Skip to main content
Top
Published in: European Journal of Clinical Microbiology & Infectious Diseases 1/2017

01-01-2017 | Original Article

Clinical outcomes and treatment approach for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in Israel

Authors: E. Berla-Kerzhner, A. Biber, M. Parizade, D. Taran, G. Rahav, G. Regev-Yochay, D. Glikman

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 1/2017

Login to get access

Abstract

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly documented worldwide. We recently identified two major CA-MRSA clones in Israel: USA300 and t991. Here, we assessed clinical outcomes by CA-MRSA clones and the physicians’ treatment approach to CA-MRSA infections. All community-onset, clinical MRSA isolates detected during 2011–2013 by Maccabi Healthcare Services were collected and characterized phenotypically and genotypically; data were collected retrospectively from electronic medical records. Of 309 patients with MRSA infections, 64 were identified as CA-MRSA (21 %). Of the CA-MRSA infections, 72 % had skin and soft tissue infections (SSTIs), 38 % were Panton–Valentine leukocidin (PVL)+, the major clone being USA300 (n = 13, 54 %). Of PVL− isolates (n = 40, 62 %), t991 was the major clone. Age was the only predictor for PVL+ CA-MRSA infection (p < 0.001). Patients with PVL+ CA-MRSA had higher incidence of SSTI recurrences (1.061 vs. 0.647 events per patient/per year, p < 0.0001) and were more likely to have the SSTI drained (64 % vs. 21 %, p = 0.003) when compared to PVL− CA-MRSA. USA300 was more common among adults, while t991 was more common among children (p = 0.002). The physician’s referral to culture results and susceptibility were the only predictors of appropriate antibiotic therapy (p < 0.001). However, only a minority of physicians referred to culture results, regardless of subspecialties. PVL+ CA-MRSA isolates caused significantly more recurrences of SSTIs and increased the need for drainage compared with PVL− isolates. Physicians’ awareness of CA-MRSA as a cause of SSTIs in the community was suboptimal. Culturing of pus-producing SSTIs is crucial for providing adequate antimicrobials and elucidating MRSA epidemiology.
Appendix
Available only for authorised users
Literature
2.
go back to reference Kluytmans J, van Belkum A, Verbrugh H (1997) Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 10(3):505–520PubMedPubMedCentral Kluytmans J, van Belkum A, Verbrugh H (1997) Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 10(3):505–520PubMedPubMedCentral
4.
go back to reference David MZ, Glikman D, Crawford SE, Peng J, King KJ, Hostetler MA, Boyle-Vavra S, Daum RS (2008) What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 197(9):1235–1243. doi:10.1086/533502 CrossRefPubMed David MZ, Glikman D, Crawford SE, Peng J, King KJ, Hostetler MA, Boyle-Vavra S, Daum RS (2008) What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 197(9):1235–1243. doi:10.​1086/​533502 CrossRefPubMed
5.
go back to reference Regev-Yochay G, Raz M, Carmeli Y, Shainberg B, Navon-Venezia S, Pinco E, Leavitt A, Keller N, Rahav G, Malley R, Rubinstein E; Maccabi Implementing Judicious Antibiotic Prescription Study Group (2009) Parental Staphylococcus aureus carriage is associated with staphylococcal carriage in young children. Pediatr Infect Dis J 28(11):960–965. doi:10.1097/INF.0b013e3181a90883 CrossRefPubMed Regev-Yochay G, Raz M, Carmeli Y, Shainberg B, Navon-Venezia S, Pinco E, Leavitt A, Keller N, Rahav G, Malley R, Rubinstein E; Maccabi Implementing Judicious Antibiotic Prescription Study Group (2009) Parental Staphylococcus aureus carriage is associated with staphylococcal carriage in young children. Pediatr Infect Dis J 28(11):960–965. doi:10.​1097/​INF.​0b013e3181a90883​ CrossRefPubMed
6.
