title: Emergence of community-associated methicillin-resistant Staphylococcus aureus associated with pediatric infection in Cambodia.
abstract: BACKGROUND
  The incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is rising in the developed world but appears to be rare in developing countries. One explanation for this difference is that resource poor countries lack the diagnostic microbiology facilities necessary to detect the presence of CA-MRSA carriage and infection.
  
  
  RESULTS
  We developed diagnostic microbiology capabilities at the Angkor Hospital for Children, Siem Reap, western Cambodia in January 2006 and in the same month identified a child with severe community-acquired impetigo caused by CA-MRSA. A study was undertaken to identify and describe additional cases presenting between January 2006 and December 2007. Bacterial isolates underwent molecular characterization using multilocus sequence typing, staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the presence of the genes encoding Panton-Valentine Leukocidin (PVL). Seventeen children were identified with CA-MRSA infection, of which 11 had skin and soft tissue infection and 6 had invasive disease. The majority of cases were unrelated in time or place. Molecular characterization identified two independent MRSA clones; fifteen isolates were sequence type (ST) 834, SCCmec type IV, PVL gene-negative, and two isolates were ST 121, SCCmec type V, PVL gene-positive.
  
  
  CONCLUSIONS
  This represents the first ever report of MRSA in Cambodia, spread of which would pose a significant threat to public health. The finding that cases were mostly unrelated in time or place suggests that these were sporadic infections in persons who were CA-MRSA carriers or contacts of carriers, rather than arising in the context of an outbreak.
authors.affiliation: Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia.
authors.forename: Kheng
authors.initials: K
authors.lastname: Chheng
authors.forename: Sarah
authors.initials: S
authors.lastname: Tarquinio
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Lina
authors.initials: L
authors.lastname: Sin
authors.forename: Janjira
authors.initials: J
authors.lastname: Thaipadungpanit
authors.forename: Premjit
authors.initials: P
authors.lastname: Amornchai
authors.forename: Ngoun
authors.initials: N
authors.lastname: Chanpheaktra
authors.forename: Sarinna
authors.initials: S
authors.lastname: Tumapa
authors.forename: Hor
authors.initials: H
authors.lastname: Putchhat
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002876:Chromosomes, Bacterial; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology
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