title: Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus among skin and soft tissue infections in an emergency department in Guyana.
abstract: OBJECTIVE
  The characteristics of staphylococcal skin and soft tissue infections (SSTIs) are poorly understood in northern South America and the Caribbean. The objectives of this study were to determine the frequency of methicillin resistance among Staphylococcus aureus isolates in an emergency department (ED) in Guyana and to identify specific molecular characteristics of these methicillin-resistant Staphylococcus aureus (MRSA) strains.
  
  
  METHODS
  This was a cross-sectional study conducted at the main teaching hospital in Georgetown, Guyana. Eligible subjects included patients of all ages with SSTIs with obtainable purulent material. Purulent material was cultured, and S. aureus isolates were evaluated for antibiotic susceptibilities by disc diffusion. Molecular characterisation of MRSA isolates included identification of SCCmec type, assignment of genetic relatedness by rep-PCR and determination of the presence of two exotoxins, Panton-Valentine Leukocidin (PVL) and LukAB.
  
  
  RESULTS
  Eighty-five samples were collected; of these, 47 grew S. aureus. 24 of the 47 S. aureus samples were MRSA (51%; 95% CI 37% to 65%), representing 28% of all samples. All MRSA isolates were SCCmec type IV, PVL positive, LukAB positive and were highly related to the current epidemic clone in the USA, USA300.
  
  
  CONCLUSIONS
  Here, we demonstrate a clinically significant proportion of methicillin resistance in SSTI-associated staphylococcal isolates. Guyanese isolates were highly related to the most common community-associated strain seen in the USA, USA300. These results have important implications for empiric antibiotic therapy and infection control policies in Guyana and similar settings.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Adeline
authors.identifier: http://orcid.org/0000-0002-8736-4119
authors.initials: A
authors.lastname: Dozois
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Thomsen
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Jimenez-Truque
authors.affiliation: Department of Laboratory Services, Georgetown Public Hospital Corporation, Georgetown, Guyana.
authors.forename: Nicole
authors.initials: N
authors.lastname: Soper
authors.affiliation: Department of Laboratory Services, Georgetown Public Hospital Corporation, Georgetown, Guyana.
authors.forename: Alexis
authors.initials: A
authors.lastname: Pearson
authors.affiliation: Department of Laboratory Services, Georgetown Public Hospital Corporation, Georgetown, Guyana.
authors.forename: Pheona
authors.initials: P
authors.lastname: Mohamed-Rambaran
authors.affiliation: Division of International Health, Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Dettorre
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: C Buddy
authors.initials: CB
authors.lastname: Creech
authors.affiliation: Division of International Health, Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Seth W
authors.initials: SW
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000235:genetics; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006172:Guyana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification; D008875:Middle Aged; D015995:Prevalence; D017422:Sequence Analysis, DNA; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; C586430:leukocidin AB, Staphylococcus aureus
keywords: infectious diseases, bacterial; local; soft tissue infection