Dewi Santosaningsih, Sanarto Santoso, Nanik Setijowati, Harun A. Rasyid, Nyoman S. Budayanti, Ketut Suata, Dicky B. Widhyatmoko, Priyo B. Purwono, Kuntaman Kuntaman, Damayanti Damayanti, Cita R. S. Prakoeswa, Mitchell Laurens, Josephine W. I. van Nierop, Geraldine L. Nanninga, Neline Oudenes, Michelle de Regt, Susan V. Snijders, Henri A. Verbrugh, Juliëtte A. Severin
Objectives: To define the role of Staphylococcus aureus in community settings among patients with skin and soft tissue infections (SSTI) in Indonesia. Methods: Staphylococcus 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. Results: Staphylococcus 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. Conclusions: Community-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. © 2017 John Wiley & Sons Ltd
Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia; Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Public Health, Faculty of Medicine, Brawijaya University, Malang, Indonesia; Department of Microbiology, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Indonesia; Department of Microbiology, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia; Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia; BaseClear BV, Leiden, Netherlands; Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
