Transmission of a Panton-Valentine Leucocidin-Positive, Methicillin-Resistant Staphylococcus aureus Strain between Humans and a Dog

Abstract

Panton-Valentine leucocidin-positive methicillin-resistant Staphylococcus aureus (MRSA) strains with identical resistance patterns were cultured from recurrent infections of a 51-year-old patient, her healthy husband, son, and dog, and pulsed-field gel electrophoresis showed that all MRSA strains were indistinguishable. CASE REPORTIn 2002, a 51-year-old female patient with a diabetic foot was admitted to the surgical ward of a Dutch teaching hospital in the province Overijssel. Cultures were taken from the ulcer at admission, and a methicillin-resistant Staphylococcus aureus (MRSA) strain, resistant to fusidic acid and tetracyclines but susceptible to macrolides, trimethoprim-sulfamethoxazole, quinolones, rifampin, and aminoglycosides was cultured, while cultures from nose, throat, and perineum did not grow MRSA. The patient was treated successfully with trimethoprim-sulfamethoxazole. Two months later the patient was screened for the MRSA carrier state, and a sample from her throat was culture positive for an MRSA strain with the same resistance pattern, while nostril, perineum, and wound cultures were MRSA negative. She developed a urinary tract infection with a positive MRSA culture again 4 months after the initial treatment. Therapy with ciprofloxacin and rifampin was started, after which the MRSA infection was eradicated for half a year, based on monthly negative cultures of urine, nostrils, throat, wound, and perineum. However, the final screening for carrier state after this half-year revealed an MRSA strain again in cultures from the nose, throat, and perineum. After these findings a source of the recurrent MRSA carrier state was suspected at her home. Samples were taken from the nose and throat of the patient's husband (57 years old), son (25 years old), and their dog, a German Shepherd, who were all clinically healthy. The samples from the throat of the husband and from the nose of the son and dog were culture positive for MRSA. In a last effort to eradicate the patient's MRSA infection, all family members (including the dog) were treated simultaneously with ciprofloxacin and rifampin. This last treatment eradicated the MRSA carrier state of all persons and the dog. Follow-up cultures of nostrils, throat, and perineum of all persons and the dog were taken for 6 months, and all cultures remained negative.All isolates were sent to the National Institute of Public Health and the Environment (RIVM) for identification and genotyping by pulsed-field gel electrophoresis (PFGE). The staphylococci isolated from the patient (isolates from the ulcer, throat, and urine), her husband and son, and the dog were all identified as S. aureus by conventional methods, Vitek 2 (BioMérieux, Marcy-l'Étoile, France) and Martineau PCR (8). Susceptibility testing was performed using the Vitek 2 assay according to the manufacturer's instructions. All isolates had the same resistance pattern: they were resistant to all beta-lactams, fusidic acid, and tetracycline and were susceptible to aminoglycosides, fluoroquinolones, erythromy...

Presence, Distribution, and Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureusin a Small Animal Teaching Hospital: A Year-Long Active Surveillance Targeting Dogs and Their Environment

“…Several studies have implicated hospital surfaces contaminated with nosocomial pathogens, including MRSA, in the dissemination of hospital-acquired infections (Rampling et al 2001, Schultsz et al 2003, Hota 2004, Kramer et al 2006, Sexton et al 2006, Boyce 2007, Weber et al 2010, Otter et al 2011. Paralleling these are reports of the increasing role of MRSA in nosocomial infections in veterinary settings (Seguin et al 1999, Leonard, et al 2006, Weese et al 2007, Benedict et al 2008, McLean and Ness 2008, van Duijkeren et al 2010. A recent study of veterinary teaching hospitals accredited by the American Veterinary Medicine Association (AVMA) found that MRSA was the second most common pathogen (13/31, 42%) associated with nosocomial outbreaks (Benedict et al 2008).…”

Potential Role of Pet Animals in Household Transmission of Methicillin-Resistant Staphylococcus aureus: A Narrative Review

“…Rifampin was used effectively in conjunction with ciprofloxacin (van Duijkeren et al 2005, Sing et al 2008) and doxycycline (van Duijkeren et al 2004) with subsequent negative nares cultures for the pet animal. The ciprofloxacin/ rifampin combination appeared to be effective in curbing further human infection in case of a colonized cat and dog (van Duijkeren et al 2005, Sing et al 2008, although the cat was not resampled to confirm clearance of MRSA (Sing et al 2008). In one case (Manian 2003), 5% vancomycin ointment was used in the nares of both infected humans and the colonized dog, but complications resulted before all subjects were free of colonization and infection.…”

CA-MRSA: Epidemiology of a Pathogen of a Great Concern

“…Everyone was treated with rifampicin and ciprofloxacin. After six months of treatment, no new samples were recovered in the tests for detection of CA-MRSA among the family members and the dog (Van Duijkeren et al, 2005).…”

“…Cases of S. aureus with intermediate resistance to vancomycin (VISA) in addition to presenting heteroresistance are increasingly common in health centers where MRSA infections are treated with vancomycin (Trakulsomboon et al, 2001;Van Duijkeren et al, 2005;Kim et al, 2000).…”

“…There is transmission of CA-MRSA between humans and animals, and these strains may carry genes codifying for Panton-Valentine Leukocidin (PVL) (Rutland et al, 2009;Van Duijkeren et al, 2005). A diabetic patient first diagnosed with cellulitis in the bicep region in December 2007 was positive for S. aureus in February 2008 from ankle biopsies and of nasal swab cultures; both isolates had the same profile of resistance to trimethoprim/ sulfamethoxazole, clindamycin, erythromycin, tetracycline and ciprofloxacin, and were, therefore, treated both times with vancomycin .…”