via PFGE diversity within the methicillin-resistant Staphylococcus aureus clonal lineage ST398 – 7thSpace Interactive.

The results of the 132 lung infection of Staphylococcus aureus resistant phenomenon is more serious, only to vancomycin, nitrofurantoin and sulfamethoxazole, and other drugs because of the sensitive high rate of them selected by the multiplex PCR 10 with PVL gene The Staphylococcus aureus, all for the MRSA strain, three for the ST239-SCC Ⅲ, 2 strain ST398-SCCmec Ⅲ, 2 strain ST398-SCCmec Ⅳ, ST25-SCCmec Ⅲ, ST59-SCCmec Ⅰ and ST88-SCCmec Ⅲ each one. Conclusion of the lung infection of Staphylococcus aureus resistant to multiple antibiotics, a multi-drug resistance; PVL gene of its carrying a certain percentage. (Of three)

Translated version of http://www.cqvip.com/qk/96631X/200801/26423335.html.

Thirty-one case-patients with MRSA with spa types related to MRSA CC398 were detected from October 29, 2003, through February 16, 2007. Of these, 6 were excluded from the study because they had secondary cases (3 family clusters). Of the remaining eligible casepatients,

we were unable to interview 4 because of a death (n = 1) and refusal to participate (n = 3). The questionnaire was therefore administered to 21 of 25 primary case-patients. Median age of the case-patients was 29 years (age range 8 months to 80 years), and 13 (62%) were female.

Three case-patients reported having Dutch relatives, and 2 case-patients had a connection to the People’s Republic of China; 1 case-patient was an adopted child from China and another casepatient had adopted a child from China.

Ten case-patients (48%) reported having had an infection, of which all were skin and soft tissue infections. Moreover, sinusitis developed in 1 case-patient, and a severe invasive infection with multiorgan failure after knee surgery developed in another case-patient.

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Methicillin-resistant Staphylococcus aureus of clonal lineage ST398 that exhibits related spa types and contains SCCmec elements of types IVa or V has been isolated from colonized and infected humans and companion animals (e.g., dog, pig, horse) in Germany and Austria. Of particular concern 5 is the association of these cases with cases of nosocomial ventilator-associated pneumonia.

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Methicillin-resistant Staphylococcus aureus ST398 in humans and animals, Central Europe..

Objectives: To determine the transmission rate of animal-related ST398 MRSA and other MRSA isolates within Dutch hospitals.

Methods: Data were collected in 51 Dutch hospitals from July 2006 to January 2007. An index patient was defined as a carrier of MRSA (not necessarily infected) that was treated in a hospital without transmission precautions. As part of the Dutch MRSA policy all possible contact patients and healthcare workers (HCW) are screened for MRSA after identification of an index patient.

Results: During 306 months of observation, there were 80 index patients: 24 ST398 and 56 with other MRSA genotypes. Other genotypes included typical hospital-associated genotypes, but not USA300. In 80 clinical post-exposure surveys 2134 patients and 5758 HCWs were screened for MRSA. ST398 MRSA carriage was found in 3 HCWs (0.3% of all screened HCWs) as compared to 62 secondary cases with other MRSA genotypes (0.6% of screened HCWs; 1.7% of screened contact patients). No transmission of ST398 MRSA to screened contact patients (n = 383) was documented. Index patients carrying ST398 MRSA had been hospitalised shorter before isolation measures were taken than carriers of other MRSA genotypes (median respectively 1.5 and 4 days; p = 0.04); the number of contacts screened per day of exposure, however, did not differ between both groups (p = 0.75). The risk of transmission of ST398 MRSA per day of exposure was 25% of the risk of spread of the other MRSA genotypes (95% CI = 0.08 to 0.78; p = 0.01).

Conclusion: During 306 hospital-months the risk of transmission of pig-related ST398 MRSA was lower than that of other MRSA genotypes. Not a single documented case of patient-to-patient spread was found.

European Society of Clinical Microbiology and Infectious Diseases.

In 2007 the Scottish MRSA Reference Laboratory carried out PFGE, using smaI on about 6,000 MRSA isolates referred by Diagnostic Laboratories and three were repeatedly found to be non-typeable. All three isolates were had identical PFGE patterns when the restriction enzyme apaI was used and all had the spa type t034. They were resistant to no antibiotic groups tested other then beta-lactams and, specifically, were sensitive to tetracyclines. They were SCCmec type III. Two of the isolates were typed by MLST and both were ST368. These features show them to be different from most reported ST398 isolates but isolates with similar antibiograms, spa types and SCCmec types have been reported from both Europe and Canada. All three patients had infections which responded to appropriate treatment. Epidemiological investigations of the patients, carried out by local hospital Infection Control Teams, were directed towards finding associations with pigs or pig farming but no such associations were found. The only link discovered was that all three had been in-patients in the same hospital, though not in the same ward or in the same department.

International Symposium on Staphylococci and Staphylococcal Infections – ST398 MRSA infections in Scotland – No pig association apparent.

