title: Genetic diversity of Staphylococcus aureus in Buruli ulcer.
abstract: BACKGROUND
  Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing. The present study was therefore aimed at investigating the diversity and topography of S. aureus colonizing BU patients during treatment.
  
  
  METHODS
  We investigated the presence, diversity, and spatio-temporal distribution of S. aureus in 30 confirmed BU patients from Ghana during treatment. S. aureus was isolated from nose and wound swabs, and by replica plating of wound dressings collected bi-weekly from patients. S. aureus isolates were characterized by multiple-locus variable number tandem repeat fingerprinting (MLVF) and spa-typing, and antibiotic susceptibility was tested.
  
  
  RESULTS
  Nineteen (63%) of the 30 BU patients tested positive for S. aureus at least once during the sampling period, yielding 407 S. aureus isolates. Detailed analysis of 91 isolates grouped these isolates into 13 MLVF clusters and 13 spa-types. Five (26%) S. aureus-positive BU patients carried the same S. aureus genotype in their anterior nares and wounds. S. aureus isolates from the wounds of seven (37%) patients were distributed over two different MLVF clusters. Wounds of three (16%) patients were colonized with isolates belonging to two different genotypes at the same time, and five (26%) patients were colonized with different S. aureus types over time. Five (17%) of the 30 included BU patients tested positive for methicillin-resistant S. aureus (MRSA).
  
  
  CONCLUSIONS
  The present study showed that the wounds of many BU patients were contaminated with S. aureus, and that many BU patients from the different communities carried the same S. aureus genotype during treatment. This calls for improved wound care and hygiene.
authors: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Nana Ama
authors: NA
authors: Amissah
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Corinna
authors: C
authors: Glasner
authors: Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Anthony
authors: A
authors: Ablordey
authors: Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Caitlin S
authors: CS
authors: Tetteh
authors: Pakro Health Centre, Ghana Health Service, Pakro, Ghana.
authors: Nana Konama
authors: NK
authors: Kotey
authors: Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Isaac
authors: I
authors: Prah
authors: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Tjip S
authors: TS
authors: van der Werf
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: John W
authors: JW
authors: Rossen
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Jan Maarten
authors: JM
authors: van Dijl
authors: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Ymkje
authors: Y
authors: Stienstra
mesh_terms: D000328:Adult; D015373:Bacterial Typing Techniques; D054312:Buruli Ulcer / Q000150:complications / Q000382:microbiology*; D060085:Coinfection / Q000382:microbiology*; D005260:Female; D014644:Genetic Variation / Q000235:genetics; D005869:Ghana; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D018598:Minisatellite Repeats / Q000235:genetics; D019911:Mycobacterium ulcerans / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D009666:Nose / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology