3, 2010, pp. 720-7.
Valsesia G, Rossi M, Bertschy S, et al. Emergence of SCCmec type IV and SCCmec type V methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leukocidin genes in a large academic teaching hospital in central Switzerland: external invaders or persisting circulators? J Clin Microbiol. 2010;48(3):720-7.
Valsesia, G., Rossi, M., Bertschy, S., & Pfyffer, G. E. (2010). Emergence of SCCmec type IV and SCCmec type V methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leukocidin genes in a large academic teaching hospital in central Switzerland: external invaders or persisting circulators? Journal of Clinical Microbiology, 48(3), pp. 720-7. doi:10.1128/JCM.01890-09.
Valsesia G, et al. Emergence of SCCmec Type IV and SCCmec Type V Methicillin-resistant Staphylococcus Aureus Containing the Panton-Valentine Leukocidin Genes in a Large Academic Teaching Hospital in Central Switzerland: External Invaders or Persisting Circulators. J Clin Microbiol. 2010;48(3):720-7. PubMed PMID: 20042625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergence of SCCmec type IV and SCCmec type V methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leukocidin genes in a large academic teaching hospital in central Switzerland: external invaders or persisting circulators? AU - Valsesia,Giorgia, AU - Rossi,Marco, AU - Bertschy,Sonja, AU - Pfyffer,Gaby E, Y1 - 2009/12/30/ PY - 2010/1/1/entrez PY - 2010/1/1/pubmed PY - 2010/5/25/medline SP - 720 EP - 7 JF - Journal of clinical microbiology JO - J. Clin. Microbiol. VL - 48 IS - 3 N2 - The hospital epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has changed in the past few years due to the encroachment of community-associated MRSA (CA-MRSA) strains into health care settings. MRSA strains that were isolated during a 2-year period from patients of the Luzerner Kantonsspital were analyzed to elucidate their epidemiology. Moreover, extended surveillance of individuals who were contacts of those patients was carried out for 6 months to identify the routes of spread and to assess the quality of the infection control measures used in our setting. Patient data were collected to distinguish CA-MRSA strains from health care-associated MRSA (HA-MRSA) strains by epidemiological criteria, as defined by the Centers for Disease Control and Prevention (CDC). On the basis of the CDC definition, the majority of the strains were considered to be HA-MRSA. However, 87% of them belonged to staphylococcal cassette chromosome mec (SCCmec) types IV and V, which are traditionally associated with CA-MRSA. Surprisingly, classical nosocomial SCCmec types I and II represented a minority, whereas SCCmec type III was completely absent. By PFGE analysis, four predominant clonal lineages and 21 highly variable sporadic genotypes were detected. Twenty-eight percent of the MRSA strains studied carried the genes encoding the Panton-Valentine leukocidin (PVL), of which 21% and 83% were associated with SCCmec types IV and V, respectively. Among 289 contact individuals screened for MRSA carriage throughout the extended surveillance, a single secondary patient was discovered. The possibility of nosocomial transmission could be excluded. The high proportions of SCCmec type IV and V strains as well as PVL-positive strains suggest strong infiltration of CA-MRSA into our institution. Moreover, the low endemic prevalence of MRSA demonstrates that current infection control measures are sufficient to limit its spreading and the emergence of large epidemic outbreaks. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/20042625/Emergence_of_SCCmec_type_IV_and_SCCmec_type_V_methicillin_resistant_Staphylococcus_aureus_containing_the_Panton_Valentine_leukocidin_genes_in_a_large_academic_teaching_hospital_in_central_Switzerland:_external_invaders_or_persisting_circulators L2 - http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=20042625 DB - PRIME DP - Unbound Medicine ER -