Kyoung-Ho Song1,2, Eu Suk Kim1,2, Kyung-Hwa Park3, Hee Jung Choi4, Kye-Hyung Kim5, Shinwon Lee6, Jeong-Hwan Hwang7, Eun Ju Choo8, Yoonseon Park9, Eun Jung Lee10, Young Keun Kim11, Min Hyok Jeon12, Chisook Moon13, Joo-Hee Hwang1,2, Jeong Su Park14, Kyoung Un Park14, Pyoeng Gyun Choe2, Ji Hwan Bang2,15, Myoung-Don Oh2, Hong Bin Kim1,2. 1. 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea. 2. 2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea. 3. 3 Department of Infectious Diseases, Chonnam National University Medical School , Gwangju, Republic of Korea. 4. 4 Department of Internal Medicine, School of Medicine, Ewha Womans University , Seoul, Republic of Korea. 5. 5 Department of Internal Medicine, Pusan National University School of Medicine , Busan, Republic of Korea. 6. 6 Department of Internal Medicine, Daegu Fatima Hospital , Daegu, Republic of Korea. 7. 7 Department of Internal Medicine, Chonbuk National University Medical School , Jeonju, Republic of Korea. 8. 8 Department of Internal Medicine, Soonchunhyang University Bucheon Hospital , Bucheon, Republic of Korea. 9. 9 Department of Internal Medicine, National Health Insurance Service Ilsan Hospital , Goyang, Republic of Korea. 10. 10 Department of Internal Medicine, Soonchunhyang University Seoul Hospital , Seoul, Republic of Korea. 11. 11 Department of Internal Medicine, Yonsei University Wonju College of Medicine , Wonju, Republic of Korea. 12. 12 Department of Internal Medicine, Soonchunhyang University Cheonan Hospital , Cheonan, Republic of Korea. 13. 13 Department of Internal Medicine, Inje University College of Medicine , Busan, Republic of Korea. 14. 14 Department of Laboratory Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea. 15. 15 Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center , Seoul, Republic of Korea.
Abstract
AIM: Panton-Valentine leukocidin (PVL) is a virulent cytotoxin and an indicator of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. In this study, we evaluated the prevalence and clinical and molecular characteristics of PVL-positive invasive S. aureus (ISA) infections in Korea. RESULTS: A collection of 1,962 nonduplicate clinical isolates were screened for multilocus sequence typing, staphylococcal cassette chromosome mec (SCCmec), accessory gene regulator typing, major toxins, and antimicrobial susceptibility. Twenty-eight (1.4%) PVL-positive S. aureus samples were found; of them 19 (67.9%) were MRSA (8 CA and 11 healthcare-associated infections). Seventeen patients (60.7%) were men (median age: 63 years; range: 13-93 years) and 12 patients (42.9%) had no underlying comorbidities. The most common infections were skin and skin structure infection (SSSI) and pneumonia. The 30-day mortality rate was 37.0%. The most common PVL-positive MRSA clones were ST8-SCCmec IVa and ST30-SCCmec IVc along with their single-locus variants. Antimicrobial susceptibility and toxin-gene profile differed according to the clone. CONCLUSIONS: ISA infections caused by PVL-positive strains are rare in Korea, with the two most common infections being SSSI and pneumonia. Our findings indicated that several PVL-positive MRSA clones, predominantly ST8-SCCmecIVa and ST30-SCCmecIVc, were circulating and causing sporadic cases of ISA infections in the community and hospital settings.
AIM: Panton-Valentine leukocidin (PVL) is a virulent cytotoxin and an indicator of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. In this study, we evaluated the prevalence and clinical and molecular characteristics of PVL-positive invasive S. aureus (ISA) infections in Korea. RESULTS: A collection of 1,962 nonduplicate clinical isolates were screened for multilocus sequence typing, staphylococcal cassette chromosome mec (SCCmec), accessory gene regulator typing, major toxins, and antimicrobial susceptibility. Twenty-eight (1.4%) PVL-positive S. aureus samples were found; of them 19 (67.9%) were MRSA (8 CA and 11 healthcare-associated infections). Seventeen patients (60.7%) were men (median age: 63 years; range: 13-93 years) and 12 patients (42.9%) had no underlying comorbidities. The most common infections were skin and skin structure infection (SSSI) and pneumonia. The 30-day mortality rate was 37.0%. The most common PVL-positive MRSA clones were ST8-SCCmec IVa and ST30-SCCmec IVc along with their single-locus variants. Antimicrobial susceptibility and toxin-gene profile differed according to the clone. CONCLUSIONS: ISA infections caused by PVL-positive strains are rare in Korea, with the two most common infections being SSSI and pneumonia. Our findings indicated that several PVL-positive MRSA clones, predominantly ST8-SCCmecIVa and ST30-SCCmecIVc, were circulating and causing sporadic cases of ISA infections in the community and hospital settings.