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High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA

Harch, Susan AJ, MacMorran, Eleanor, Tong, Steven YC, Holt, Deborah C, Wilson, Judith, Athan, Eugene and Hewagama, Saliya 2017, High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA, BMC infectious diseases, vol. 17, pp. 1-7, doi: 10.1186/s12879-017-2460-3.

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Title High burden of complicated skin and soft tissue infections in the Indigenous population of Central Australia due to dominant Panton Valentine leucocidin clones ST93-MRSA and CC121-MSSA
Author(s) Harch, Susan AJ
MacMorran, Eleanor
Tong, Steven YC
Holt, Deborah C
Wilson, Judith
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Hewagama, Saliya
Journal name BMC infectious diseases
Volume number 17
Article ID 405
Start page 1
End page 7
Total pages 7
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017
ISSN 1471-2334
Keyword(s) abscess
methicillin resistance
Panton Valentine leucocidin
Staphylococcus aureus
adolescent
adult
bacterial toxins
child
community-acquired infections
exotoxins
female
humans
leukocidins
male
methicillin-resistant Staphylococcus aureus
middle aged
molecular epidemiology
Northern Territory
population groups
prevalence
prospective studies
skin
soft tissue infections
Staphylococcal infections
young adult
science and technology
life sciences and biomedicine
infectious diseases
Summary BACKGROUND: Superficial skin and soft tissue infections (SSTIs) are common among the Indigenous population of the desert regions of Central Australia. However, the overall burden of disease and molecular epidemiology of Staphylococcus aureus complicated SSTIs has yet to be described in this unique population.

METHODS: Alice Springs Hospital (ASH) admission data was interrogated to establish the population incidence of SSTIs. A prospective observational study was conducted on a subset of S. aureus complicated SSTIs (carbuncles and furuncles requiring surgical intervention) presenting during a one month period to further characterize the clinical and molecular epidemiology. High resolution melting analysis was used for clonal complex discrimination. Real-time polymerase chain reaction identifying the lukF component of the Panton Valentine leucocidin (pvl) gene determined pvl status. Clinical and outcome data was obtained from the ASH medical and Northern Territory shared electronic health records.

RESULTS: SSTIs represented 2.1% of ASH admissions during 2014. 82.6% occurred in Indigenous patients (n = 382) with an estimated incidence of 18.9 per 1, 000 people years compared to the non-Indigenous population of 2.9 per 1000, with an incident rate ratio of 6.6 (95% confidence interval 5.1-8.5). Clinical and molecular analysis was performed on 50 isolates from 47 patients. Community-associated methicillin-resistant S. aureus (CA-MRSA) predominated (57% of isolates). The high burden of SSTIs is partly explained by the prevalence of pvl positive strains of S. aureus (90% isolates) for both CA-MRSA and methicillin-susceptible S. aureus (MSSA). ST93-MRSA and CC121-MSSA were the most prevalent clones. SSTIs due to ST93-MRSA were more likely to require further debridement (p = 0.039), however they also more frequently received inactive antimicrobial therapy (p < 0.001).

CONCLUSIONS: ST93-MRSA and CC121-MSSA are the dominant causes of carbuncles and furuncles in Central Australia. Both of these virulent clones harbor pvl but the impact on clinical outcomes remains uncertain. The high prevalence of CA-MRSA supports empiric vancomycin use in this population when antimicrobial therapy is indicated. Prompt surgical intervention remains the cornerstone of treatment.
Language eng
DOI 10.1186/s12879-017-2460-3
Field of Research 0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30101636

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.