title: Methicillin-susceptible Staphylococcus aureus clone related to the early pandemic phage type 80/81 causing an outbreak among residents of three occupational centres in Barcelona, Spain.
abstract: In the 1950s an unusually virulent and transmissible penicillin-resistant Staphylococcus aureus clone harbouring Panton-Valentine leukocidin (PVL) genes, known as phage type 80/81 and subsequently identified as multilocus sequence type (ST) 30, emerged and caused serious infections in hospitals and the community. We describe an outbreak of skin infections caused by a PVL-positive, methicillin-susceptible S. aureus (MSSA) strain of ST1472, related to phage type 80/81, in three associated occupational centres. After identification of the first patient an active case-finding strategy was initiated among the three centres. Epidemiological and clinical features were indistinguishable from outbreaks currently caused by community-acquired methicillin-resistant S. aureus. The S. aureus was cultured and identified from nasal swabs and skin lesions by conventional methods; PVL was detected using a PCR assay. Pulsed-field gel electrophoresis and DNA-array-based genotyping were applied to MSSA isolates. MSSA was identified in nasal swabs from 49 of 133 individuals (37%). A single pulsed-field gel electrophoresis pattern, belonging to ST1472 (CC30) and PVL positivity, were detected in 20 individuals, including eight of 18 skin cultures, i.e. 15% of the screened individuals were colonized by the epidemic strain. Nasal and cutaneous decontamination with 5% nasal mupirocin ointment and 2% aqueous chlorhexidine was implemented for all individuals. Patients with active skin infections were treated with a first-generation cephalosporin. General recommendations were made to prevent cross-transmission. No new cases were reported over the following 90 days.
authors.affiliation: Department of Infectious Diseases, IDIBELL, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain. ogasch@bellvitgehospital.cat
authors.forename: O
authors.initials: O
authors.lastname: Gasch
authors.forename: A
authors.initials: A
authors.lastname: Hornero
authors.forename: M A
authors.initials: MA
authors.lastname: Domínguez
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: C
authors.initials: C
authors.lastname: Suárez
authors.forename: S
authors.initials: S
authors.lastname: Gómez
authors.forename: M
authors.initials: M
authors.lastname: Camoez
authors.forename: J
authors.initials: J
authors.lastname: Linares
authors.forename: J
authors.initials: J
authors.lastname: Ariza
authors.forename: M
authors.initials: M
authors.lastname: Pujol
mesh_terms: D000293:Adolescent; D000328:Adult; D001427:Bacterial Toxins / Q000235:genetics; D001434:Bacteriophage Typing; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005098:Exotoxins / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D017053:Infection Control / Q000379:methods; D007956:Leukocidins / Q000235:genetics; D008297:Male; D008712:Methicillin; D046228:Microarray Analysis; D008875:Middle Aged; D058889:Molecular Typing; D009666:Nose / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012867:Skin / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000145:classification* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D008712:Methicillin