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Volume 13, Number 4—April 2007

Global Distribution of Panton-Valentine Leukocidin–positive Methicillin-resistant Staphylococcus aureus, 2006

Anne Tristan*†Comments to Author , Michele Bes*, Helene Meugnier*, Gerard Lina*, Bülent Bozdogan†, Patrice Courvalin†, Marie-Elisabeth Reverdy*, Mark C. Enright‡, François Vandenesch*, and Jerome Etienne*
Author affiliations: *INSERM, Lyon, France; †Unité des Agents Antibactériens, Centre National de Référence des Antibiotiques, Institut Pasteur, Paris; ‡Imperial College London, London, England, United Kingdom;

Main Article

Table 1

Geographic distribution of PVL-positive CA-MRSA clones according to their agr-type, ST, and spa type*

agrtype ST (CC) No. (%) spa type(spa CC) No. (%) Location
Other reports in literature
Detected before 2003 Newly detected (this work)
agr1 46 (9.8)
ST8 (8) 25 (54.3) USA (4) Netherlands, France, Spain, N. Norway (23)
Switzerland, French Polynesia Greece (24)
t008 (s) 25 (100.0)
ST59 7 (15.2) USA (4) Netherlands, France, Singapore Taïwan (25)
t437 (8) 6 (85.7)
t216 (8) 1 (14.3)
ST22 (22) 3 (6.5) Netherlands, Germany
t005 (4) 2 (66.7)
t310 (4) 1 (33.3)
ST766 (22) 1 (2.2) Singapore
t1276 (4) 1 (100.0)
ST377 10 (21.7) Netherlands, France, Greece, Switzerland, Australia
t355 (6) 9 (90.0)

t595 (6)
1 (10.0)

agr2 9 (1.9)
ST5 (5) 9 (100.0) France, Switzerland, Algeria
t311 (5) 5 (55.5)
t1277 3 (33.3)

1 (11.1)

agr3 414 (88.3)
ST80 357 (83.2) France, Switzerland (4) Algeria, Singapore, Romania, Germany, Belgium, Greece, Slovenia, Netherlands Denmark (7), Sweden (7), notheren Norway (23), England (26), Finland (27), Libya (28), Croatia (29), Scotland (7), Greece (24)
t044 (1) 333 (93.3)
t131 (1) 9 (2.5)
t376 (1) 8 (2.2)
t639 (1) 2 (0.6)
t237 (1) 1 (0.3)
t1199 (1) 1 (0.3)
t1201 (1) 1 (0.3)
t1206 (1) 1 (0.3)
t1200 (†) 1 (0.3)
ST30 (30) 20 (4.8) New Zealand, Western Samoa (4) Netherlands, Australia, Japan, Switzerland, Singapore, China, French Polynesia Sweden (30), Brazil (31), Uruguay (32), England (26), Hong Kong (10)
t019 (2) 17 (75.0)
t021 (2) 1 (5.0)
t318 (2) 1 (5.0)
t1273 (2) 1 (5.0)
ST37 (30) 1 (0.2) Netherlands
t914 (2) 1 (100.0)
ST93 4 (1.0) Australia (4)
t202 (s) 4 (100.0)
ST1 32 (7.7) USA (4) France, Singapore Switzerland (28), Canada (33)
t128 (3) 18 (56.2)
t125 (3) 3 (9.4)
t558 (3) 1 (3.1)
t175 (7) 8 (25.0)
t1274 (7) 1 (3.1)
t1272 (s) 1 (3.1)

*PVL, Panton-Valentine leukodin; CA-MRSA, community-acquired methicillin-resistant Staphylococcus aureus; agr, accessory gene regulator; ST, sequence type; CC, clonal complexes; spa CC, spa clonal complexes.
†Excluded because <3 repeats; s, singleton.

