PURPOSE: We investigated the clinical features and epidemiology of staphylococcal scalded skin syndrome (SSSS) from year 2006 to 2015 in Changwon city, Korea. METHODS: We reviewed medical records of 69 patients diagnosed with SSSS from year 2006 to 2015. Antibiotic susceptibility testing was performed by agar dilution method. Methicillin-resistant Staphylococcus aureus (MRSA) was phenotypically identified by oxacillin susceptibility testing and genotypically confirmed by the existence of the mecA gene. RESULTS: The median age of patients was 2.0 years (range 0.2–6 years). Three (4.3%), 53 (76.8%), and 13 (18.9%) patients showed the generalized type, the intermediate type, and the abortive type, respectively. Patients occurred throughout the year, but most patients occurred between July and October. MRSA was isolated from 54 of the 60 patients regardless of the clinical types. All patients recovered without any complications. CONCLUSIONS: There was a constant occurrence of SSSS patients caused by MRSA in Changwon area during 2006 and 2015. It is needed to constantly monitor the occurrence of patients with SSSS.
Agar ; Epidemiology ; Gyeongsangnam-do ; Humans ; Korea ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Methods ; Oxacillin ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

BACKGROUND: We evaluated the performance of the BD MAX StaphSR Assay (SR assay; BD, USA) for direct detection of Staphylococcus aureus and methicillin resistance not only in S. aureus but also in coagulase-negative Staphylococci (CNS) from positive blood cultures. METHODS: From 228 blood culture bottles, 103 S. aureus [45 methicillin-resistant S. aureus (MRSA), 55 methicillin-susceptible S. aureus (MSSA), 3 mixed infections (1 MRSA+Enterococcus faecalis, 1 MSSA+MRCNS, 1 MSSA+MSCNS)], and 125 CNS (102 MRCNS, 23 MSCNS) were identified by Vitek 2. For further analysis, we obtained the cycle threshold (Ct) values from the BD MAX system software to determine an appropriate cutoff value. For discrepancy analysis, conventional mecA/mecC PCR and oxacillin minimum inhibitory concentrations (MICs) were determined. RESULTS: Compared to Vitek 2, the SR assay identified all 103 S. aureus isolates correctly but failed to detect methicillin resistance in three MRSA isolates. All 55 MSSA isolates were correctly identified by the SR assay. In the concordant cases, the highest Ct values for nuc, mecA, and mec right-extremity junction (MREJ) were 25.6, 22, and 22.2, respectively. Therefore, we selected Ct values from 0-27 as a range of positivity, and applying this cutoff, the sensitivity/specificity of the SR assay were 100%/100% for detecting S. aureus, and 97.9%/98.1% and 99.0%/95.8% for detecting methicillin resistance in S. aureus and CNS, respectively. CONCLUSIONS: We propose a Ct cutoff value for nuc/mec assay without considering MREJ because mixed cultures of MSSA and MRCNS were very rare (0.4%) in the positive blood cultures.
Anti-Bacterial Agents/pharmacology ; Bacteremia/diagnosis/microbiology ; Coagulase/metabolism ; Humans ; Methicillin-Resistant Staphylococcus aureus/drug effects/genetics/*isolation & purification ; Microbial Sensitivity Tests ; Oxacillin/pharmacology ; Reagent Kits, Diagnostic ; Staphylococcus/drug effects/enzymology/genetics/isolation & purification ; Staphylococcus aureus/drug effects/genetics/*isolation & purification

PURPOSE: This study analyzed clinical characteristics of Staphylococcus aureus keratitis according to methicillin-resistance. METHODS: The authors performed a retrospective chart review of 46 isolates in 46 eyes with Staphylococcus aureus keratitis that were followed up for more than 2 months between January 1998 and December 2014. Comparative analyses of the epidemiology, predisposing factors, initial clinical manifestations, antibiotics susceptibility and clinical outcome between methicillin-resistant Staphylococcus aureus (MRSA) keratitis and methicillin-sensitive Staphylococcus aureus (MSSA) keratitis were performed. Risk factors of poor visual outcome were analyzed using logistic regression analysis. RESULTS: Among 46 eyes, MRSA was present in 15 eyes (33%) and MSSA in 31 eyes (67%). Male (61%) and older than 60 year-old group (48%) were common. Ocular surface disease/ocular surgery history and trauma were more common as a predisposing factor. Vancomycin was 100% sensitive to both the MRSA and MSSA groups. Antibiotics susceptibility to MRSA was significantly low in the oxacillin (0%), gentamicin (13.3%) and trimethoprim/sulfamethoxazole (53.3%) groups. Sensitivity to fluoroquinolone was 81.3% (MRSA 64.3% vs. MSSA 94.4%; p = 0.064). There were no differences in early corneal findings between the groups. The ratio of BCVA 0.5 or more was 24.4% initially and increased to 44.4% after treatment among all eyes (p = 0.046). Risk factors for poor visual outcomes included a BCVA less than 0.1 at initial evaluation (p = 0.033). CONCLUSIONS: Among eyes with Staphylococcus aureus keratitis, 33% were MRSA. The ratio of BCVA 0.5 or more increased after treatment among all eyes. There were no differences between MRSA and MSSA eyes in terms of epidemiology, predisposing factors, initial clinical manifestations or clinical outcome, except for antibiotic susceptibility. For positive patient outcomes, a treatment approach considering methicillin-resistance as well as various factors affecting clinical course is recommended.
Anti-Bacterial Agents ; Causality ; Epidemiology ; Gentamicins ; Humans ; Keratitis* ; Logistic Models ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Retrospective Studies ; Risk Factors ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin

BACKGROUND: Staphylococcus aureus is a well-known microbe that colonizes or infects the skin in atopic dermatitis (AD). The prevalence of methicillin-resistant S. aureus (MRSA) in AD has recently been increasing. OBJECTIVE: This study aimed to determine the antimicrobial susceptibility patterns in AD skin lesions and evaluate the prevalence of MRSA in Korea. We also recommend proper first-line topical antibiotics for Korean patients with AD. METHODS: We studied S. aureus-positive skin swabs (n=583) from the lesional skin of infants, children, and adults who presented to our outpatient clinic with AD from July 2009 to April 2012. RESULTS: S. aureus exhibited high susceptibility against most antimicrobial agents. However, it exhibited less susceptibility to benzylpenicillin, erythromycin, clindamycin, and fusidic acid. The prevalence of MRSA was 12.9% among 583 S. aureus isolates, and the susceptibility to oxacillin was significantly lower in infants in both acute and chronic AD lesions. CONCLUSION: S. aureus from AD has a high prevalence of MRSA and multidrug resistance, especially in infants. In addition, the rate of fusidic acid resistance is high among all age groups, and mupirocin resistance increases with age group regardless of lesional status. This is the first study comparing the antimicrobial susceptibility rates of S. aureus isolates from AD cases with respect to age and lesion status in Korea.
Adult ; Ambulatory Care Facilities ; Anti-Bacterial Agents ; Anti-Infective Agents ; Child ; Clindamycin ; Colon ; Dermatitis, Atopic* ; Drug Resistance, Multiple ; Erythromycin ; Fusidic Acid ; Humans ; Infant ; Korea* ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mupirocin ; Oxacillin ; Penicillin G ; Prevalence* ; Skin ; Staphylococcus aureus* ; Staphylococcus*

BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is an emerging health problem in pediatrics. Risk factors are not well established in children.
OBJECTIVE: To determine the risk factors for the development of methicillin-resistant Staphylococcus aureus infections arising in the community.
METHODOLOGY: A restrospective case-control study was performed from January 2004 to December 2011. Cases included patients who were culture positive for Staphylococcus aureus and resistant to methicillin/oxacillin while Control included patients who were sensitive to methicillin/oxacillin. The study identified and analyzed the epidemiology, risk factors and resistance pattern of CA-MRSA isolates.
RESULTS: Three hundred twety three (323) patients with Staphylococcus aureus infections were enrolled: 172 were CA-MRSA infections (cases); and 151 were community acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) infections (control). Demographic characteristics and clinical profile were skin (cellulitis, furunculosis and abscess) and pulmonary (pneumonica and empyema). The survival rate was high for both groups (>90%). The final multivariate logistic regresion model showed that level of crowding and socio-economic status remained model showed that level of crowding and socio-economic status remained as risk factors for CA-MRSA. The odds of having CA-MRSA in crowded households is 0.35 (90%CI 0.20-0.62) less likely when compared to the odds of acquiring MRSA in less crowded households (p=0.003). Those who had low socio-eonomic had 2.49 times higher chance (90%CI; 1.39 -4.47) of aquiring CA-MRSA compared to those with higher socio-economic status (p=0.01).
CONCLUSION: CA-MRSA is an emerging problem. This warrants recognition of patients with significant risk factors such as low socio-economic status and level of crowding. This may serve guide in choosing the appropriate antimicrobial theraply.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Methicillin ; Methicillin-resistant Staphylococcus Aureus ; Oxacillin ; Furunculosis ; Anti-infective Agents ; Staphylococcal Infections ; Community-acquired Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens worldwide. This study was performed to investigate the characterization of MRSA isolated from healthy persons in Gwangju area. A total of 404 nasal swab samples was collected during October 2011 and May 2012 in Gwangu, Korea. A survey on MRSA was conducted with meat distributors (n=230), pre-school children (n=108), officers (n=66), respectively. To confirm the MRSA, polymerase chain reaction (PCR) for the S. aureus specific gene and mecA gene was performed. A total of 34 (8.4%) MRSA isolates was isolated from 404 nasal swab samples: 6.1% (14/230) from meat distributors, 16.7% (18/108) from pre-school children, and 3.0% (2/66) from officers samples, respectively. The most prevalent antimicrobial resistance observed in the MRSA isolates was to ampicillin 100% (34/34), followed by penicillin 97.1% (33/34), oxacillin 94.1% (32/34) and erythromycin 52.9% (18/34). All MRSA isolates were then characterized by panton-valentine leukocidin (pvl) gene detected by PCR, staphylococcal cassette chromosome mec (SCCmec) typing, and pulsed-field gel electrophoresis (PFGE) with Sma I digestion. 34 MRSA isolates from nasal carriage were pvl gene negative, SCCmec type IV; 73.5% (25/34), type II; 17.6% (6/34), type III; 2.9% (1/34), and untypable; 5.9% (2/34), respectively. 34 MRSA isolates showed 16 PFGE patterns. These results indicated that isolation rates of community-associated methicillin-resistant S. aureus (CA-MRSA) from healthy persons were low (8.4%), but continuous surveillance and monitoring should be performed to prevent the spread of MRSA in the community.
Adenosine ; Ampicillin ; Bacterial Toxins ; Child ; Digestion ; Electrophoresis, Gel, Pulsed-Field ; Erythromycin ; Exotoxins ; Humans ; Korea ; Leukocidins ; Meat ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Penicillins ; Polymerase Chain Reaction

BACKGROUND: We performed surveillance cultures of the surfaces of X-ray cassettes to assess contamination with methicillin-resistant Staphylococcus aureus (MRSA). METHODS: The surfaces of 37 X-ray cassettes stored in a radiology department were cultured using mannitol salt agar containing 6 microg/mL oxacillin. Suspected methicillin-resistant staphylococcal colonies were isolated and identified by biochemical testing. Pulsed-field gel electrophoresis (PFGE) analysis was performed to determine the clonal relationships of the contaminants. RESULTS: Six X-ray cassettes (16.2%) were contaminated with MRSA. During the isolation procedure, we also detected 19 X-ray cassettes (51.4%) contaminated with methicillin-resistant Staphylococcus haemolyticus (MRSH), identified as yellow colonies resembling MRSA on mannitol salt agar. PFGE analysis of the MRSA and MRSH isolates revealed that most isolates of each organism were identical or closely related to each other, suggesting a common source of contamination. CONCLUSIONS: X-ray cassettes, which are commonly in direct contact with patients, were contaminated with MRSA and MRSH. In hospital environments, contaminated X-ray cassettes may serve as fomites for methicillin-resistant staphylococci.
Anti-Bacterial Agents/pharmacology ; Diagnostic Equipment/*microbiology ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification ; Microbial Sensitivity Tests ; Oxacillin/pharmacology ; Staphylococcus haemolyticus/drug effects/*isolation & purification

OBJECTIVE: To investigate the mechanisms by which MecA gene expression leads to β-lactam resistance in methicillin-resistant Staphylococcus aureus (MRSA), and to study the resistance mechanism of MRSA at the molecular level. METHODS: A variety of molecular biological techniques were employed, including screening MRSA using cefoxitin paper disk method, extraction of MRSA mRNA, reverse transcription into cDNA, real-time fluorescence PCR for quantitation of MecA gene expression, and agar dilution method for assessment of minimum inhibitory concentrations in MRSA treated with cefoxitin, oxacillin, vancomycin, or linezolid. RESULTS: According to the level of resistance of MRSA to cefoxitin, 40 MRSA strains were divided into a low resistance group (n=12), a middle resistance group (n=15), and a high resistance group (n=13). The expression level of the MecA gene in the low resistance group, the middle resistance group, and the high resistance group was 58.87±30.30, 363.37±200.05, and 1257.72±446.63, respectively. MRSA resistance to cefoxitin and oxacillin was 100%; MRSA resistance to vancomycin or linezolid could not be detected. For all 40 MRSA strains the MIC90 for vancomycin was 2.0 μg/mL. CONCLUSION MecA gene expression levels may correlate with the MRSA level of resistance to cefoxitin within a certain range of concentration.
Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; genetics ; metabolism ; Cefoxitin ; pharmacology ; Drug Resistance, Multiple, Bacterial ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; genetics ; metabolism ; Microbial Sensitivity Tests ; methods ; Oxacillin ; pharmacology ; Penicillin-Binding Proteins