go back to reference Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA; Participants in the Centers for Disease Control and Prevention-Convened Experts’Meeting on Management of MRSA in the Community (2006) Strategies for clinical management of MRSA in the community: summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. Available online at: http://www.cdc.gov/mrsa/pdf/MRSA-Strategies-ExpMtgSummary-2006.pdf. Accessed 12 Dec 2015 Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA; Participants in the Centers for Disease Control and Prevention-Convened Experts’Meeting on Management of MRSA in the Community (2006) Strategies for clinical management of MRSA in the community: summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. Available online at: http://​www.​cdc.​gov/​mrsa/​pdf/​MRSA-Strategies-ExpMtgSummary-2006.​pdf. Accessed 12 Dec 2015
7.
go back to reference Lina G, Piémont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J (1999) Involvement of Panton–Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 29(5):1128–1132. doi:10.1086/313461 CrossRefPubMed Lina G, Piémont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J (1999) Involvement of Panton–Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 29(5):1128–1132. doi:10.​1086/​313461 CrossRefPubMed
8.
go back to reference Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, Leitch CD, Daum RS (1998) Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 279(8):593–598CrossRefPubMed Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, Leitch CD, Daum RS (1998) Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 279(8):593–598CrossRefPubMed
9.
go back to reference Adler A, Givon-Lavi N, Moses AE, Block C, Dagan R (2010) Carriage of community-associated methicillin-resistant Staphylococcus aureus in a cohort of infants in southern Israel: risk factors and molecular features. J Clin Microbiol 48(2):531–538. doi:10.1128/JCM.02290-08 CrossRefPubMed Adler A, Givon-Lavi N, Moses AE, Block C, Dagan R (2010) Carriage of community-associated methicillin-resistant Staphylococcus aureus in a cohort of infants in southern Israel: risk factors and molecular features. J Clin Microbiol 48(2):531–538. doi:10.​1128/​JCM.​02290-08 CrossRefPubMed
10.
go back to reference Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, Lin F, Lin J, Carleton HA, Mongodin EF, Sensabaugh GF, Perdreau-Remington F (2006) Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet 367(9512):731–739. doi:10.1016/S0140-6736(06)68231-7 CrossRefPubMed Diep BA, Gill SR, Chang RF, Phan TH, Chen JH, Davidson MG, Lin F, Lin J, Carleton HA, Mongodin EF, Sensabaugh GF, Perdreau-Remington F (2006) Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet 367(9512):731–739. doi:10.​1016/​S0140-6736(06)68231-7 CrossRefPubMed
11.
go back to reference Saiman L, O’Keefe M, Graham PL 3rd, Wu F, Saïd-Salim B, Kreiswirth B, LaSala A, Schlievert PM, Della-Latta P (2003) Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 37(10):1313–1319. doi:10.1086/379022 CrossRefPubMed Saiman L, O’Keefe M, Graham PL 3rd, Wu F, Saïd-Salim B, Kreiswirth B, LaSala A, Schlievert PM, Della-Latta P (2003) Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 37(10):1313–1319. doi:10.​1086/​379022 CrossRefPubMed
12.
go back to reference O’Brien FG, Pearman JW, Gracey M, Riley TV, Grubb WB (1999) Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 37(9):2858–2862PubMedPubMedCentral O’Brien FG, Pearman JW, Gracey M, Riley TV, Grubb WB (1999) Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 37(9):2858–2862PubMedPubMedCentral
13.
go back to reference Huang H, Flynn NM, King JH, Monchaud C, Morita M, Cohen SH (2006) Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and hospital-associated MRSA infections in Sacramento, California. J Clin Microbiol 44:2423–2427CrossRefPubMedPubMedCentral Huang H, Flynn NM, King JH, Monchaud C, Morita M, Cohen SH (2006) Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and hospital-associated MRSA infections in Sacramento, California. J Clin Microbiol 44:2423–2427CrossRefPubMedPubMedCentral
14.
go back to reference Maree CL, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG (2007) Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 13:236–242CrossRefPubMedPubMedCentral Maree CL, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG (2007) Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 13:236–242CrossRefPubMedPubMedCentral
16.
