High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA

Abstract

BackgroundSuperficial skin and soft tissue infections (SSTIs) are common among the Indigenous population of the desert regions of Central Australia. However, the overall burden of disease and molecular epidemiology of Staphylococcus aureus complicated SSTIs has yet to be described in this unique population.MethodsAlice Springs Hospital (ASH) admission data was interrogated to establish the population incidence of SSTIs. A prospective observational study was conducted on a subset of S. aureus complicated SSTIs (carbuncles and furuncles requiring surgical intervention) presenting during a one month period to further characterize the clinical and molecular epidemiology. High resolution melting analysis was used for clonal complex discrimination. Real-time polymerase chain reaction identifying the lukF component of the Panton Valentine leucocidin (pvl) gene determined pvl status. Clinical and outcome data was obtained from the ASH medical and Northern Territory shared electronic health records.ResultsSSTIs represented 2.1% of ASH admissions during 2014. 82.6% occurred in Indigenous patients (n = 382) with an estimated incidence of 18.9 per 1, 000 people years compared to the non-Indigenous population of 2.9 per 1000, with an incident rate ratio of 6.6 (95% confidence interval 5.1–8.5). Clinical and molecular analysis was performed on 50 isolates from 47 patients. Community-associated methicillin-resistant S. aureus (CA-MRSA) predominated (57% of isolates). The high burden of SSTIs is partly explained by the prevalence of pvl positive strains of S. aureus (90% isolates) for both CA-MRSA and methicillin-susceptible S. aureus (MSSA). ST93-MRSA and CC121-MSSA were the most prevalent clones. SSTIs due to ST93-MRSA were more likely to require further debridement (p = 0.039), however they also more frequently received inactive antimicrobial therapy (p < 0.001).ConclusionsST93-MRSA and CC121-MSSA are the dominant causes of carbuncles and furuncles in Central Australia. Both of these virulent clones harbor pvl but the impact on clinical outcomes remains uncertain. The high prevalence of CA-MRSA supports empiric vancomycin use in this population when antimicrobial therapy is indicated. Prompt surgical intervention remains the cornerstone of treatment.

Molecular characterization of community‐associated methicillin‐resistant Staphylococcus aureus from pet dogs

“…Trimethoprim resistance is rare amongst Australian clinical community‐associated MRSA isolates but is frequently detected in hospital‐associated MRSA strain ST239‐II (AGAR, ; Tong, Varrone, et al, ). Our findings are consistent with a global rise in the prevalence of trimethoprim resistance amongst MRSA—including recent reports of dfrG ‐positive ST5‐IV in Western Australia (Coombs, ) and dfrG ‐positive CC5 MRSA and methicillin‐susceptible S. aureus (MSSA) in Central Australia (Harch et al, ). To our knowledge, this is the first report of trimethoprim‐resistant ST5‐IV in eastern Australia and the first report of trimethoprim‐resistant ST5‐IV from a dog.…”

Burden of skin disease in two remote primary healthcare centres in northern and central Australia

“…11 Indigenous Australians have a higher incidence of post-streptococcal glomerulonephritis, rate ratio of 53.6 for indigenous to non-indigenous Australians 11 and of hospitalisations related to Staphylococcal skin infections. 10,12 An incidence of skin infections of 70 per 100 personyears is remarkably high. Studies in other populations have noted a rate approximately 10× lower.…”

“…241/439 (55%) were female and median age of the combined population was 20 years of age. Over 12 months, 6445 visits and 7392 presentation reasons were recorded, with median number of presentations/patient/year of 11 (interquartile range [6][7][8][9][10][11][12][13][14][15][16][17][18]. There was no seasonality to the presentations ( Fig.…”

Verificação Da Temperatura De Distribuição De Refeições Quentes Ofertadas Em Uma Instituição De Longa Permanência Para Idosos E a Correlação Com O Crescimento Microbiológico

“…Quando em contato com as membranas celulares do hospedeiro, reduz a resistência imunológica por lise de leucócitos ou apoptose e tem como alvo os receptores de complemento (GOUDARZI et al, 2019). Em vários estudos, os isolados de S. aureus portadores da toxina PVL estão ligados a infecções cutâneas, incluindo abscessos, furúnculos e feridas cirúrgicas (CHANGCHIEN et al, 2016;FUNAKI et al, 2019;HARCH et al, 2017;IMMERGLUCK et al, 2017;OLANIYI et al, 2018;SHAHINI SHAMS ABADI et al, 2017;SINA et al, 2013). (GOUDARZI et al, 2019).…”