title: Clinical, molecular and epidemiological description of a cluster of community-associated methicillin-resistant Staphylococcus aureus isolates from injecting drug users with bacteraemia.
abstract: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an increasing problem, predominantly in previously healthy individuals including notable risk groups such as the homeless, those who play close-contact sports, military personnel, men who have sex with men (MSM) and injecting drug users (IDUs). Over a 5-month period, four IDUs were admitted to Addenbrooke's Hospital, Cambridge, UK, with MRSA bacteraemia. All four patients presented with complex clinical features, with more than one focus of infection, and were linked epidemiologically. The atypical antibiogram of the MRSA isolates (ciprofloxacin-susceptible) prompted further characterization, both phenotypically (antibiotic resistance typing; phage typing) and genotypically (detection of toxin genes by PCR; pulsed-field gel electrophoresis (PFGE); Staphylococcal chromosome cassette (SCC) mec typing; multi-locus sequence typing (MLST)). All four isolates had similar antibiograms, were Panton-Valentine Leucocidin (PVL) toxin gene-negative, harboured SCCmec type IV and were closely related as shown by phage typing and PFGE. These isolates were representatives of a community-associated clone, ST1-MRSA-IV, known to be circulating in IDUs in the UK since 2001. This paper presents a detailed description of the clinical, microbiological and epidemiological features of a series of CA-MRSA bacteraemias in IDUs in the UK.
authors.affiliation: Clinical Microbiology and Public Health Laboratory, Health Protection Agency, Cambridge, UK. fiona.cooke@addenbrookes.nhs.uk
authors.forename: F J
authors.initials: FJ
authors.lastname: Cooke
authors.forename: E
authors.initials: E
authors.lastname: Gkrania-Klotsas
authors.forename: J C
authors.initials: JC
authors.lastname: Howard
authors.forename: M
authors.initials: M
authors.lastname: Stone
authors.forename: A M
authors.initials: AM
authors.lastname: Kearns
authors.forename: M
authors.initials: M
authors.lastname: Ganner
authors.forename: A J
authors.initials: AJ
authors.lastname: Carmichael
authors.forename: N M
authors.initials: NM
authors.lastname: Brown
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015373:Bacterial Typing Techniques; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D055030:Drug Users; D004917:Erythromycin / Q000494:pharmacology; D005672:Fusidic Acid / Q000494:pharmacology; D005839:Gentamicins / Q000494:pharmacology; D006801:Humans; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000378:metabolism; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D010641:Phenotype; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D047090:beta-Lactams; D005672:Fusidic Acid; D004917:Erythromycin