Trial to control an outbreak of Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus at a boarding school in Japan
Trial to control an outbreak of Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus at a boarding school in Japan
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DOI：
10.1016/j.ajic.2011.02.010
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发表时间：
2011-12-01
影响因子：
4.9
通讯作者：
Kawana, Akihiko
中科院分区：
文献类型：
--
作者：
Higashiyama, Masaaki;Ito, Teruyo;Kawana, Akihiko
背景：我们对2007年左右日本一家医院耐甲氧西林金黄色葡萄球菌（MRSA）感染的回顾性调查表明，社区相关MRSA （CA-MRSA）菌株在日本寄宿学校的健康学生中传播，经常引起皮肤病，并表现出相同的抗生素谱模式。方法：自2008年5月起对该学校进行6个月的皮肤病监测，对部分高危人群进行MRSA携带检查，并调查其生活环境，包括环境文化。此外，我们从2008年11月开始加强卫生习惯，改善已知的危险因素，并观察皮肤病的发生情况和MRSA携带率，以评估感染控制情况。结果：从21例皮肤病患者中分离出MRSA菌株。3组MRSA定殖率为7.6% ~ 36.6%。引入感染控制后，皮肤病和MRSA携带率均显著下降。遗传分析显示，主要传播pvl阳性SCCmec IVc克隆（共41/47株），表现为与USA300不同的脉冲场类型。结论：这是日本首次报告pvl阳性CA-MRSA暴发，表明通过在封闭社区进行监测对传播进行了系统管理。
Background: Our retrospective investigation of methicillin-resistant Staphylococcus aureus (MRSA) infection at a hospital in Japan around 2007 suggested dissemination of community-associated MRSA (CA-MRSA) strains among healthy students in a Japanese boarding school, which frequently caused skin disease and exhibited the same antibiogram patterns.Methods: Active surveillance of skin diseases for 6 months after May 2008, examination of MRSA carriage in selected high-risk groups, and investigation of their life circumstances, including environmental cultures, were conducted in the school. Furthermore, we strengthened hygiene practices and improved recognized risk factors from November 2008 and observed the occurrence of skin diseases and MRSA carriage rate for the evaluation of infection controls.Results: We identified 21 patients with skin diseases in whom MRSA strains were isolated. MRSA colonization rates in 3 selected groups ranged from 7.6% to 36.6%. The rates of both skin disease and MRSA carriage decreased significantly after infection controls were introduced. Genetic analysis revealed a main dissemination of a PVL-positive SCCmec IVc clone (41/47 isolates in total), presenting as a different pulsed-field type than USA300.Conclusion: This first report of a PVL-positive CA-MRSA outbreak in Japan demonstrates systematic management of dissemination by conducting surveillance in a closed community.