BACKGROUND: The purpose of this study was to investigate perception of hand hygiene and actual hand washing practices of people who used public facilities as well as the presence of indicator bacteria and food-borne pathogens on their hands. Data from this study will be used as a tool for public education and provide basic information on the potential risk for the spread of infectious disease by hands. MATERIALS AND METHODS: Sixty S. aureus and 15 methicillin-resistant S. aureus (MRSA) were recovered from 500 swab samples from hands of people in public places, including super markets and amusement facilities in Gwangju Metropolitan City during February to May 2011. Using conventional methods and the Vitek system, all of the isolates were confirmed as Staphylococcus auerus (S. aureus). Antimicrobial susceptibility was determined by performing disk diffusion testing according to the Clinical Laboratory Standard Institute guidelines. The minimum inhibition concentrations (MICs) of MRSA isolates were tested using E-test strips. To confirm the MRSA, polymerase chain reaction (PCR) for the S. aureus-specific gene and mecA gene was performed. Gene detection using PCR, SCCmec typing, Panton-Valentine Leukocidin (PVL), and Multilocus sequence typing (MLST) were performed on all isolates of MRSA. RESULTS: Of 60 S. aureus isolates, 48 (80%) harbored at least one type of enterotoxin gene: two, three, four, and five types of enterotoxin gene were found in 16 (26.7%), seven (11.7%), 10 (16.7%), and eight (13.3%) isolates, respectively. The most prevalent antimicrobial resistance observed in the S. aureus isolates was to penicillin (92%, 55/60), followed by erythromycin (35%, 21/60), oxacillin (32%, 19/60), and ampicillin (23%, 14/60). No resistance was observed against vancomycin, clindamycin, linazolid, rifampin, imipenem, trimethoprim/sulfamethoxazole, and telithromycin. In this study, based on molecular characterization of MRSA isolates, all MRSA, except for one isolate, belonged to ST72 and SCCmec type IV. Eleven of 15 (78.6%) MRSA were ST72:SCCmecIV:t324. CONCLUSIONS: In this study, we detected serious pathogens, including S. aureus and MRSA, from swab samples of peoples' hands. Most S. aureus isolates harbored the enterotoxin gene and the types of MRSA isolated in this study were community-associated MRSA, indicating the importance of washing hands for public health.
Adenosine ; Ampicillin ; Bacteria ; Bacterial Toxins ; Clindamycin ; Communicable Diseases ; Diffusion ; Enterotoxins ; Erythromycin ; Exotoxins ; Hand ; Hand Disinfection ; Hand Hygiene ; Imipenem ; Ketolides ; Leukocidins ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Multilocus Sequence Typing ; Oxacillin ; Penicillins ; Polymerase Chain Reaction ; Public Facilities ; Public Health ; Rifampin ; Staphylococcus ; Staphylococcus aureus ; Vancomycin

OBJECTIVE: Methicillin resistant Staphylococcus aureus (MRSA) is the most common cause of postoperative infection in instrumented fusion surgery. Although MRSA is well-known cause of nosocomial infection, emerging evidence supports that there could be MRSA infection from community. This study evaluated the nasal colonization rate of MRSA among healthy adults within the age range of spinal fusion surgery in Korea. METHODS: Nasal swabs were collected from 99 participants who visited health promotion center. A structured questionnaire regarding healthcare-associated MRSA risk factors was collected simultaneously. Staphylococcus aureus was confirmed by latex agglutination. The resistance to methicillin was identified by oxacillin screening test. RESULTS: Of the 99 participants, 12 (12.1%) had S. aureus isolates. The nasal carriage rate of methicillin susceptible S. aureus (MSSA) was 9 (9.1%). MRSA was identified in 3 participants (3.0%). CONCLUSION: Among the age range of possible spinal fusion surgery, nasal colonization study revealed substantial rate of preoperative MRSA carriers even in healthy adults. A postoperative MRSA infection should not be exclusively considered to be due to surgery-related contamination.
Adult ; Agglutination ; Colon ; Cross Infection ; Health Promotion ; Humans ; Latex ; Mass Screening ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Nasal Surgical Procedures ; Oxacillin ; Surveys and Questionnaires ; Risk Factors ; Spinal Fusion ; Staphylococcus ; Staphylococcus aureus ; Surgical Wound Infection