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

ObjectivesTo define the role of Staphylococcus aureus in community settings among patients with skin and soft tissue infections (SSTI) in Indonesia. MethodsStaphylococcus 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. ResultsStaphylococcus 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. ConclusionsCommunity-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. ObjectifsDefinir le role de Staphylococcus aureus en milieu communautaire chez les patients atteints d'infections de la peau et des tissus mous (IPTM) en Indonesie. MethodesS. aureus a ete cultive a partir des narines, de la gorge et des plaies de 567 patients ambulatoires presentant une IPTM. Le gene mecA et les genes codant pour la leucocidine de Panton-Valentine (PVL, lukF-PV et lukS-PV) et la toxine exfoliative (ET; eta et etb) ont ete determines par PCR. La parente clonale entre S. aureus resistant a la methicilline (SARM) et S. aureus PVL-positif a ete analysee en utilisant un typage MLVA (Multilocus Variable-Number Tandem-Repeat Analysis) et un typage multilocus (MLST) pour un sous-ensemble d'isolats. La cassette mec du chromosome staphylococcique (SCCmec) a ete determinee pour tous les isolats de SARM. De plus, les determinants pour l'IPTM a S. aureus et pour S. aureus PVL/ET-positif versus PVL/ET-negatif ont ete evalues. ResultatsS. aureus a ete isole de plaies d'IPTM de 257 (45,3%) patients, dont huit (3,1%) etaient des SARM. Les genes codant pour la PVL et la ET ont ete detectes dans 21,8% et 17,5% des S. aureus sensibles a la methicilline (SASM), respectivement. Le SARM PVL-positif n'a pas ete detecte. Le portage rhinopharynge de S. aureus etait un determinant independant de l'IPTM a S. aureus (odds ratio [OR] 1,8). Une infection primaire de la peau (OR: 5,4) et une antibiotherapie anterieure (OR: 3,5) ont ete associees a un SASM PVL-positif. Une infection primaire de la peau (OR: 2.2) etait le seul facteur associe au SASM ET-positif. Le typage MLVA a revele deux regroupements de SASM plus repandus. Un isolat ST1-SARM-SCCmec de type IV et un regroupement ST239-MRSA-SCCmec de type III ont ete trouves. ConclusionsLes IPTM acquises dans la communaute en Indonesie etaient frequemment causees par SASM PVL-positif et le ST239-SARM associe a l'hopital pourrait s'etre propage de l'hopital vers la communaute.