title: Community-acquired methicillin-resistant Staphylococcus aureus in a Malaysian tertiary centre.
abstract: Abstract. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a pathogen recognized to be distinct in both phenotype and genotype from hospital-acquired MRSA. We have identified CA-MRSA cases in Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, including their antibiotic susceptibility patterns and genotypic characteristics. Cases were identified during January to December 2009 from routine clinical specimens, where culture and antibiotic susceptibility results yielded pauci-resistant MRSA isolates suspected as being CA-MRSA. The patients' clinical data were collected and their specimens were sent for molecular confirmation and analysis. Five cases of CA-MRSA were identified, which had a multi-sensitive pattern on antibiotic susceptibility tests and were resistant to only penicillin and oxacillin. All cases were skin and soft-tissue infections, including diabetic foot with gangrene, infected scalp hematoma, philtrum abscess in a healthcare worker, thrombophlebitis complicated with abscess and infected bedsore. All five cases were confirmed MRSA by detection of mecA. SCCmec typing (ccr and mec complex) revealed SCCmec type IV for all cases except the infected bedsore case. Panton-Valentine leukocidin gene was positive in all isolates. As clinical features among methicillin-sensitive Staphylococcus aureus, CA-MRSA and "nosocomial CA-MRSA" are indistinct, early recognition is necessary in order to initiate appropriate antibiotics and infection control measures. Continual surveillance of pauci-resistant MRSA and molecular analysis are necessary in order to identify emerging strains as well as their epidemiology and transmission, both in the community and in healthcare setting.
authors.affiliation: Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. zettiz@gmail.com
authors.forename: Zetti Zainol
authors.initials: ZZ
authors.lastname: Rashid
authors.forename: Norazlah
authors.initials: N
authors.lastname: Bahari
authors.forename: Amizah
authors.initials: A
authors.lastname: Othman
authors.forename: Roslinda
authors.initials: R
authors.lastname: Jaafar
authors.forename: Nurul Azmawati
authors.initials: NA
authors.lastname: Mohamed
authors.forename: Idimaz
authors.initials: I
authors.lastname: Jabbari
authors.forename: Anita
authors.initials: A
authors.lastname: Sulong
authors.forename: Rohaidah
authors.initials: R
authors.lastname: Hashim
authors.forename: Norazah
authors.initials: N
authors.lastname: Ahmad
mesh_terms: D001431:Bacteriological Techniques; D017714:Community-Acquired Infections / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005838:Genotype; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development* / Q000302:isolation & purification; D012874:Skin Diseases, Infectious / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000382:microbiology*; D062606:Tertiary Care Centers