title: Outbreak of Skin Infections Due to Panton-Valentine Leukocidin-Positive Methicillin-Susceptible Staphylococcus aureus in a French Prison in 2010-2011.
abstract: Background. An outbreak of PVL-positive MSSA skin and soft tissue-infections (SSTIs) was suspected in May 2010 when recurrent SSTI was diagnosed in an inmate of a large prison in Nantes, France. Methods and findings. Retrospective and prospective investigations were performed. Microbiological characterisation was by DNA microarray testing (S. aureus genotyping - Identibac, Alere). We identified 14 inmates meeting our clinical and microbiological case definition for PVL-MSSA SSTI between March 2010 and April 2011. The SSTIs developed in tattooed areas in 4 patients and in areas shaved daily with a mechanical razor in 4 other patients. All case isolates exhibited a similar SmaI pulsed-field gel electrophoresis pattern. Microarray analysis showed that all 14 isolates harboured genes encoding PVL and enterotoxins (A, H, K, and Q) and belonged to clonal complex 1 (CC1). Individual and collective hygiene measures, education delivered to inmates and prison employees, and antibiotic treatment of SSTIs were successful in controlling the outbreak. No new cases were identified after April 2011. Routine screening for PVL-positive MSSA carriage was not feasible. Conclusions. Our data suggest that tattooing and shaving with mechanical razors may constitute risk factors for SSTIs among previously colonised inmates and contribute to the PVL-MSSA outbreak in the prison. Allowing inmates access to professional tattooists and to the hygiene and safety conditions available to people in the community would help to prevent tattoo-related infections.
authors.affiliation: Bacteriology and Hygiene Department, Nantes University Hospital, 44000 Nantes, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Bourigault
authors.affiliation: Bacteriology and Hygiene Department, Nantes University Hospital, 44000 Nantes, France; University of Nantes, EA 3826, Medical School, 44000 Nantes, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Corvec
authors.affiliation: Jail Medical Center, 44000 Nantes, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Brulet
authors.affiliation: Jail Medical Center, 44000 Nantes, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Robert
authors.affiliation: Jail Medical Center, 44000 Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mounoury
authors.affiliation: Jail Medical Center, 44000 Nantes, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Goubin
authors.affiliation: Infectious Diseases Department, Nantes University Hospital, 44000 Nantes, France.
authors.forename: David
authors.initials: D
authors.lastname: Boutoille
authors.affiliation: Regional Unit of Epidemiology and Diseases Control, Pays de la Loire Area, 44000 Nantes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hubert
authors.affiliation: National Reference Center for Staphylococci, University of Lyon, 69000 Lyon, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Bes
authors.affiliation: National Reference Center for Staphylococci, University of Lyon, 69000 Lyon, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Tristan
authors.affiliation: National Reference Center for Staphylococci, University of Lyon, 69000 Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Etienne
authors.affiliation: Bacteriology and Hygiene Department, Nantes University Hospital, 44000 Nantes, France; University of Nantes, EA 3826, Medical School, 44000 Nantes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Lepelletier