A Geographic Variant of the<i>Staphylococcus aureus</i>Panton‐Valentine Leukocidin Toxin and the Origin of Community‐Associated Methicillin‐Resistant<i>S. aureus</i>USA300

O'Hara, F. Patrick; Guex, Nicolas; Word, J. Michael; Miller, Linda A.; Becker, Julie; Walsh, Stacey L.; Scangarella, N.; West, Joshua; Shawar, Ribhi; Amrine-Madsen, Heather

doi:10.1086/524684

Cited by 64 publications

(108 citation statements)

References 43 publications

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“…This disease spectrum is also similar to that of earlier reports of infections caused by MRSA from this region (13,14). O'Hara et al, using phylogenetic analyses of the lukSF-PV sequences coding PVL toxin in a sample of international clinical MRSA isolates, recently hypothesized that USA300 emerged after a CC8 MRSA strain acquired the PVL genes from the preexisting, virulent MW2 strain (33). If this event was the genesis of USA300, this event may have occurred in the lower 48 states, and USA300 had not spread to southwestern Alaska, where USA400 strains still predominated in early 2006.…”

Section: Discussionsupporting

confidence: 84%

Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureus, Rural Southwestern Alaska1

David

Rudolph²,

Hennessy³

et al. 2008

Emerg. Infect. Dis.

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USA300 is the dominant strain responsible for community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections in most of the United States. We examined isolates from outbreaks of MRSA skin infections in rural southwestern Alaska in 1996 and 2000 (retrospective collection) and from the hospital serving this region in 2004-2006 (prospective collection). Among 36 retrospective collection isolates, 92% carried Panton-Valentine leukocidin (PVL) genes; all carried staphylococcal chromosomal cassette mec (SCCmec) type IV. None belonged to clonal complex (CC) 8, the CC associated with USA300; 57% were sequence type (ST) 1, and 26% were ST30; 61% were clindamycin resistant. In the prospective collection, 42 isolates were PVL+ and carried SCCmec type IV; 83.3% were ST1, 9.5% were ST30, and 7.1% were ST8. Among 120 prospective isolates, 57.5% were clindamycin resistant. CA-MRSA epidemiology in southwestern Alaska differs from that in the lower 48 states; ST8 strains were rarely identifi ed and clindamycin resistance was common.

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Section: Discussionsupporting

confidence: 84%

Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureus, Rural Southwestern Alaska1

David

Rudolph²,

Hennessy³

et al. 2008

Emerg. Infect. Dis.

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“…These strains are genetically similar in susceptibility and toxin profile, as well as spa type, to the recently described ST22 PVL-MRSA United Kingdom strains, rather than the predominant hospital-acquired MRSA (HA-MRSA) ST22 EMRSA-15 clone (5). This study observed the previously noted geographical and clonal bias in the distribution of the PVL haplotypes, with the R haplotype limited to a few lineages, predominantly in the United States and more recently Australia (22,29). Due to previous reports of R haplotypes being found in the United Kingdom in significant numbers of MRSA strains (4,24), the dearth of R haplotypes in this small study population may reflect more on the methicillin susceptibility of the isolates rather than geographical location.…”

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confidence: 49%

“…Most isolates (n ϭ 17; 89.5%) were of the H variant as defined by O'Hara et al (22), with both H1 and H2 groups present. The nonsynonymous nucleotide 527 A-to-G mutation which defines the R variant occurred only in a single isolate (TS1).…”

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confidence: 84%

“…This bicomponent, poreforming toxin, encoded by a highly conserved Ϸ1.9-kb lukSF-PV locus consisting of two adjacent, cotranscribed lukF and lukS genes (26), has 12 major single nucleotide polymorphisms (SNPs), the majority of which are synonymous. A nonsynonymous mutation at position 527, however, serves as the basis of the H and R isoforms (2,12,22,28). Currently, though most research is focused on PVL-positive MRSA (PVL-MRSA), a rising incidence of PVL-positive, methicillin-sensitive S. aureus (PVL-MSSA) infections reported recently is the main contributing factor in the increased incidence of PVL-positive strains in some locales, with approximately 60% of total PVL-positive S. aureus isolates in England in the past 5 years found to be susceptible to methicillin (6,16,29).…”

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confidence: 99%

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Molecular Characterization and Panton-Valentine Leucocidin Typing of Community-Acquired Methicillin-Sensitive Staphylococcus aureus Clinical Isolates

