Clinical outcomes and treatment approach for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in Israel

  • E. Berla-Kerzhner
  • A. Biber
  • M. Parizade
  • D. Taran
  • G. Rahav
  • G. Regev-Yochay
  • D. GlikmanEmail author
Original Article


Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly documented worldwide. We recently identified two major CA-MRSA clones in Israel: USA300 and t991. Here, we assessed clinical outcomes by CA-MRSA clones and the physicians’ treatment approach to CA-MRSA infections. All community-onset, clinical MRSA isolates detected during 2011–2013 by Maccabi Healthcare Services were collected and characterized phenotypically and genotypically; data were collected retrospectively from electronic medical records. Of 309 patients with MRSA infections, 64 were identified as CA-MRSA (21 %). Of the CA-MRSA infections, 72 % had skin and soft tissue infections (SSTIs), 38 % were Panton–Valentine leukocidin (PVL)+, the major clone being USA300 (n = 13, 54 %). Of PVL− isolates (n = 40, 62 %), t991 was the major clone. Age was the only predictor for PVL+ CA-MRSA infection (p < 0.001). Patients with PVL+ CA-MRSA had higher incidence of SSTI recurrences (1.061 vs. 0.647 events per patient/per year, p < 0.0001) and were more likely to have the SSTI drained (64 % vs. 21 %, p = 0.003) when compared to PVL− CA-MRSA. USA300 was more common among adults, while t991 was more common among children (p = 0.002). The physician’s referral to culture results and susceptibility were the only predictors of appropriate antibiotic therapy (p < 0.001). However, only a minority of physicians referred to culture results, regardless of subspecialties. PVL+ CA-MRSA isolates caused significantly more recurrences of SSTIs and increased the need for drainage compared with PVL− isolates. Physicians’ awareness of CA-MRSA as a cause of SSTIs in the community was suboptimal. Culturing of pus-producing SSTIs is crucial for providing adequate antimicrobials and elucidating MRSA epidemiology.


Fusidic Acid Impetigo Maccabi Healthcare Service Major Clone Arginine Catabolic Mobile Element 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Hanaa Jaber for laboratory assistance, Tali Bdolah-Abram and Carmit Rubin for statistical analyses, and Dana Elhadad for reviewing the paper.

Compliance with ethical standards


This study was supported by grant number 3-7599 from the Chief Scientist Office of the Israeli Ministry of Health.

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Institutional Review Boards of the Sheba Medical Center, Galilee Medical Center, and Maccabi Healthcare Services.

Informed consent

Since no identifying data of patients were recorded and the nature of the study was retrospective from electronic medical charts, the Institutional Review Boards gave permission to waiver informed consent from patients.

Supplementary material

10096_2016_2789_MOESM1_ESM.doc (76 kb)
ESM 1 (DOC 76.0 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • E. Berla-Kerzhner
    • 1
  • A. Biber
    • 2
  • M. Parizade
    • 3
  • D. Taran
    • 3
  • G. Rahav
    • 2
  • G. Regev-Yochay
    • 2
    • 4
  • D. Glikman
    • 5
    • 6
    Email author
  1. 1.Hebrew UniversityJerusalemIsrael
  2. 2.Sheba Medical CenterRamat GanIsrael
  3. 3.Maccabi Healthcare ServicesRehovotIsrael
  4. 4.Gertner InstituteRamat GanIsrael
  5. 5.Pediatric Infectious Diseases ServiceGalilee Medical CenterNahariyaIsrael
  6. 6.The Faculty of Medicine in the GalileeBar-Ilan UniversitySafedIsrael

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