title: Staphylococcus aureus in dermatology outpatients with special emphasis on community-associated methicillin-resistant strains.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) emerged as a community-associated pathogen (CA-MRSA) in the past 6 years. This prospective study investigated dermatology outpatients with inflammatory skin diseases, leg ulcers, and skin infections for Panton-Valentine leukocidin (PVL)-positive S. aureus, often associated with deep skin infection. In case of PVL positivity, molecular typing and PCR demonstration of resistance genes were performed. Out of 248 patients, 130 carried S. aureus, 24 being lukS-PV lukF-PV positive. Eighteen were MRSA, 11 of them belonging to the multilocus sequence typing clonal complex (CC)5, 1 to CC45, and 2/18 to CC8. Out of 18 patients, 4 were CA-MRSA containing lukS-PV lukF-PV as an important trait of CA-MRSA. Out of four CA-MRSA isolates, two were of type ST080 containing far-1 coding for fusidic acid (FUS) resistance and two were FUS sensitive (ST152 and ST001). The FUS-sensitive CA-MRSA, which corresponded to the CA-MRSA of ST001 from the United States, was detected in Germany for the first time, indicating that dermatologists are first in line to detect CA-MRSA. In contrast to CA-MRSA from other continents, far-1-coded FUS resistance represents a typical marker for the widespread CA-MRSA ST080 in Europe, especially in Germany. The significant risk factor for the acquisition of CA-MRSA was visits to foreign countries and/or professional or private contacts with foreigners.
authors.affiliation: Department of Dermatology, University of Heidelberg, Heidelberg, Germany. Electronic address: japut@pei.de.
authors.forename: Uta
authors.initials: U
authors.lastname: Jappe
authors.affiliation: National Reference Centre for Staphylococci (NCS), Robert-Koch-Institute, Wernigerode Branch, Wernigerode, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Heuck
authors.affiliation: National Reference Centre for Staphylococci (NCS), Robert-Koch-Institute, Wernigerode Branch, Wernigerode, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Strommenger
authors.affiliation: Institute of Hygiene, University of Heidelberg, Heidelberg, Germany.
authors.forename: Constanze
authors.initials: C
authors.lastname: Wendt
authors.affiliation: National Reference Centre for Staphylococci (NCS), Robert-Koch-Institute, Wernigerode Branch, Wernigerode, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Werner
authors.affiliation: Department of Infectious Diseases and Epidemiology, Robert-Koch-Institute, Berlin, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Altmann
authors.affiliation: National Reference Centre for Staphylococci (NCS), Robert-Koch-Institute, Wernigerode Branch, Wernigerode, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Witte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D005098:Exotoxins / Q000378:metabolism; D005260:Female; D005672:Fusidic Acid / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D007956:Leukocidins / Q000378:metabolism; D008297:Male; D008712:Methicillin / Q000627:therapeutic use; D016106:Methicillin Resistance / Q000235:genetics*; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D005672:Fusidic Acid; D008712:Methicillin