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Clinical and molecular epidemiology of ciprofloxacin-susceptible MRSA encoding PVL in England and Wales

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Abstract

We aimed to enhance our case ascertainment of meticillin-resistant Staphylococcus aureus encoding Panton-Valentine leucocidin (PVL-MRSA), determine the patient demographic, risk factor and disease associations, and define the clonal diversity amongst isolates referred to the UK Health Protection Agency’s Staphylococcus Reference Unit. PVL-MRSA collected during 2005–6 from community-based and hospitalised patients located across England and Wales were identified by polymerase chain reaction (PCR). Representative geographically and temporally unrelated isolates were characterised via toxin gene profiling, SCCmec, spa and agr typing, multilocus sequence typing (MLST) and minimum inhibitory concentration (MIC) determinations. PVL-MRSA were identified from 275 patients. Affected individuals were <1 to 95 years of age (mean 30, median 27 years). Forty-five isolates were from 18 household or community-based clusters and 23 isolates were from outbreaks in healthcare settings. Overall, 58% (n = 161) had skin and soft tissue infections and 9% (n = 25) presented with or developed more serious disease, including eight patients (3%) with necrotising pneumonia, five of whom subsequently died. PVL-MRSA were genetically diverse and harboured SCCmecIV or VT/VII. Representatives of MLST clonal complexes (CCs) 8, 30 and 80 were identified the most often. The 275 PVL-MRSA included internationally disseminated community-associated MRSA (CA-MRSA) strains, as well as other minor lineages, and were associated with typical risk factors and disease presentations.

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Acknowledgements

The authors would like to thank the microbiologists and HPUs across England and Wales. Additional thanks go to Clare Martin for providing database support and Marjorie Ganner for providing data entry and technical assistance.

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Authors and Affiliations

  1. Laboratory of Healthcare Associated Infections, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom

    M. J. Ellington, C. Perry, M. Ganner, I. McCormick Smith, S. Sabersheikh, A. Holmes, B. D. Cookson & A. M. Kearns

  2. Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom

    M. Warner & R. L. Hill

  3. Department of Primary Care & Population Sciences, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom

    L. Shallcross

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  1. M. J. Ellington
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Correspondence to M. J. Ellington.

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Ellington, M.J., Perry, C., Ganner, M. et al. Clinical and molecular epidemiology of ciprofloxacin-susceptible MRSA encoding PVL in England and Wales. Eur J Clin Microbiol Infect Dis 28, 1113–1121 (2009). https://doi.org/10.1007/s10096-009-0757-x

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