Import and Spread of Panton-Valentine Leukocidin–Positive Staphylococcus aureus Through Nasal Carriage and Skin Infections in Travelers Returning From the Tropics and Subtropics

Zanger, Philipp; Nurjadi, Dennis; Schleucher, Regina; Scherbaum, Helmut; Wolz, Christiane; Kremsner, Peter G.; Schulte, Berit

doi:10.1093/cid/cir822

Cited by 77 publications

(51 citation statements)

References 55 publications

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“…This is of outmost importance, not only for patients in Gabon but also for travelers returning from the tropics which have acquired infections in the visited country [22]. Our study provides the basis for future prospective studies for instance on invasive infections and clearly points out the need for a more rational use of antibiotic agents paired with improved education of health care workers on the use of anti-infective drugs as part of antibiotic stewardship programs.…”

Section: Discussionmentioning

confidence: 81%

Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

et al. 2013

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BackgroundPhysicians depend on reliable information on the local epidemiology of infection and antibiotic resistance rates to guide empiric treatment in critically ill patients. As these data are scarce for Central Africa, we performed a retrospective analysis of microbiological findings from a secondary care hospital in Gabon.MethodsMicrobiological reports from 2009 to 2012 were used to assess the non-susceptibility rates of the three most common isolates from six major types of infections (bloodstream, ear-eye-nose-throat, surgical site, skin and soft tissue, urinary tract and wound infection).ResultsA high diversity of pathogens was found, but Staphylococcus aureus was predominant in the majority of infections. Overall, the three most prevalent pathogens in children were S. aureus (33.7%), Streptococcus pyogenes (8.1%) and Escherichia coli (4.5%) and in adults S. aureus (23.5%), E. coli (15.1%) and Klebsiella pneumoniae (7.4%). In total, 5.8% (n = 19) of all S. aureus isolates were methicillin resistant. The proportion of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae was 15.4% (n = 78), 49.4% of all K. pneumoniae were ESBL-producer (n = 42).ConclusionThe high diversity of potential pathogens and high resistance rates in Gram-negative bacteria challenge a rational empiric use of antibiotics. Countrywide continuous sentinel surveillance is therefore urgently needed.

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Section: Discussionmentioning

confidence: 81%

Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

et al. 2013

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“…This study presents evidence of a parallel spread of the European CA-MRSA lineage to most areas of present-day distribution soon after the successful dominant clone emerged. The lack of phylogeographic signal is likely the result of extensive human travel activities within Europe and through immigration from primarily North Africa and the Middle East into Europe (24, 25, 83). Put together, both phenomena shaped the dispersal pattern of the CA-MRSA clone.…”

Section: Discussionmentioning

confidence: 99%

Origin and Evolution of European Community-Acquired Methicillin-Resistant Staphylococcus aureus

Stegger

Wirth

Andersen

et al. 2014

mBio

105

118

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Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) was recognized in Europe and worldwide in the late 1990s. Within a decade, several genetically and geographically distinct CA-MRSA lineages carrying the small SCCmec type IV and V genetic elements and the Panton-Valentine leukocidin (PVL) emerged around the world. In Europe, the predominant CA-MRSA strain belongs to clonal complex 80 (CC80) and is resistant to kanamycin/amikacin and fusidic acid. CC80 was first reported in 1993 but was relatively rare until the late 1990s. It has since been identified throughout North Africa, the Middle East, and Europe, with recent sporadic reports in sub-Saharan Africa. While strongly associated with skin and soft tissue infections, it is rarely found among asymptomatic carriers. Methicillin-sensitive S. aureus (MSSA) CC80 strains are extremely rare except in sub-Saharan Africa. In the current study, we applied whole-genome sequencing to a global collection of both MSSA and MRSA CC80 isolates. Phylogenetic analyses strongly suggest that the European epidemic CA-MRSA lineage is derived from a PVL-positive MSSA ancestor from sub-Saharan Africa. Moreover, the tree topology suggests a single acquisition of both the SCCmec element and a plasmid encoding the fusidic acid resistance determinant. Four canonical SNPs distinguish the derived CA-MRSA lineage and include a nonsynonymous mutation in accessory gene regulator C (agrC). These changes were associated with a star-like expansion into Europe, the Middle East, and North Africa in the early 1990s, including multiple cases of cross-continent imports likely driven by human migrations.

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“…Evidence further suggests that colonization with MRSA or strains harboring virulence genes imposes a significantly greater risk for the development of subsequent infections than does colonization with MSSA (31). The enhanced virulence of CA-MRSA has been well recognized, and the underlying mechanism has gradually been revealed over the past few years (32)(33)(34)(35). Although our data also suggest a greater virulence potential for MRSA strains, we were unable to draw any definite conclusion on autoinfections of the carried S. aureus strains due to the limited cases with subsequent infections, and because no responsible pathogen was isolated from the diseased subjects.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Carriage in Healthy Adolescents

et al. 2013

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bTo determine the long-term carriage patterns, strain relatedness, and incidence of subsequent infections among methicillinresistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) carriers, we screened 154 high school students for nasal carriage of S. aureus on 8 occasions over 11 months. Persistent carriage was defined as a positive culture on >7 occasions. Two consecutive isolates from the same subject comprised a pair, and strain relatedness was determined for each pair by molecular typing.

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Import and Spread of Panton-Valentine Leukocidin–Positive Staphylococcus aureus Through Nasal Carriage and Skin Infections in Travelers Returning From the Tropics and Subtropics

Cited by 77 publications

References 55 publications

Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

Origin and Evolution of European Community-Acquired Methicillin-Resistant Staphylococcus aureus

Longitudinal Analysis of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Carriage in Healthy Adolescents

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