Main Article

  1. Naimi  TS, LeDell  KH, Como-Sabetti  K, Borchardt  SM, Boxrud  DJ, Etienne  J, Comparison of community- and health care–associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290:297684. DOIPubMedGoogle Scholar
  2. Bocchini  CE, Hulten  KG, Mason  EO Jr, Gonzalez  BE, Hammerman  WA, Kaplan  SL. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. 2006;117:43340. DOIPubMedGoogle Scholar
  3. Garnier  F, Tristan  A, Francois  B, Etienne  J, Delage-Corre  M, Martin  C, Pneumonia and new methicillin-resistant Staphylococcus aureus clone. Emerg Infect Dis. 2006;12:498500.PubMedGoogle Scholar
  4. Vandenesch  F, Naimi  T, Enright  MC, Lina  G, Nimmo  GR, Heffernan  H, Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:97884.PubMedGoogle Scholar
  5. Dufour  P, Gillet  Y, Bes  M, Lina  G, Vandenesch  F, Floret  D, Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis. 2002;35:81924. DOIPubMedGoogle Scholar
  6. Wannet  WJ, Heck  ME, Pluister  GN, Spalburg  E, van Santen  MG, Huijsdans  XW, Panton-Valentine leukocidin positive MRSA in 2003: the Dutch situation. Euro Surveill. 2004;9:289.PubMedGoogle Scholar
  7. Faria  NA, Oliveira  DC, Westh  H, Monnet  DL, Larsen  AR, Skov  R, Epidemiology of emerging methicillin-resistant Staphylococcus aureus (MRSA) in Denmark: a nationwide study in a country with low prevalence of MRSA infection. J Clin Microbiol. 2005;43:183642. DOIPubMedGoogle Scholar
  8. Roberts  JC, Krueger  RL, Peak  KK, Veguilla  W, Cannons  AC, Amuso  PT, Community-associated methicillin-resistant Staphylococcus aureus epidemic clone USA300 in isolates from Florida and Washington. J Clin Microbiol. 2006;44:2256. DOIPubMedGoogle Scholar
  9. Pan  ES, Diep  BA, Charlebois  ED, Auerswald  C, Carleton  HA, Sensabaugh  GF, Population dynamics of nasal strains of methicillin-resistant Staphylococcus aureus—and their relation to community-associated disease activity. J Infect Dis. 2005;192:8118. DOIPubMedGoogle Scholar
  10. Ho  PL, Cheung  C, Mak  GC, Tse  CW, Ng  TK, Cheung  CH, Molecular epidemiology and household transmission of community-associated methicillin-resistant Staphylococcus aureus in Hong Kong. Diagn Microbiol Infect Dis. 2006;[Sep 19; Epub ahead of print]
  11. Vlack  S, Cox  L, Peleg  AY, Canuto  C, Stewart  C, Conlon  A, Carriage of methicillin-resistant Staphylococcus aureus in a Queensland Indigenous community. Med J Aust. 2006;184:5569.PubMedGoogle Scholar
  12. Hsu  LY, Tristan  A, Koh  TH, Bes  M, Etienne  J, Kurup  A, Community associated methicillin-resistant Staphylococcus aureus, Singapore. Emerg Infect Dis. 2005;11:3412.PubMedGoogle Scholar
  13. Moran  GJ, Krishnadasan  A, Gorwitz  RJ, Fosheim  GE, McDougal  LK, Carey  RB, Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:66674. DOIPubMedGoogle Scholar
  14. Del Giudice  P, Blanc  V, Durupt  F, Bes  M, Martinez  JP, Counillon  E, Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections. Br J Dermatol. 2006;154:11824. DOIPubMedGoogle Scholar
  15. Jarraud  S, Mougel  C, Thioulouse  J, Lina  G, Meugnier  H, Forey  F, Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect Immun. 2002;70:63141. DOIPubMedGoogle Scholar
  16. Oliveira  DC, de Lencastre  H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2002;46:215561. DOIPubMedGoogle Scholar
  17. Tristan  A, Ying  L, Bes  M, Etienne  J, Vandenesch  F, Lina  G. Use of multiplex PCR to identify Staphylococcus aureus adhesins involved in human hematogenous infections. J Clin Microbiol. 2003;41:44657. DOIPubMedGoogle Scholar
  18. Strommenger  B, Kettlitz  C, Werner  G, Witte  W. Multiplex PCR assay for simultaneous detection of nine clinically relevant antibiotic resistance genes in Staphylococcus aureus. J Clin Microbiol. 2003;41:408994. DOIPubMedGoogle Scholar
  19. Mellmann  A, Friedrich  AW, Rosenkotter  N, Rothganger  J, Karch  H, Reintjes  R, Automated DNA sequence-based early warning system for the detection of methicillin-resistant Staphylococcus aureus outbreaks. PLoS Med. 2006;3:e33. DOIPubMedGoogle Scholar
  20. Harmsen  D, Claus  H, Witte  W, Rothganger  J, Turnwald  D, Vogel  U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41:54428. DOIPubMedGoogle Scholar
  21. Sammeth  M, Weiniger  T, Harmsen  D, Stoye  J. Alignment of Tandem Repeats with Excision, Duplication, Substitution and Indels (EDSI). Proceedings of WABI, Mallorca, Spain, 2005 Oct 3–6. In: Casadio R, Myers G, editors. Algorithms in bioinformatics. Vol. 3692. New York: Springer-Verlag; 2005.
