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Abstract

Vol.52 No.11 November 2004

Emergence of Panton-Valentine leukocidin positive community-acquired methycillin-resistant Staphylococcus aureus -Status of infection and bacteriological features-

Tatsuo Yamamoto, Ikue Taneike, Saori Nakagawa and Nobuhiro Iwakura

Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences,
757 Ichibanchou, Asahimachidori, Niigata, Japan

Abstract

In the United States, children are reported to have died of community-acquired methycillin-resistant Staphylococcus aureus (CA-MRSA) infection between 1997 and 1999. During The same period, CA-MRSA was also isolated and reported in Europe and Australia. The characteristics of the pathogen were clarified, and CA-MRSA infection became the focus of global attention as a global infection. CA-MRSA differs from conventional MRSA (hospital-acquired MRSA, HA-MRSA) in origin. It produces a leukocidin, PVL, and in many cases, has a type IV methycillin-resistance region (type IV SCCmec). Genetically, CA-MRSA consists of several different continent-specific clones. Analysies such as multi-locus sequence typing (MLST), spa typing, agr allele analysis, and toxin gene pattern analysis are used. One clone has thus far been confirmed in Europe, several in the United States, 2in Oceania, and 2 prevalent in Asia. Drug sensitivity depends on the type of prevalent clone, and some strains of CA-MRSA are susceptible to many antimicrobial agents other than penicillin/cephems. In many cases, such CA-MRSA is associated with skin/soft tissue infection, and is frequently detected in children. Fatal necrotizing pneumonia and bacteremia appear to be increasing. CA-MRSA in Japan differs from European and North American cases in that; the proportion of PVL-negative strains is relatively high and genetic features vary. PVL-positive CA-MRSA, which is rarely isolated, is common to Oceania CA-MRSA in many respects, although not identical, rather than to European and North American CA-MRSA. PVL-positive CA-MRSA infection is spreading even among young, healthy individuals. A survey on the worldwide distribution, identification of populations and areas at high risk for colonization and infection, and analysis of the detailed infectious mechanism are curently under way.

Key word

community-acquired infection, MRSA, Panton-Valentine leukocidin, staphylococcal cassette chromosome mec, multilocus sequence typing

Received

September 28, 2004

Accepted

October 26, 2004

Jpn. J. Chemother. 52 (11): 635-653, 2004