Emergence of Panton-Valentine leucocidin-positive ST8-methicillin-resistant Staphylococcus aureus (USA300 clone) in Korea causing healthcare-associated and hospital-acquired bacteraemia

• Published in: European journal of clinical microbiology & infectious diseases Vol. 35; no. 8; pp. 1323 - 1329
• Main Authors: Jung, J., Song, E. H., Park, S. Y., Lee, S.-R., Park, S.-J., Sung, H., Kim, M.-N., Kim, S.-H., Lee, S.-O., Choi, S.-H., Woo, J. H., Kim, Y. S., Chong, Y. P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2016; Springer Nature B.V
• Subjects: Antimicrobial agents; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial Toxins; Biomedical and Life Sciences; Biomedicine; Cloning; Cohort analysis; Communicable Diseases, Emerging - epidemiology; Communicable Diseases, Emerging - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Disease Outbreaks - statistics & numerical data; Epidemics; Exotoxins; Health care; Hospitals; Humans; Incidence; Infectious diseases; Internal Medicine; Leukocidins; Medical Microbiology; Medical schools; Medicine; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Methicillin-Resistant Staphylococcus aureus - pathogenicity; Original Article; Patients; Pneumonia; Prevalence; Prospective Studies; Public health; Republic of Korea - epidemiology; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus aureus; Staphylococcus infections; United States > US; South Korea; Virulence Gene Profile; Medical Review Ethic Committee; SCCmec Type; Arginine Catabolic Mobile Element; USA300 Clone
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-016-2668-y

Panton-Valentine leucocidin (PVL)-positive sequence type (ST)8-MRSA-SCC mec IVa (USA300) is the epidemic strain of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in North America. USA300 is extremely rare in South Korea, and PVL-negative ST72 SCC mec type IVc is the predominant CA-MRSA clone. In a multicentre, prospective cohort study of S. aureus bacteraemia, we identified PVL-positive ST8-MRSA isolates by performing multilocus sequence typing and PCR for PVL. We analyzed the clinical characteristics of patients with PVL-positive ST8-MRSA bacteraemia, and performed SCC mec , spa , and agr typing, PCR for arginine catabolic mobile element (ACME), virulence gene profiling, and pulsed-field gel electrophoresis (PFGE). Among a total of 818 MRSA isolates, we identified ten isolates of PVL-positive ST8-MRSA (USA300) (3 from Hospital D, 4 from Hospital G, and 3 from Hospital A), all of which involved exclusively healthcare-associated (5 isolates) and hospital-acquired bacteraemia (5 isolates). This strain accounted for 8~10 % of the hospital-acquired MRSA bacteraemia in Hospitals D and G. Bacteraemia of unknown origin was the most common type of infection followed by pneumonia. All the isolates were SCC mec type IVa, spa type t008, and agr group I. Eight of the isolates harboured ACME. In a PFGE analysis, four isolates were identical to the USA300 control strain, five differed by a single band, and the remaining one differed by two bands. All the isolates were pulsed-field type USA300. This is the first report of healthcare-associated and hospital-acquired bacteraemia caused by USA300 in South Korea. USA300 seems to be an emerging hospital clone in this country.