Community-Onset Methicillin-Resistant Staphylococcus aureus Associated with Antibiotic Use and the Cytotoxin Panton-Valentine Leukocidin during a Furunculosis Outbreak in Rural Alaska
Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PV...
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| Published in | The Journal of infectious diseases Vol. 189; no. 9; pp. 1565 - 1573 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Chicago, IL
University Chicago Press
01.05.2004
University of Chicago Press Oxford University Press |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0022-1899 1537-6613 |
| DOI | 10.1086/383247 |
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| Abstract | Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region. Methods. We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE). Results. Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7–12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE. Conclusion. Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. |
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| AbstractList | Background.
Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region.
Methods.
We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE).
Results.
Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE.
Conclusion.
Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. Duting a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region. Methods. We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, ans isolate relatedness was determined by use of pulsed-field gel electrophoresis (FGE). Results. Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P = .01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 17-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE. Conclusion. Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region. Methods. We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE). Results. Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7–12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE. Conclusion. Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region.BACKGROUNDCommunity-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region.We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE).METHODSWe conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE).Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE.RESULTSCase patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE.Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska.CONCLUSIONSelective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region. We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE). Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P = .01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P < .001). The majority of MRSA isolates were closely related by PFGE. Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region. We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE). Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE. Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska. |
| Author | Bruden, Dana Mongkolrattanothai, Kanokporn Sparks, Rachel Rudolph, Karen Butler, Jay C. Hennessy, Thomas W. Parkinson, Alan Donlan, Rodney M. Reasonover, Alisa Baggett, Henry C. Martinez, Patricia |
| Author_xml | – sequence: 1 givenname: Henry C. surname: Baggett fullname: Baggett, Henry C. organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 2 givenname: Thomas W. surname: Hennessy fullname: Hennessy, Thomas W. email: thennessy@cdc.gov organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 3 givenname: Karen surname: Rudolph fullname: Rudolph, Karen organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 4 givenname: Dana surname: Bruden fullname: Bruden, Dana organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 5 givenname: Alisa surname: Reasonover fullname: Reasonover, Alisa organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 6 givenname: Alan surname: Parkinson fullname: Parkinson, Alan organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 7 givenname: Rachel surname: Sparks fullname: Sparks, Rachel organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska – sequence: 8 givenname: Rodney M. surname: Donlan fullname: Donlan, Rodney M. organization: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 9 givenname: Patricia surname: Martinez fullname: Martinez, Patricia organization: Yukon-Kuskokwim Health Corporation, Bethel, Alaska – sequence: 10 givenname: Kanokporn surname: Mongkolrattanothai fullname: Mongkolrattanothai, Kanokporn organization: Section of Pediatric Infectious Diseases, University of Chicago, Illinois – sequence: 11 givenname: Jay C. surname: Butler fullname: Butler, Jay C. organization: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage,, Bethel, Alaska |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15806200$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/15116291$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright 2004 Infectious Diseases Society of America 2004 by the Infectious Diseases Society of America 2004 2004 INIST-CNRS Copyright University of Chicago, acting through its Press May 1 2004 |
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| Issue | 9 |
| Keywords | Skin disease Microbiology Furunculosis Meticillin Infection Resistance Antibiotic Bacteriosis Bacteria Micrococcales Micrococcaceae Antibacterial agent Staphylococcal infection Staphylococcus aureus |
| Language | English |
| License | CC BY 4.0 |
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| Notes | Present affilation: Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia. istex:96D57E1C727AB7F06ECC621870EE79BF81EFA2E7 ark:/67375/HXZ-9BHTN629-S ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 |
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| PublicationTitle | The Journal of infectious diseases |
| PublicationTitleAbbrev | The Journal of Infectious Diseases |
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| PublicationYear | 2004 |
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| Snippet | Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a... Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. Duting a... Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a... Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin... BACKGROUND: Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a... |
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| SubjectTerms | Adolescent Adult Alaska - epidemiology Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotics Bacteria Bacterial Toxins Bacteriology Biological and medical sciences Case-Control Studies Child Child, Preschool Community-Acquired Infections - epidemiology Community-Acquired Infections - microbiology Disease Outbreaks Epidemiology Exotoxins - metabolism Female Fundamental and applied biological sciences. Psychology Furunculosis Furunculosis - epidemiology Furunculosis - microbiology Humans Infant Infant, Newborn Infections Infectious diseases Leukocidins - genetics Leukocidins - metabolism Male Medical sciences Methicillin - pharmacology Methicillin - therapeutic use Methicillin Resistance Methicillin resistant staphylococcus aureus Microbiology Miscellaneous Population Surveillance Predisposing factors Risk Factors Rural Population Staphylococcus aureus Staphylococcus aureus - drug effects Staphylococcus aureus - genetics Staphylococcus aureus - metabolism Surveillance |
| Title | Community-Onset Methicillin-Resistant Staphylococcus aureus Associated with Antibiotic Use and the Cytotoxin Panton-Valentine Leukocidin during a Furunculosis Outbreak in Rural Alaska |
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