Otokunefor

Sloan

Kearns³

et al. 2012

J Clin Microbiol

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Limited comprehensive molecular typing data exist currently for Panton-Valentine leucocidin (PVL)-positive, methicillin-sensitive Staphylococcus aureus (PVL-MSSA) clinical isolates. Characterization of PVL-MSSA isolates by multilocus sequence typing (MLST) and spa typing in this study showed a genetic similarity to PVL-positive, methicillin-resistant S. aureus (PVL-MRSA) strains, although three novel spa types and a novel MLST (ST1518) were detected. Furthermore, the detection of PVL phages and haplotypes in PVL-MSSA identical to those previously found in PVL-MRSA isolates highlights the role these strains may play as precursors of emerging lineages of clinical significance.

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“…As for future trends in S. aureus, it remains to be seen whether a stabilization or reduction in the proportion of S. aureus isolates that are MRSA will correspond to an absolute decrease in S. aureus infections. The emergence and rapid spread of CA-MRSA may have been related to the emergence of strains possessing certain fitness characteristics, such as carrying Panton-Valentine leukocidin genes (2,12,34), rather than to methicillin resistance. There is some evidence that these characteristics are becoming associated with MSSA, making those strains more competitive against MRSA strains (35).…”

Section: Discussionmentioning

confidence: 99%

Trends and Characteristics of Culture-Confirmed Staphylococcus aureus Infections in a Large U.S. Integrated Health Care Organization

2012

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Infections due to Staphylococcus aureus present a substantial health problem in the United States (20, 23). S. aureus is a major cause of hospital-acquired pneumonia and lower respiratory tract infections (37) and the primary cause of surgical-site infections (36) and skin and soft tissue infections (SSTIs) (29) and is now likely the leading cause of invasive bacterial disease (20,23). Throughout the 1990s, S. aureus infections in hospitalized patients were increasingly caused by methicillin-resistant S. aureus (MRSA), making treatment of these infections more difficult (20,21,23,40). Moreover, between 1990 and 2005, there was an even more dramatic increase in community-associated MRSA (CA-MRSA) infections (1,5,10,11,19,27,32 In general, surveillance activity for MRSA has been limited to bloodstream or invasive infections and to health care-associated and hospital onset disease, and there have been few populationbased studies. As the epidemiology of S. aureus disease changes, inclusion of community-associated, community onset, and noninvasive disease is important for assessing the magnitude of the burden of disease in the population, for setting priorities for prevention and control, and for creating guidelines for empirical antibiotic treatment.In this retrospective study covering 12 years, we describe laboratory-confirmed S. aureus infections in a large cohort of persons of all ages, using isolates from sterile and nonsterile sites in both ambulatory and inpatient settings. We describe trends in methicillin resistance of laboratory-confirmed S. aureus isolates and trends in the incidence of S. aureus bloodstream infections and explore the relationship of patient demographics and infection onset type to the likelihood of S. aureus infections being methicillin resistant. MATERIALS AND METHODSSetting. Kaiser Permanente of Northern California (KPNC) is a nonprofit, integrated health care delivery system providing care to over 3 million members. The member population reflects the general population in the Northern California region, although as an insured population, it underrepresents persons with annual incomes less than $25,000 (9% of the KPNC member population 25 to 79 years of age versus 21% of the general Northern California population 25 to 79 years of age) and overrepresents persons with annual incomes greater than $100,000 (30% versus 26%). Although racially diverse, the KPNC population also somewhat underrepresents Latinos/Hispanics (19% versus 22%) and overrepresents African-Americans (8% versus 5.5%) (15). KPNC provides services in more than 15 counties and operates more than 40 outpatient clinics and 18 hospitals throughout Northern California. Laboratory results and diagnostic data from hospital discharges and ambulatory settings, including emergency departments, are archived in databases. KPNC databases contain individual patient records and are readily linked using the patient's unique medical record number, which remains with the patient for life.

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A Geographic Variant of theStaphylococcus aureusPanton‐Valentine Leukocidin Toxin and the Origin of Community‐Associated Methicillin‐ResistantS. aureusUSA300

Cited by 64 publications

References 43 publications

Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureus, Rural Southwestern Alaska1

Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureus, Rural Southwestern Alaska1

Molecular Characterization and Panton-Valentine Leucocidin Typing of Community-Acquired Methicillin-Sensitive Staphylococcus aureus Clinical Isolates

Trends and Characteristics of Culture-Confirmed Staphylococcus aureus Infections in a Large U.S. Integrated Health Care Organization

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