Nosocomial outbreak of multidrug-resistant USA300 methicillin-resistant Staphylococcus aureus causing severe furuncles and carbuncles in Japan

Abstract

USA300 methicillin-resistant Staphylococcus aureus (MRSA) has been attracting worldwide attention as a cause of community-associated MRSA (CA-MRSA) infections in the 21st century. Nosocomial outbreaks of CA-MRSA clones have been progressively more reported in Europe and the USA, but only one very recent report from Kyoto found in Japan. In February 2008, a severe MRSA infection occurred in one immunocompromised patient and three healthy medical staff members at the Department of Dermatology, Graduate School of Medicine, University of the Ryukyus. The epidemiological and clinical pattern of the infection prompted us to characterize the molecular features of the MRSA strain involved. The causative MRSA strain belonged to the multi-locus sequence type 8, staphylococcal cassette chromosome mec (SCCmec) type IVa, spa1 (alternatively t008), agr1 and coagulase type III, and carried the Panton-Valentine leukocidin (PVL) gene and the arginine catabolic mobile element. Pulsed-field gel electrophoresis analysis showed that the MRSA responsible for the outbreak was the USA300 clone. All of the isolated USA300 clones had multiple resistance against six non-β-lactam antimicrobial drugs. We report here the first nosocomial outbreak of multidrug-resistant USA300 MRSA infections in Japan. This report shows that the USA300 clone can manifest severe skin infections such as furuncles and carbuncles even in healthy persons, which require drainage and i.v. treatment, and suggests that the clone can spread in hospital settings worldwide.

The emerging ST8 methicillin-resistant Staphylococcus aureus clone in the community in Japan: associated infections, genetic diversity, and comparative genomics

“…In this study, we characterized ST8 CA-MRSA/J (a successful native clone in Japan), clinically and genetically (at the genome levels) for the first time, compared with ST8 CA-MRSA USA300. Regarding SSTIs caused by ST8 CA-MRSA/J, deep pyogenic skin infections with severe pain and extremely large abscesses were rare, in contrast to PVL-positive CA-MRSA (including USA300) [1,4,16,18,19], which may be the result of lack of PVL in ST8 CA-MRSA/J. Bullous impetigo is a common disease among children [4,27], and ET-producing S. aureus is a major cause [27].…”

“…McDougal and L.L. McDonald) and three Japanese isolates: NN36 from a 3-month-old Indian girl with abscesses [16]; NN47 from an 11-month-old Japanese girl with cellulitis and sepsis followed by osteomyelitis [17]; and 549 from an inpatient and medical staff with abscesses and cellulitis [18]. PVL-positive CA-MRSA included ST22 strain NN48 from familial infection cases [19], ST30 strains NN1 and NN12 from bullous impetigo and bloodstream infection [11], ST59 strains PM1 (from Taiwan [20]) and OS7 from cellulitis [21], and ST80 strains HT20030345 (from the Netherlands) and HT200 30442 (France) [22]; strains HT20030345 and HT200 30442 were kindly provided by Jerome Etienne.…”

A New Local Variant (ST764) of the Globally Disseminated ST5 Lineage of Hospital-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) Carrying the Virulence Determinants of Community-Associated MRSA

“…The control strains used in this study include N315 (ST5 [31]), Mu50 (ST5 [31]), I6 (ST5 [32]), I8 (ST5 [32]), I10 (ST5 [this study]), BK2464 (ST5 [4]), USA300-0114 (ST8 [33]), NN36 (ST8 [34]), NN47 (ST8 [35]), 549 (ST8 [36]), PM1 (ST59 [37]), and COL (ST250 [5,6]). …”

Clinical Aspects of Infection with Methicillin-Resistant <i>Staphylococcus aureus</i> USA300 Strain, Generally Regarded as Community-Acquired, in Japan

“…Most isolates suspected as CA-MRSA were PVL-negative and did not contain the USA300 clone (16). To the best of our knowledge, only 5 cases of USA300 infection have been reported in Japan from 2007 to 2009 (17)(18)(19)(20)(21). According to these Japanese reports, CA-MRSA infection with the USA300 clone is presumed to be very rare.…”

“…These cases were presumed to be imported cases of the USA300 clone. Two other reports described outbreaks among HCWs and patients in hospitals (20,21). The remaining case was suspected to be an intra-familial infection (17).…”