High rates of community-acquired, Panton-Valentine leukocidin (PVL)- positive methicillin-resistant S. aureus (MRSA) infections in adult outpatients in Greece

Abstract

Staphylococcus aureus was isolated in 88 (30. 8%) of 286 adult patients suffering from various skin and soft-tissue infections examined in the outpatient department of a 650 bed tertiary-care hospital of Athens, Greece between January 2006 and December 2007. Twenty-seven (30.7%) of the S. aureus infections were caused by methicillin-resistant S. aureus (MRSA). All MRSA isolates were also resistant to tetracycline, fucidic acid and kanamycin, but were sensitive to gentamicin and tobramycin, as well as to to cotrimoxazole, chloramphenicol, quinolones, clindamycin and erythromycin. All isolates belonged to staphylococcal cassette chromosome mec elements (SCCmec) type IV, and were found to carry the lukF-PV and lukS genes coding for Panton-Valentine leukocidin (PVL). Pulsed-field gel electrophoresis (PFGE) and spa-typing revealed high genetic similarity among all MRSA isolates and with the PFGE pattern of the well-described ST80 clone that seems to be spreading through Europe. The high prevalence of MRSA among S. aureus infections in the community signify that empiric therapy in Greece, when clinically indicated, should exclude β-lactam antibiotics. Moreover, the establishment of an active screening for PVL-positive community-acquired (CA)-MRSA carriage and the adoption of a search and destroy strategy for CA-MRSA in all patients admitted with purulent skin and soft-tissue is of high priority in Greece as well as in all European countries which face high rates of CA-MRSA infection.

Variable-Number Tandem Repeat Analysis and Multilocus Sequence Typing Data Confirm the Epidemiological Changes Observed with Staphylococcus aureus Strains Isolated from Bloodstream Infections

“…This suggests that the current emergence of luk-positive strains in France is not associated with an epidemic spread such as that reported in Greece (28). In contrast, three of the five tst-positive MRSA strains identified in 2007 to 2008 were all ST8-IV-agr1 and shared similar PFGE patterns, suggesting the installation of these strains at a regional level.…”

Distribution of the Most Prevalent Spa Types among Clinical Isolates of Methicillin-Resistant and -Susceptible Staphylococcus aureus around the World: A Review

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Could chloramphenicol be used against ESKAPE pathogens? A review ofin vitrodata in the literature from the 21st century

“…It is probable that Klebsiella strains with MDR phenotype carry the co-presence of chloramphenicol resistance determinants (e.g., cat genes) with other resistance determinants in transposons on plasmids [90]. [12] 2002 Serbia 44 E. faecium KB 2% VR 73 [13] 2002 Brazil 23 E. faecium E-test Broth-MD 100% VR 78 [14] 2002 UK 54 E. faecium Broth-MD 57.4% VR 55 † [15] 2002 Colombia 23 E. faecium VITEK system 100% VR 100 [16] 2003 NA 616 E. faecium Broth-MD 100% VR 99.7 [17] 2003 NA 1997 (Y): 214 E. faecium VITEK system Broth-MD 43% VR 90 [18] 1998 ( [54] 2008 Korea 16 MicroScan 100 [55] 2009 Nepal 63 KB 92 [56] 2009 Pakistan 42 KB 67 [57] 2009 Greece 27 § KB 100 [58] 2009 China 129 Agar dilution 99 [ …”