go back to reference Biber A, Parizade M, Taran D, Jaber H, Berla-Kerzhner E, Rubin C, Rahav G, Glikman D, Regev-Yochay G (2015) Molecular epidemiology of community-onset methicillin-resistant Staphylococcus aureus infections in Israel. Eur J Clin Microbiol Infect Dis 34(8):1603–1613. doi:10.1007/s10096-015-2395-9 CrossRefPubMed Biber A, Parizade M, Taran D, Jaber H, Berla-Kerzhner E, Rubin C, Rahav G, Glikman D, Regev-Yochay G (2015) Molecular epidemiology of community-onset methicillin-resistant Staphylococcus aureus infections in Israel. Eur J Clin Microbiol Infect Dis 34(8):1603–1613. doi:10.​1007/​s10096-015-2395-9 CrossRefPubMed
17.
go back to reference Regev-Yochay G, Carmeli Y, Raz M, Pinco E, Etienne J, Leavitt A, Rubinstein E, Navon-Venezia S (2006) Prevalence and genetic relatedness of community-acquired methicillin-resistant Staphylococcus aureus in Israel. Eur J Clin Microbiol Infect Dis 25(11):719–722. doi:10.1007/s10096-006-0210-3 CrossRefPubMed Regev-Yochay G, Carmeli Y, Raz M, Pinco E, Etienne J, Leavitt A, Rubinstein E, Navon-Venezia S (2006) Prevalence and genetic relatedness of community-acquired methicillin-resistant Staphylococcus aureus in Israel. Eur J Clin Microbiol Infect Dis 25(11):719–722. doi:10.​1007/​s10096-006-0210-3 CrossRefPubMed
18.
go back to reference Nevet A, Ashkenazi S, Samra Z, Livni G (2010) Community-associated methicillin-resistant Staphylococcus aureus infections in Israel. Isr Med Assoc J 12(7):428–430PubMed Nevet A, Ashkenazi S, Samra Z, Livni G (2010) Community-associated methicillin-resistant Staphylococcus aureus infections in Israel. Isr Med Assoc J 12(7):428–430PubMed
19.
go back to reference Glikman D, Davidson S, Kudinsky R, Geffen Y, Sprecher H (2010) First isolation of SCCmec IV- and Panton–Valentine leukocidin-positive, sequence type 8, community-associated methicillin-resistant Staphylococcus aureus in Israel. J Clin Microbiol 48(10):3827–3828. doi:10.1128/JCM.00746-10 CrossRefPubMedPubMedCentral Glikman D, Davidson S, Kudinsky R, Geffen Y, Sprecher H (2010) First isolation of SCCmec IV- and Panton–Valentine leukocidin-positive, sequence type 8, community-associated methicillin-resistant Staphylococcus aureus in Israel. J Clin Microbiol 48(10):3827–3828. doi:10.​1128/​JCM.​00746-10 CrossRefPubMedPubMedCentral
20.
go back to reference Glikman D (2009) Community-associated methicillin-resistant Staphylococcus aureus infections among children in the western Galilee region: the beginning of an epidemic? Harefuah 148(11):761–765PubMed Glikman D (2009) Community-associated methicillin-resistant Staphylococcus aureus infections among children in the western Galilee region: the beginning of an epidemic? Harefuah 148(11):761–765PubMed
22.
go back to reference Vento TJ, Calvano TP, Cole DW, Mende K, Rini EA, Tully CC, Landrum ML, Zera W, Guymon CH, Yu X, Beckius ML, Cheatle KA, Murray CK (2013) Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan. BMC Infect Dis 13(1):325. doi:10.1186/1471-2334-13-325 CrossRefPubMedPubMedCentral Vento TJ, Calvano TP, Cole DW, Mende K, Rini EA, Tully CC, Landrum ML, Zera W, Guymon CH, Yu X, Beckius ML, Cheatle KA, Murray CK (2013) Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan. BMC Infect Dis 13(1):325. doi:10.​1186/​1471-2334-13-325 CrossRefPubMedPubMedCentral
23.
go back to reference David MZ, Taylor A, Lynfield R, Boxrud DJ, Short G, Zychowski D, Boyle-Vavra S, Daum RS (2013) Comparing pulsed-field gel electrophoresis with multilocus sequence typing, spa typing, staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for Panton–Valentine leukocidin, arcA, and opp3 in methicillin-resistant Staphylococcus aureus isolates at a U.S. Medical Center. J Clin Microbiol 51(3):814–819. doi:10.1128/JCM.02429-12 CrossRefPubMedPubMedCentral David MZ, Taylor A, Lynfield R, Boxrud DJ, Short G, Zychowski D, Boyle-Vavra S, Daum RS (2013) Comparing pulsed-field gel electrophoresis with multilocus sequence typing, spa typing, staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for Panton–Valentine leukocidin, arcA, and opp3 in methicillin-resistant Staphylococcus aureus isolates at a U.S. Medical Center. J Clin Microbiol 51(3):814–819. doi:10.​1128/​JCM.​02429-12 CrossRefPubMedPubMedCentral
24.
go back to reference Mehrotra M, Wang G, Johnson WM (2000) Multiplex PCR for detection of genes for Staphylococcus aureus enterotoxins, exfoliative toxins, toxic shock syndrome toxin 1, and methicillin resistance. J Clin Microbiol 38(3):1032–1035PubMedPubMedCentral Mehrotra M, Wang G, Johnson WM (2000) Multiplex PCR for detection of genes for Staphylococcus aureus enterotoxins, exfoliative toxins, toxic shock syndrome toxin 1, and methicillin resistance. J Clin Microbiol 38(3):1032–1035PubMedPubMedCentral
25.
go back to reference Shopsin B, Gomez M, Montgomery SO, Smith DH, Waddington M, Dodge DE, Bost DA, Riehman M, Naidich S, Kreiswirth BN (1999) Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol 37(11):3556–3563PubMedPubMedCentral Shopsin B, Gomez M, Montgomery SO, Smith DH, Waddington M, Dodge DE, Bost DA, Riehman M, Naidich S, Kreiswirth BN (1999) Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol 37(11):3556–3563PubMedPubMedCentral
26.
28.
go back to reference Planet PJ, Diaz L, Kolokotronis SO, Narechania A, Reyes J, Xing G, Rincon S, Smith H, Panesso D, Ryan C, Smith DP, Guzman M, Zurita J, Sebra R, Deikus G, Nolan RL, Tenover FC, Weinstock GM, Robinson DA, Arias CA (2015) Parallel epidemics of community-associated methicillin-resistant Staphylococcus aureus USA300 infection in North and South America. J Infect Dis 212(12):1874–1882. doi:10.1093/infdis/jiv320 CrossRefPubMedPubMedCentral Planet PJ, Diaz L, Kolokotronis SO, Narechania A, Reyes J, Xing G, Rincon S, Smith H, Panesso D, Ryan C, Smith DP, Guzman M, Zurita J, Sebra R, Deikus G, Nolan RL, Tenover FC, Weinstock GM, Robinson DA, Arias CA (2015) Parallel epidemics of community-associated methicillin-resistant Staphylococcus aureus USA300 infection in North and South America. J Infect Dis 212(12):1874–1882. doi:10.​1093/​infdis/​jiv320 CrossRefPubMedPubMedCentral
29.
go back to reference David MZ, Acree ME, Sieth JJ, Boxrud DJ, Dobbins G, Lynfield R, Boyle-Vavra S, Daum RS (2015) Pediatric Staphylococcus aureus isolate genotypes and infections from the dawn of the community-associated methicillin-resistant S. aureus epidemic era in Chicago, 1994 to 1997. J Clin Microbiol 53(8):2486–2491. doi:10.1128/JCM.00096-15 CrossRefPubMedPubMedCentral David MZ, Acree ME, Sieth JJ, Boxrud DJ, Dobbins G, Lynfield R, Boyle-Vavra S, Daum RS (2015) Pediatric Staphylococcus aureus isolate genotypes and infections from the dawn of the community-associated methicillin-resistant S. aureus epidemic era in Chicago, 1994 to 1997. J Clin Microbiol 53(8):2486–2491. doi:10.​1128/​JCM.​00096-15 CrossRefPubMedPubMedCentral
30.
go back to reference Borer A, Gilad J, Yagupsky P, Peled N, Porat N, Trefler R, Shprecher-Levy H, Riesenberg K, Shipman M, Schlaeffer F (2002) Community-acquired methicillin-resistant Staphylococcus aureus in institutionalized adults with developmental disabilities. Emerg Infect Dis 8(9):966–970. doi:10.3201/eid0809.020030 CrossRefPubMedPubMedCentral Borer A, Gilad J, Yagupsky P, Peled N, Porat N, Trefler R, Shprecher-Levy H, Riesenberg K, Shipman M, Schlaeffer F (2002) Community-acquired methicillin-resistant Staphylococcus aureus in institutionalized adults with developmental disabilities. Emerg Infect Dis 8(9):966–970. doi:10.​3201/​eid0809.​020030 CrossRefPubMedPubMedCentral
31.
go back to reference Ladhani S (2003) Understanding the mechanism of action of the exfoliative toxins of Staphylococcus aureus. FEMS Immunol Med Microbiol 39(2):181–189CrossRefPubMed Ladhani S (2003) Understanding the mechanism of action of the exfoliative toxins of Staphylococcus aureus. FEMS Immunol Med Microbiol 39(2):181–189CrossRefPubMed
Metadata
Title
Clinical outcomes and treatment approach for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in Israel
Authors
E. Berla-Kerzhner
A. Biber
M. Parizade
D. Taran
G. Rahav
G. Regev-Yochay
D. Glikman
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Clinical Microbiology & Infectious Diseases / Issue 1/2017
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-016-2789-3

Other articles of this Issue 1/2017

European Journal of Clinical Microbiology & Infectious Diseases 1/2017 Go to the issue