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Molecular epidemiology of community-onset methicillin-resistant Staphylococcus aureus infections in Israel

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Abstract

Data on community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) in Israel are scarce. The objective of this study was to characterize the major CA-MRSA clones in Israel. All clinical MRSA isolates detected in the community during a period of 2.5 years (2011–2013) from individuals insured by a major health maintenance organization in Israel were collected, with additional data from medical records. Antibiotic susceptibility patterns and staphylococcal chromosomal cassette mec (SCCmec) typing were determined. SCCmec IV and V isolates were further typed by pulsed-field gel electrophoresis (PFGE), spa typing, and detection of a panel of toxin genes. MRSA were detected in 280 patients, mostly from skin infections. Patients with SCCmec IV (n = 120, 43 %) were younger (p < 0.0001) and reported less contact with healthcare facilities. Almost all isolates were trimethoprim–sulfamethoxazole susceptible (98 %). spa-CC032, a typical nosocomial MRSA clone, accounted for 28 % of SCCmec IV. The two major CA-MRSA clones were t008 USA300 (13 %) and t991 (10 %); t991 was isolated mainly from children (75 %), was Panton–Valentine leukocidin (PVL) negative but eta-positive, and was typically susceptible to most antibiotic groups. PVL-positive strains (n = 31) included mainly USA300 (52 %) and t019 (13 %). While multiple genetic lineages were evident among community-onset MRSA in Israel, approximately 20 % are typical CA-MRSA clones, mainly USA300 and a local clone, t991.

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Acknowledgments

We greatly acknowledge Efrat Steinberger for her assistance and Roberto Azar for help with the sequencing. We also acknowledge Hermínia de Lencastre for sending us the EMRSA-15 strain and Robert S. Daum for sending the USA300 strain used here as reference strains.

Compliance with ethical standards

Ethical approval was granted from the Institutional Review Boards of the Galilee Medical Center, the Sheba Medical Center, and Maccabi Healthcare Services. All procedures performed were in accordance with the ethical standards of the institute and with the 1964 Helsinki Declaration and its later amendments. Patients were identified with a unique code number, while the anonymity status of the patients to any third party was preserved and guaranteed during and after the study. Since this was a retrospective study, informed consent was not required.

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

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

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Author notes

    Authors and Affiliations

    1. Infectious Dis. Unit, Sheba Medical Center, Ramat-Gan, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

      A. Biber, H. Jaber, G. Rahav & G. Regev-Yochay

    2. Central Laboratory, Maccabi Healthcare Services, Rehovot, Israel

      M. Parizade & D. Taran

    3. The Faculty of Medicine, The Hebrew University, Jerusalem, Israel

      E. Berla

    4. Infectious Dis. Epidemiology Section, Gertner Institute, Ramat-Gan, Israel

      C. Rubin & G. Regev-Yochay

    5. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

      G. Rahav & G. Regev-Yochay

    6. Pediatric Infectious Dis. Service, Galilee Medical Center, Nahariya, The Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

      D. Glikman

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    1. A. Biber
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    Correspondence to G. Regev-Yochay.

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    D. Glikman and G. Regev-Yochay contributed equally to this work.

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    Biber, A., Parizade, M., Taran, D. et al. Molecular epidemiology of community-onset methicillin-resistant Staphylococcus aureus infections in Israel. Eur J Clin Microbiol Infect Dis 34, 1603–1613 (2015). https://doi.org/10.1007/s10096-015-2395-9

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