Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002-2005.
BACKGROUND
Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulence determinants. Strains harboring the lukS-lukF gene (which codes for Panton-Valentine leukocidin) are frequently associated with severe furunculosis. Generally applicable strategies for the control of community outbreaks of furunculosis have not been defined.


METHODS
We report the investigation and successful termination of an outbreak of furunculosis due to lukS-lukF-positive S. aureus in a German village (n=144). Nasal swab specimens were obtained from village residents. A retrospective cohort study was conducted. Nasally colonized persons, persons who had current furuncles or who had experienced relapsing furuncles since 2002, and their family members underwent stringent decolonization measures using mupirocin nasal ointment and disinfecting wash solution. Multiple nasal swab specimens were obtained to monitor the long-term outcome of decolonization measures.


RESULTS
From January 1998 through December 2004, 42 cases and 59 relapses of furunculosis were identified by active case finding. Of 140 participants tested, 51 (36%) were found to be nasally colonized with S. aureus. In 9 participants, the strain was positive for lukS-lukF. No methicillin resistance was detected. Risk of furunculosis was associated with contact with case patients (relative risk, 6.8; 95% confidence interval, 3.2-14.3) and nasal colonization with a lukS-lukF-positive strain of S. aureus (relative risk, 3.6; 95% confidence interval, 2.3-5.9). Passive surveillance implemented in January 2005 did not detect any case of lukS-lukF-positive, S. aureus-associated furuncles in this village.


CONCLUSIONS
This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population.
Wiese-Posselt
Miriam
M
Department for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany. Wiese-PosseltM@rki.de
Heuck
Dagmar
D
Draeger
Andreas
A
Mielke
Martin
M
Witte
Wolfgang
W
Ammon
Andrea
A
Hamouda
Osamah
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D005667:Furunculosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000235:genetics; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D007956:Leukocidins; C108483:leukocidin S-component protein, Staphylococcus; C074300:LukF protein, Staphylococcus aureus; D016712:Mupirocin