title: Trial to control an outbreak of Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus at a boarding school in Japan.
abstract: BACKGROUND
  Our retrospective investigation of methicillin-resistant Staphylococcus aureus (MRSA) infection at a hospital in Japan around 2007 suggested dissemination of community-associated MRSA (CA-MRSA) strains among healthy students in a Japanese boarding school, which frequently caused skin disease and exhibited the same antibiogram patterns.
  
  
  METHODS
  Active surveillance of skin diseases for 6 months after May 2008, examination of MRSA carriage in selected high-risk groups, and investigation of their life circumstances, including environmental cultures, were conducted in the school. Furthermore, we strengthened hygiene practices and improved recognized risk factors from November 2008 and observed the occurrence of skin diseases and MRSA carriage rate for the evaluation of infection controls.
  
  
  RESULTS
  We identified 21 patients with skin diseases in whom MRSA strains were isolated. MRSA colonization rates in 3 selected groups ranged from 7.6% to 36.6%. The rates of both skin disease and MRSA carriage decreased significantly after infection controls were introduced. Genetic analysis revealed a main dissemination of a PVL-positive SCCmec IVc clone (41/47 isolates in total), presenting as a different pulsed-field type than USA300.
  
  
  CONCLUSIONS
  This first report of a PVL-positive CA-MRSA outbreak in Japan demonstrates systematic management of dissemination by conducting surveillance in a closed community.
authors.affiliation: Department of Internal Medicine, National Defense Medical College, Saitama, Japan. dr22055@ndmc.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Higashiyama
authors.forename: Teruyo
authors.initials: T
authors.lastname: Ito
authors.forename: Xiao
authors.initials: X
authors.lastname: Han
authors.forename: Junichiro
authors.initials: J
authors.lastname: Nishiyama
authors.forename: Akemi
authors.initials: A
authors.lastname: Tanno
authors.forename: Toshiko
authors.initials: T
authors.lastname: Wada
authors.forename: Youichi
authors.initials: Y
authors.lastname: Funaoka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Kei
authors.initials: K
authors.lastname: Mikita
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okusa
authors.forename: Koki
authors.initials: K
authors.lastname: Kaku
authors.forename: Junichi
authors.initials: J
authors.lastname: Hatada
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kawana
mesh_terms: D000293:Adolescent; D000328:Adult; D001427:Bacterial Toxins / Q000235:genetics*; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016000:Cluster Analysis; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D005098:Exotoxins / Q000235:genetics*; D005838:Genotype; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000379:methods*; D007564:Japan; D007956:Leukocidins / Q000235:genetics*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D012307:Risk Factors; D012574:Schools; D013207:Staphylococcal Skin Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D037521:Virulence Factors / Q000235:genetics*
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors