Epidemiological typing of community-acquired methicillin-resistant Staphylococcus aureus isolates from children in Taiwan.
BACKGROUND
A 1400-bed tertiary medical center in northern Taiwan was used to conduct an epidemiological study of children hospitalized with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection during a 5-year period.


METHODS
Nineteen previously healthy children with predominantly skin and soft-tissue CA-MRSA infections were enrolled into the study. Seventeen CA-MRSA isolates were examined for antimicrobial susceptibility and molecular typing.


RESULTS
A comparison of our results with the reported resistance rates among CA-MRSA isolates from other countries showed uniformly high macrolide resistance (100%). Of the 17 MRSA isolates in our study, all had the macrolide-lincosamide-streptogramin-constitutive phenotype and the ermB gene. Moreover, on the basis of molecular typing results, 11 (65%) of 17 CA-MRSA isolates were genetically related (as determined by pulsed-field gel electrophoresis), and multilocus sequence typing revealed a sequence type of 59 in all isolates. Staphylococcal toxin genes lukS-PV and lukF-PV were detected in all isolates. However, staphylococcal cassette chromosome mec type IV was only detected in 3 (17.6%) of 17 isolates; the remaining 14 isolates were untypeable.


CONCLUSIONS
Analysis of our data suggests the predominance of a single endemic CA-MRSA strain with high macrolide resistance in our community. Clinical improvement with incision and drainage was noted for most patients, despite treatment with an ineffective antibiotic, so the need for a change in treatment guidelines should be addressed.
Wang
Chih-Chien
CC
Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. ndmcccw@yahoo.com.tw
Lo
Wen-Tsung
WT
Chu
Mong-Ling
ML
Siu
L K
LK
D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D015373:Bacterial Typing Techniques / Q000379:methods*; D002648:Child; D002876:Chromosomes, Bacterial / Q000235:genetics; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000235:genetics / Q000378:metabolism; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics; D008297:Male; D016106:Methicillin Resistance; D008780:Methyltransferases / Q000235:genetics; D008826:Microbial Sensitivity Tests / Q000379:methods; D010641:Phenotype; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000235:genetics / Q000378:metabolism; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D013624:Taiwan / Q000453:epidemiology
D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D007956:Leukocidins; C108483:leukocidin S-component protein, Staphylococcus; C074300:LukF protein, Staphylococcus aureus; D008780:Methyltransferases; C431709:ErmA protein, Bacteria