title: Characterisation of clinical Staphylococcus aureus isolates harbouring mecA or Panton-Valentine leukocidin genes from four tertiary care hospitals in Indonesia.
abstract: OBJECTIVE
  To determine the prevalence, antimicrobial susceptibility profiles and clonal distribution of either methicillin-resistant Staphylococcus aureus (MRSA) or Panton-Valentine leukocidin (PVL)-positive S. aureus obtained from clinical cultures in Indonesian hospitals.
  
  
  METHODS
  S. aureus isolates from clinical cultures of patients in four tertiary care hospitals in Denpasar, Malang, Padang and Semarang were included. We assessed the antimicrobial susceptibility profiles using the Vitek2(®) system, determined the presence of the mecA gene and genes encoding PVL using PCR and analysed the clonal relatedness with Raman spectroscopy. SCCmec typing was performed for all MRSA isolates. Multilocus sequence typing (MLST) was performed for a subset of isolates.
  
  
  RESULTS
  In total, 259 S. aureus strains were collected. Of these, 17/259 (6.6%) and 48/259 (18.5%) were MRSA and PVL-positive methicillin-susceptible S. aureus (MSSA), respectively. The prevalence of MRSA and PVL-positive MSSA ranged between 2.5-8.9% and 9.5-29.1%, respectively and depended on geographic origin. PVL-positive MRSA were not detected. Raman spectroscopy of the strains revealed multiple Raman types with two predominant clusters. We also showed possible transmission of a ST239-MRSA-SCCmec type III strain and a ST121 PVL-positive MSSA in one of the hospitals.
  
  
  CONCLUSIONS
  We showed that MRSA and PVL-positive MSSA are of clinical importance in Indonesian hospitals. A national surveillance system should be set-up to further monitor this. To reduce the prevalence of MRSA in Indonesian hospitals, a bundle of intervention measures is highly recommended.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr.Saiful Anwar Hospital, Malang, Indonesia.
authors.forename: Dewi
authors.initials: D
authors.lastname: Santosaningsih
authors.affiliation: Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr.Saiful Anwar Hospital, Malang, Indonesia.
authors.forename: Sanarto
authors.initials: S
authors.lastname: Santoso
authors.affiliation: Department of Microbiology, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia.
authors.forename: Nyoman S
authors.initials: NS
authors.lastname: Budayanti
authors.affiliation: Department of Microbiology, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia.
authors.forename: Ketut
authors.initials: K
authors.lastname: Suata
authors.affiliation: Department of Microbiology, Faculty of Medicine, Diponegoro University/Dr.Kariadi Hospital, Semarang, Indonesia.
authors.forename: Endang S
authors.initials: ES
authors.lastname: Lestari
authors.affiliation: Department of Microbiology, Faculty of Medicine, Diponegoro University/Dr.Kariadi Hospital, Semarang, Indonesia.
authors.forename: Hendro
authors.initials: H
authors.lastname: Wahjono
authors.affiliation: Department of Microbiology, Faculty of Medicine, Andalas University/Dr.M.Djamil Hospital, Padang, Indonesia.
authors.forename: Aziz
authors.initials: A
authors.lastname: Djamal
authors.affiliation: Department of Microbiology, Faculty of Medicine, Airlangga University/Dr.Soetomo Hospital, Surabaya, Indonesia.
authors.forename: Kuntaman
authors.initials: K
authors.lastname: Kuntaman
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.|Microbiology Unit, Biomérieux, Inc., La Balme, France.
authors.forename: Alex
authors.initials: A
authors.lastname: van Belkum
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.|BaseClear BV, Leiden, the Netherlands.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Laurens
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Snijders
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.|Molecular Diagnostics, Jeroen Bosch Hospital, Tilburg, the Netherlands.
authors.forename: Diana
authors.initials: D
authors.lastname: Willemse-Erix
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Wil H
authors.initials: WH
authors.lastname: Goessens
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Henri A
authors.initials: HA
authors.lastname: Verbrugh
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Juliëtte A
authors.initials: JA
authors.lastname: Severin
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics / Q000302:isolation & purification*; D001427:Bacterial Toxins / Q000235:genetics / Q000302:isolation & purification*; D024901:Drug Resistance, Multiple, Bacterial; D005098:Exotoxins / Q000235:genetics / Q000302:isolation & purification*; D006580:Genetic Carrier Screening / Q000379:methods; D006801:Humans; D007214:Indonesia; D007956:Leukocidins / Q000235:genetics / Q000302:isolation & purification*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D015337:Multicenter Studies as Topic; D058885:Multilocus Sequence Typing; D060885:Multiplex Polymerase Chain Reaction; D046915:Penicillin-Binding Proteins / Q000235:genetics / Q000302:isolation & purification*; D013059:Spectrum Analysis, Raman; D013203:Staphylococcal Infections / Q000235:genetics / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D063128:Tertiary Health Care / Q000706:statistics & numerical data
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus
keywords: Asia; Asie; Indonesia; Indonésie; LPV; PVL; SAMR; SARM; Staphylococcus aureus; methicillin-resistant S. aureus; panton-valentine leukocidin