Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureusStrains Causing Neonatal Toxic Shock Syndrome-Like Exanthematous Disease in Neonatal and Perinatal Wards

Abstract

Neonatal toxic shock syndrome-like exanthematous disease (NTED) is a new neonatal disease caused by toxic shock syndrome toxin 1 (TSST-1). We conducted a prospective surveillance study and characterized the methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from patients with NTED and compared them with the strains from patients with other MRSA infections and asymptomatic carriers. The study was performed in the neonatal intensive care unit and a general neonatal and maternal ward in the Tokyo Women's Medical University Hospital (TWMUH) from September to December 1998. Among 103 patients eligible for the study, MRSA was detected in 62 (60.2%) newborns; of these 62 newborns, 8 (12.9%) developed NTED, 1 (1.6%) had another MRSA infection, and 53 (85.5%) were asymptomatic MRSA carriers. Sixty-nine MRSA strains were obtained from the 62 newborns. DNA fingerprinting by pulsed-field gel electrophoresis showed two clusters: clone A with 8 subtypes and clone B. Sixty-seven of the 69 MRSA strains (97.1%) belonged to clone A, and type A1 was the most predominant (42 of 69 strains; 60.9%) in every neonatal and perinatal ward. All but one of the clone A strains had the TSST-1 and staphylococcal enterotoxin C genes. We also analyzed eight MRSA strains from eight NTED patients in five hospitals in Japan other than TWMUH. All the MRSA strains from NTED patients also belonged to clone A. These results suggest that a single clone that predominated in the neonatal wards of six hospitals might have caused NTED. However, the occurrence of NTED might not be dependent on the presence of an NTED-specific strain.

Comparison of Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Strains Isolated from a Tertiary Hospital in Terengganu, Malaysia

“…Although Collery et al (34) reported that strains possessing the tst gene are often associated with agr type III, none of our agr type III strains harbored the tst gene. This is important because the tst gene encodes for toxic shock syndrome toxins, causing neonatal toxic shock syndromelike exanthematous disease and staphylococcal purpura fulminans (30,35).…”

Characterisation of the Virulence Factors and Genetic Types of Methicillin Susceptible Staphylococcus aureus from Patients and Healthy Individuals

“…Toxic shock syndrome toxin-1 (encoded by tst) that causes neonatal toxic shock syndrome-like exanthematous disease and Staphylococcal purpura fulminans [25,26] was detected in five community and one clinical strain.…”

Methicillin-ResistantStaphylococcus pseudintermediusin a Veterinary Teaching Hospital

“…A single colony was suspended to a McFarland 1.0 standard in 100 l of TE buffer (20 mM Tris, 2 mM EDTA [pH 7.5]) with 10 U of achromopeptidase (Wako Chemical, Co., Ltd., Osaka, Japan), and the suspension was incubated at 55°C for 10 min. After centrifugation at 18,500 ϫ g for 5 min, the supernatants were used as crude DNA extracts for PCR (22).…”