Chest Infections: Chest Infections I |

Diversity of SCCmec Genotype PVL Gene and Found in Community-Acquired Methicillin-Resistant Staphylococcus aureus FREE TO VIEW

Jian Ping Zhou, PhD; Qing Yun Li, PhD
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Ruijin Hospital, Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A108. doi:10.1016/j.chest.2016.02.113
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SESSION TITLE: Chest Infections I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Staphylococcus aureus (SA) has been known as a major pathogen causing various infectious diseases like wound infections, pneumonia, septicemia and endocarditis with beta-lactam antibiotics being the drugs of choice for their therapy. From 2001 to 2002, community-acquired MRSA infection was reported to represent 8 to 20 percent of all MRSA isolates by a large multiple-center study. It is generally considered that CA-MRSA is always represented with various SCCmec genotype and positive PVL expression. Here, we present three cases of CA-MRSA with a SCCmec genotypes similar to HA-MRSA and negative PVL gene expression.

CASE PRESENTATION: Case 1: A 67-year old male presented with three-day history of fever, cough and expectoration with past medical history of diabetes mellitus. Chest radiography revealed pathy infiltration with cavern in the inferior lobe of left lung. MRSA was isolated from the sputum and broncho-alveolar lavage fluid (BALF) on the second day of hospitalization. He was empirically treated with moxifloxacin before and vancomycin after the confirmation of MRSA. Case 2: A 35-year young male presented with 7-day history of fever, malaise and right chest pain without any underlying disease. Chest radiography revealed bilateral reticulonodular with patchy infiltration. MRSA was isolated from the sputum on the clinical consultation before admission. He was initially treated with ceftriaxone and then with vancomycin after the positive MRSA culture. Case 3: A 24-year young female presented with 5-day history of fever, malaise and left chest pain. Her underlying disease is also diabetes mellitus. Chest radiography (figure 3) revealed irregular patchy infiltration in the left pulmonary hilus. MRSA was isolated from the sputum on the clinical consultation before admission. She was treated with ciprofloxacin at first and then with vancomycin instead.

DISCUSSION: In our cases, the result of three isolates had significant difference in pre-existing condition, site of infection, antibiotic resistance by the comparison of the commonly recognized characteristics of CA-MRSA. It suggested that SCCmec IV and PVL gene might not be reliable markers for CA-MRSA. The molecular diversity of CA-MRSA was reflected by different combination of SCCmec genotypes, PVL gene and maybe other pathogenicity toxins. Probably, these diversity implied their certain infection sites, virulent capacity and antibiotic resistance.

CONCLUSIONS: It is necessary for physicians to pay attention to the different molecular features of CA-MRSA in various infection sites with integrated view of SCCmec genotype and PVL gene and integrated view of clinical features and laboratory findings.

Reference #1: Palavecino E. Community-acquired methicillin resistant Staphylococcus aureus infections. Clin Lab Med 2004;24:403-18

Reference #2: Chambers HF. Community-associated MRSA—resistance and virulence converge. N Engl J Med 2005;352:1485-7.

DISCLOSURE: The following authors have nothing to disclose: Jian Ping Zhou, Qing Yun Li

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