In Denmark, a total of 32 human cases of ST398 infection have been detected since 2003, including 4 cases in 2007.

Case-control study

To identify sources of MRSA ST398 infection, a case-control study was undertaken in the spring of 2007. MRSA ST398 cases were compared with two control groups (1:2:2): one group was selected via the Central National Register, the other included persons with community-acquired MRSA of subtypes other than ST398. The groups were matched with regards to age, sex and geographical distribution. Telephone interviews were used to collect information regarding admission to hospital, other medical contact, clinical data such as skin lesions and sores, chronic diseases, use of antibiotics, travel and exposure to agriculture and animals. In cases where several MRSA ST398 infected persons were found in the same family, only the index person was included in the study.

The study comprised 21 cases and 81 controls. The median age of the cases was 29 years, 13 were females. Ten (48 %) had skin or soft tissue infections; in one case such infection was complicated by severe joint infection. Consequently, ST398 seems to present a clinical presentation identical to that of other community-acquired MRSA infections.

Compared with the CNR controls, the cases were more likely to have lived or worked on farms with livestock (odds ratio (OR) 35.4; 95% CI 2.7-469.8) and have been admitted to hospital (OR 11.4; 95% CI 1.4-94.8). Compared with the MRSA control group, cases were more likely to have lived or worked on farms with livestock (OR 14.5; 95% CI 2.7-76.7).

Thirteen (62%) cases and no controls had come into contact with swine. The owners of the farms which cases had been in contact with were contacted with a view to testing for MRSA in the current production animals.

Statens Serum Institut – News – EPI-NEWS – EPI-NEWS 2007 – No. 27-33, 2007.

A 63-year-old woman with a kidney transplant was admitted with endocarditis caused by meticillin-resistant Staphylococcus aureus (MRSA). Once her antibiotic therapy had been adjusted to the sensitivity-pattern of the bacterial strain she recovered, without the need for surgical intervention. The isolated S. aureus was typed by multi-locus sequence typing as sequence type 398, a MRSA-strain that has recently been isolated from a high percentage of Dutch pigs. This is the first report of a life-threatening infection with this pig MRSA. This strain is genetically different from the globally dispersed nosocomial MRSA-strains, and also from the strains that have been epidemic for several years in the USA as the causative agent ofcommunity-acquired skin infections. The Dutch Working Group on Infection Prevention (WIP) has recently adjusted its guidelines to halt further spread of this strain, and advises that the population at risk (pig breeders, slaughterhouse personnel and veterinarians) be held in isolation when hospitalised until MRSA colonisation has been excluded. The patient described here, however, did not belong to this population at risk.

[Endocarditis due to meticillin-resistant Staphylo...[Ned Tijdschr Geneeskd. 2006] – PubMed Result.

Three family members, three co-workers, and 8 of the 10 pigs were MRSA positive. With the exception of the initial case (the mother) all persons were solely colonized, with no signs of clinical infections. After digestion with SmaI, none of the strains showed any bands using PFGE. All isolates belonged to spa type t108 and ST398. CONCLUSION: 1. This report clearly shows clonal spread and transmission between humans and pigs in the Netherlands. 2. MLST sequence type 398 might be of international importance as pig-MRSA, since this type was shown earlier to be present in epidemiologically unrelated French pigs and pig-farmers. 3. Research is needed to evaluate whether this is a local problem or a new source of MRSA, that puts the until now successful Search and Destroy policy of the Netherlands at risk.

Community-acquired MRSA and pig-farming. [Ann Clin Microbiol Antimicrob. 2006] – PubMed Result.

MRSA exhibiting ST398 may colonize and cause infections in humans and in certain animal species such as dogs, horses, and pigs. The isolation of MRSA ST398 showing the same characteristics from a wound infection in a dog and from nasal colonization of the staff of a veterinary practice where this dog had been treated suggests that interspecies transmission may occur. The differences in spa-types between the isolates containing the same PCR results for SCCmec can be explained by a single genetic event. Because isolates taken at the same time from nasal colonization in veterinary staff of the same practice exhibit either spa-type t011 or t034, this difference does not justify discrimination between the two types. Of particular concern was the subsequent detection of MRSA ST398 not only in outpatients but also in inpatients with ventilator-associated pneumonia in the same hospital unit at about the same time (Table).

Future recording of MRSA ST398 from infected and colonized humans (especially when detected by screening at admission to hospitals) will require a thorough analysis with respect to association with animals and routes of transmission. Tracing MRSA carriers among contacts should also include pet animals, horses, and other livestock. Because of the time and labor needed to complete MLST, spa-typing combined with BURP analysis of types is an efficient tool for recognizing this clonal lineage. Furthermore, detection of MRSA by appropriate methods should be implemented into antimicrobial resistance surveillance programs in veterinary medicine.

Prof Witte is head of the laboratory for nosocomial infections at the Robert Koch Institute, Wernigerode Branch. He also is a professor on the medical faculty of Magdeburg University.

MRSA ST398, Central Europe | CDC EID.