Prevalence and characterization of Staphylococcus aureus causing community-acquired skin and soft tissue infections on Java and Bali, Indonesia.

Prevalence and characterization of Staphylococcus aureus causing community-acquired skin and soft tissue infections on Java and Bali, Indonesia.

Trop Med Int Health. 2017 Nov 10;:

Authors: Santosaningsih D, Santoso S, Setijowati N, Rasyid HA, Budayanti NS, Suata K, Widhyatmoko DB, Purwono PB, Kuntaman K, Damayanti D, Prakoeswa CRS, Laurens M, van Nierop JWI, Nanninga GL, Oudenes N, de Regt M, Snijders SV, Verbrugh HA, Severin JA

Abstract
OBJECTIVES: To define the role of Staphylococcus aureus in community settings among patients with skin and soft tissue infections (SSTI) in Indonesia.
METHODS: S. 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 analyzed 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 versus PVL/ET-negative S. aureus were assessed.
RESULTS: S. 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.
CONCLUSIONS: 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. This article is protected by copyright. All rights reserved.

PMID: 29124834 [PubMed - as supplied by publisher]

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