Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia.
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
Trop Med Int Health. 2018 Jan;23(1):34-44. doi: 10.1111/tmi.13000. Epub 2017 Dec 4.
To define the role of Staphylococcus aureus in community settings among patients with skin and soft tissue infections (SSTI) in Indonesia.
Staphylococcus aureus were cultured from anterior nares, throat and wounds of 567 ambulatory patients presenting with SSTI. The mecA gene and genes encoding Panton-Valentine leukocidin (PVL; lukF-PV and lukS-PV) and exfoliative toxin (ET; eta and etb) were determined by PCR. Clonal relatedness among methicillin-resistant S. aureus (MRSA) and PVL-positive S. aureus was analysed using multilocus variable-number tandem-repeat analysis (MLVA) typing, and multilocus sequence typing (MLST) for a subset of isolates. Staphylococcal cassette chromosome mec (SCCmec) was determined for all MRSA isolates. Moreover, determinants for S. aureus SSTI, and PVL/ET-positive vs PVL/ET-negative S. aureus were assessed.
Staphylococcus aureus were isolated from SSTI wounds of 257 (45.3%) patients, eight (3.1%) of these were MRSA. Genes encoding PVL and ETs were detected in 21.8% and 17.5% of methicillin-susceptible S. aureus (MSSA), respectively. PVL-positive MRSA was not detected. Nasopharyngeal S. aureus carriage was an independent determinant for S. aureus SSTI (odds ratio [OR] 1.8). Primary skin infection (OR 5.4) and previous antibiotic therapy (OR 3.5) were associated with PVL-positive MSSA. Primary skin infection (OR 2.2) was the only factor associated with ET-positive MSSA. MLVA typing revealed two more prevalent MSSA clusters. One ST1-MRSA-SCCmec type IV isolate and a cluster of ST239-MRSA-SCCmec type III were found.
Community-acquired SSTI in Indonesia was frequently caused by PVL-positive MSSA, and the hospital-associated ST239-MRSA may have spread from the hospital into the community.
确定金黄色葡萄球菌在印度尼西亚社区环境中皮肤和软组织感染(SSTI)患者中的作用。
从 567 名患有 SSTI 的门诊患者的前鼻、喉咙和伤口中培养金黄色葡萄球菌。通过 PCR 确定 mecA 基因以及编码杀白细胞素(PVL;lukF-PV 和 lukS-PV)和表皮剥脱毒素(ET;eta 和 etb)的基因。使用多位点可变数目串联重复分析(MLVA)分型和部分分离株的多位点序列分型(MLST)分析耐甲氧西林金黄色葡萄球菌(MRSA)和 PVL 阳性金黄色葡萄球菌之间的克隆相关性。对所有 MRSA 分离株进行葡萄球菌盒染色体 mec(SCCmec)的测定。此外,评估了金黄色葡萄球菌 SSTI 的决定因素以及 PVL/ET 阳性与 PVL/ET 阴性金黄色葡萄球菌。
257 名(45.3%)患者的 SSTI 伤口中分离出金黄色葡萄球菌,其中 8 名(3.1%)为 MRSA。21.8%和 17.5%的甲氧西林敏感金黄色葡萄球菌(MSSA)分别检测到编码 PVL 和 ET 的基因。未检测到 PVL 阳性 MRSA。鼻咽部金黄色葡萄球菌定植是金黄色葡萄球菌 SSTI 的独立决定因素(比值比 [OR] 1.8)。原发性皮肤感染(OR 5.4)和先前的抗生素治疗(OR 3.5)与 PVL 阳性 MSSA 相关。原发性皮肤感染(OR 2.2)是唯一与 ET 阳性 MSSA 相关的因素。MLVA 分型显示了两个更为常见的 MSSA 群集。发现了一个 ST1-MRSA-SCCmec 型 IV 分离株和一个 ST239-MRSA-SCCmec 型 III 集群。
印度尼西亚社区获得性 SSTI 常由 PVL 阳性 MSSA 引起,而医院相关的 ST239-MRSA 可能已从医院传播到社区。