  22. Enright  MC, Day  NP, Davies  CE, Peacock  SJ, Spratt  BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol. 2000;38:100815.PubMedGoogle Scholar
  23. Hanssen  AM, Fossum  A, Mikalsen  J, Halvorsen  DS, Bukholm  G, Sollid  JU. Dissemination of community-acquired methicillin-resistant Staphylococcus aureus clones in northern Norway: sequence types 8 and 80 predominate. J Clin Microbiol. 2005;43:211824. DOIPubMedGoogle Scholar
  24. Chini  V, Petinaki  E, Foka  A, Paratiras  S, Dimitracopoulos  G, Spiliopoulou  I. Spread of Staphylococcus aureus clinical isolates carrying Panton-Valentine leukocidin genes during a 3-year period in Greece. Clin Microbiol Infect. 2006;12:2934. DOIPubMedGoogle Scholar
  25. Wang  CC, Lo  WT, Chu  ML, Siu  LK. Epidemiological typing of community-acquired methicillin-resistant Staphylococcus aureus isolates from children in Taiwan. Clin Infect Dis. 2004;39:4817. DOIPubMedGoogle Scholar
  26. Holmes  A, Ganner  M, McGuane  S, Pitt  TL, Cookson  BD, Kearns  AM. Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency, characterization, and association with clinical disease. J Clin Microbiol. 2005;43:238490. DOIPubMedGoogle Scholar
  27. Salmenlinna  S, Lyytikainen  O, Vuopio-Varkila  J. Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis. 2002;8:6027.PubMedGoogle Scholar
  28. Harbarth  S, Francois  P, Shrenzel  J, Fankhauser-Rodriguez  C, Hugonnet  S, Koessler  T, Community-associated methicillin-resistant Staphylococcus aureus, Switzerland. Emerg Infect Dis. 2005;11:9625.PubMedGoogle Scholar
  29. Krzyszton-Russjan  J, Tambic-Andrasevic  A, Bukovski  S, Sabat  A, Hryniewicz  W. First community-acquired methicillin-resistant Staphylococcus aureus (MRSA) strains in Croatia. Clin Microbiol Infect. 2006;12:6978. DOIPubMedGoogle Scholar
  30. Miklasevics  E, Haeggman  S, Balode  A, Sanchez  B, Martinsons  A, Olsson-Liljequist  B, Report on the first PVL-positive community acquired MRSA strain in Latvia. Euro Surveill. 2004;9:2930.PubMedGoogle Scholar
  31. Ribeiro  A, Dias  C, Silva-Carvalho  MC, Berquo  L, Ferreira  FA, Santos  RN, First report of infection with community-acquired methicillin-resistant Staphylococcus aureus in South America. J Clin Microbiol. 2005;43:19858. DOIPubMedGoogle Scholar
  32. Ma  XX, Galiana  A, Pedreira  W, Mowszowicz  M, Christophersen  I, Machiavello  S, Community-acquired methicillin-resistant Staphylococcus aureus, Uruguay. Emerg Infect Dis. 2005;11:9736.PubMedGoogle Scholar
  33. Mulvey  MR, MacDougall  L, Cholin  B, Horsman  G, Fidyk  M, Woods  S. Community-associated methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis. 2005;11:84450.PubMedGoogle Scholar
  34. Otsuka  T, Saito  K, Dohmae  S, Takano  T, Higuchi  W, Takizawa  Y, Key adhesin gene in community-acquired methicillin-resistant Staphylococcus aureus. Biochem Biophys Res Commun. 2006;346:123444. DOIPubMedGoogle Scholar
  35. Seybold  U, Kourbatova  EV, Johnson  JG, Halvosa  SJ, Wang  YF, King  MD, Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care–associated blood stream infections. Clin Infect Dis. 2006;42:64756. DOIPubMedGoogle Scholar
  36. Kourbatova  EV, Halvosa  JS, King  MD, Ray  SM, White  N, Blumberg  HM. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA 300 clone as a cause of health care–associated infections among patients with prosthetic joint infections. Am J Infect Control. 2005;33:38591. DOIPubMedGoogle Scholar
  37. Ramdani-Bouguessa  N, Bes  M, Meugnier  H, Forey  F, Reverdy  ME, Lina  G, Detection of methicillin-resistant Staphylococcus aureus strains resistant to multiple antibiotics and carrying the Panton-Valentine leukocidin genes in an Algiers hospital. Antimicrob Agents Chemother. 2006;50:10835. DOIPubMedGoogle Scholar
  38. Maier  J, Melzl  H, Reischl  U, Drubel  I, Witte  W, Lehn  N, H. Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus in Germany associated with travel or foreign family origin. Eur J Clin Microbiol Infect Dis. 2005;24:6379. DOIPubMedGoogle Scholar
  39. Gillet  Y, Issartel  B, Vanhems  P, Fournet  JC, Lina  G, Bes  M, Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet. 2002;359:7539. DOIPubMedGoogle Scholar
  40. Voyich  JM, Otto  M, Mathema  B, Braughton  KR, Whitney  AR, Welty  D, Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease? J Infect Dis. 2006;194:176170. DOIPubMedGoogle Scholar

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Page updated: June 28, 2010
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