Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus Associated with Pediatric Infection in Cambodia

Abstract

BackgroundThe incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is rising in the developed world but appears to be rare in developing countries. One explanation for this difference is that resource poor countries lack the diagnostic microbiology facilities necessary to detect the presence of CA-MRSA carriage and infection.Methodology and Principal FindingsWe developed diagnostic microbiology capabilities at the Angkor Hospital for Children, Siem Reap, western Cambodia in January 2006 and in the same month identified a child with severe community-acquired impetigo caused by CA-MRSA. A study was undertaken to identify and describe additional cases presenting between January 2006 and December 2007. Bacterial isolates underwent molecular characterization using multilocus sequence typing, staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the presence of the genes encoding Panton-Valentine Leukocidin (PVL). Seventeen children were identified with CA-MRSA infection, of which 11 had skin and soft tissue infection and 6 had invasive disease. The majority of cases were unrelated in time or place. Molecular characterization identified two independent MRSA clones; fifteen isolates were sequence type (ST) 834, SCCmec type IV, PVL gene-negative, and two isolates were ST 121, SCCmec type V, PVL gene-positive.ConclusionsThis represents the first ever report of MRSA in Cambodia, spread of which would pose a significant threat to public health. The finding that cases were mostly unrelated in time or place suggests that these were sporadic infections in persons who were CA-MRSA carriers or contacts of carriers, rather than arising in the context of an outbreak.

Molecular characteristic of Staphylococcus aureus isolates in a Chinese teaching hospital

“…Moreover, this clone had been also reported in China, Nigeria and Germany Conceição et al, 2011;Schefold et al, 2007). It is noteworthy that two PVL -positive ST 121-SCCmec V-MRSA isolates emerged in Cambodia (Chheng et al, 2009). In the present study, ST121 was the most common clone in CA-MSSA.…”

Staphylococcus aureus ST121: a globally disseminated hypervirulent clone

“…A total of 126 cases with S. aureus ST121 infection have been reported to date. The severe invasive infections include streptodermia (1/126) (Cupane et al, 2012), osteomyelitis (3/126) (Chheng et al, 2009;Cupane et al, 2012), bursitis (1/126) (Cupane et al, 2012), lymphadenitis (1/126) (Cupane et al, 2012), cellulitis (9/126) (Conceição et al, 2011), bacteraemia (15/126) (Holmes et al, 2005) and septic multiple organ failure (1/126) (Rao et al, 2015); whereas, the mild superficial infections include urinary tract infection (2/126) (González-Domínguez et al, 2012;Egyir et al, 2014) (Cupane et al, 2012). Moreover, the clinical efficacy of the antimicrobial therapy may be insufficient for PVL-positive MSSA causing severe infections, for example, ST121 caused multiple organ failure, even though the favourable in vitro sensitivity testing of the causative S. aureus was conducted (Rao et al, 2015).…”

Virulence Factors and Genetic Characteristics of Methicillin-Resistant and -SusceptibleStaphylococcus aureusIsolates in Myanmar

“…44 Similarly, ST121-MSSA with the PVL gene was also isolated in other European countries 2,42 and Asian countries, including Cambodia, Thailand, and Indonesia. 10,55,60 Therefore, ST121 may be a widely distributed S. aureus clone harboring the PVL gene. Like PVL-positive MRSA and MSSA reported, 1,57,62 PVL-positive MSSA strains in Myanmar harbored egc.…”