title: Community-associated CMRSA-10 (USA-300) is the predominant strain among methicillin-resistant Staphylococcus aureus strains causing skin and soft tissue infections in patients presenting to the emergency department of a Canadian tertiary care hospital.
abstract: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen first described among individuals with no contact with health care facilities. The purpose of this study was to determine the proportion of CA-MRSA, defined by pulsed field gel electrophoresis (PFGE), in MRSA skin and soft tissue infections presenting to the Emergency Department (ED). We also aimed to describe the laboratory and clinical characteristics of CA-MRSA infections. From June 1, 2001 to May 30, 2005, MRSA isolates from skin and soft tissue infections presenting to the ED were reviewed. They were characterized by antibiotic susceptibilities and PFGE, and the presence of staphylococcal cassette chromosome (SCC) mec type IVa and Panton-Valentine leukocidin (PVL) genes was assessed on representative isolates. The medical records were reviewed to define risk factors. There were 95 isolates available for analysis, of which 58 (61%) were CMRSA-10 (USA-300), the predominant clone from 2003 onward. All representative isolates (24%) tested in this group had PVL genes and SCCmec type IVa. Their antibiogram showed 100% susceptibility to trimethoprim-sulfamethoxazole, rifampin, and fusidic acid, and 79% to clindamycin. Clinical comparison of CMRSA-10 vs. hospital PFGE type strains showed 22% vs. 60%, respectively, for recent antibiotic use (p < 0.0001), 26% vs. 6%, respectively, for intravenous drug use (p < 0.05), and 57% vs. 6%, respectively, for soft tissue abscess (p < 0.001). CMRSA-10 is a major pathogen in skin and soft tissue abscesses in our ED. It has a characteristic susceptibility, and was associated with intravenous drug use, but not with recent antibiotic usage.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia.
authors.forename: Ghada N
authors.initials: GN
authors.lastname: Al-Rawahi
authors.forename: Steve
authors.initials: S
authors.lastname: Reynolds
authors.forename: Susan D
authors.initials: SD
authors.lastname: Porter
authors.forename: Leslie
authors.initials: L
authors.lastname: Forrester
authors.forename: Leane
authors.initials: L
authors.lastname: Kishi
authors.forename: Tiffany
authors.initials: T
authors.lastname: Chong
authors.forename: William R
authors.initials: WR
authors.lastname: Bowie
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Doyle
mesh_terms: D000328:Adult; D001427:Bacterial Toxins / Q000235:genetics; D001955:British Columbia / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification* / Q000235:genetics; D012189:Retrospective Studies; D012307:Risk Factors; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D015819:Substance Abuse, Intravenous / Q000382:microbiology
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin