Prevalence and characterisation of Staphylococcus aureus causing community‐acquired skin and soft tissue infections on Java and Bali, Indonesia

• Published in: Tropical medicine & international health 2018-01, Vol.23 (1), p.34-44
• Main Authors: Santosaningsih, Dewi, Santoso, Sanarto, Setijowati, Nanik, Rasyid, Harun A., Budayanti, Nyoman S., Suata, Ketut, Widhyatmoko, Dicky B., Purwono, Priyo B., Kuntaman, Kuntaman, Damayanti, Damayanti, Prakoeswa, Cita R. S., Laurens, Mitchell, Nierop, Josephine W. I., Nanninga, Geraldine L., Oudenes, Neline, Regt, Michelle, Snijders, Susan V., Verbrugh, Henri A., Severin, Juliëtte A.
• Format: Article
• Language: English
• Subjects: Antibiotics; Communities; Community; Drug resistance; exfoliative toxin; Genes; Gram-positive bacteria; Indonesia; Indonésie; Infections; infections de la peau et des tissus mous; leucocidine de Panton‐Valentine; Leukocidin; MecA protein; Methicillin; methicillin‐resistant Staphylococcus aureus; Multilocus sequence typing; Nucleotide sequence; Panton–Valentine leukocidin; Patients; Penicillin; Pharynx; SAMR; Skin; skin and soft tissue infections; Staphylococcus aureus; Staphylococcus infections; Tissues; toxine exfoliative; Wounds
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13000

Objectives To define the role of Staphylococcus aureus in community settings among patients with skin and soft tissue infections (SSTI) in Indonesia. Methods Staphylococcus aureus were cultured from anterior nares, throat and wounds of 567 ambulatory patients presenting with SSTI. The mecA gene and genes encoding Panton–Valentine leukocidin (PVL; lukF‐PV and lukS‐PV) and exfoliative toxin (ET; eta and etb) were determined by PCR. Clonal relatedness among methicillin‐resistant S. aureus (MRSA) and PVL‐positive S. aureus was analysed using multilocus variable‐number tandem‐repeat analysis (MLVA) typing, and multilocus sequence typing (MLST) for a subset of isolates. Staphylococcal cassette chromosome mec (SCCmec) was determined for all MRSA isolates. Moreover, determinants for S. aureus SSTI, and PVL/ET‐positive vs PVL/ET‐negative S. aureus were assessed. Results Staphylococcus aureus were isolated from SSTI wounds of 257 (45.3%) patients, eight (3.1%) of these were MRSA. Genes encoding PVL and ETs were detected in 21.8% and 17.5% of methicillin‐susceptible S. aureus (MSSA), respectively. PVL‐positive MRSA was not detected. Nasopharyngeal S. aureus carriage was an independent determinant for S. aureus SSTI (odds ratio [OR] 1.8). Primary skin infection (OR 5.4) and previous antibiotic therapy (OR 3.5) were associated with PVL‐positive MSSA. Primary skin infection (OR 2.2) was the only factor associated with ET‐positive MSSA. MLVA typing revealed two more prevalent MSSA clusters. One ST1‐MRSA‐SCCmec type IV isolate and a cluster of ST239‐MRSA‐SCCmec type III were found. Conclusions Community‐acquired SSTI in Indonesia was frequently caused by PVL‐positive MSSA, and the hospital‐associated ST239‐MRSA may have spread from the hospital into the community. Objectifs Définir le rôle de Staphylococcus aureus en milieu communautaire chez les patients atteints d'infections de la peau et des tissus mous (IPTM) en Indonésie. Méthodes S. aureus a été cultivé à partir des narines, de la gorge et des plaies de 567 patients ambulatoires présentant une IPTM. Le gène mecA et les gènes codant pour la leucocidine de Panton‐Valentine (PVL, lukF‐PV et lukS‐PV) et la toxine exfoliative (ET; eta et etb) ont été déterminés par PCR. La parenté clonale entre S. aureus résistant à la méthicilline (SARM) et S. aureus PVL‐positif a été analysée en utilisant un typage MLVA (Multilocus Variable‐Number Tandem‐Repeat Analysis) et un typage multilocus (MLST) pour un sous‐ensemble d'isolats. L