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Volume 17, Number 6—June 2011
Letter

Lethal Necrotizing Pneumonia Caused by an ST398 Staphylococcus aureus Strain

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To the Editor: The prevalent colonization of livestock with methicillin-resistant Staphylococcus aureus (MRSA) sequence type (ST) 398 in many countries is a cause for consternation. However, understanding of the emergence of these organisms and their public health implications is embryonic. The perceptions that all MRSA found in livestock are of ST398 lineage or that livestock are the only reservoirs of ST398 oversimplify a complex epidemiology, therefore, prudence is required when attributing human infections with S. aureus ST398 to livestock reservoirs. The fatal infection of a young girl with ST398 methicillin-susceptible S. aureus (MSSA) is tragic (1). However, the conclusion by the authors that “the spread of S. aureus ST398 among livestock is a matter of increasing concern because strains of this sequence type were able to acquire PVL [Panton-Valentine leukocidin] genes” is misleading.

The authors report no history of livestock exposure and the spa type reported (t571) is relatively rare among livestock isolates (2,3). The isolate from the fatal case was tetracycline-susceptible and positive for PVL toxin, while livestock ST398 isolates have been almost uniformly tetracycline resistant and PVL negative. Notably, spa type t571 ST398 MSSA was detected in 9 families from the Dominican Republic living in Manhattan, New York, without contact with livestock (4). Furthermore, t571 was the only spa type of MSSA identified in a study in the Netherlands of ST398 isolates, including 3 independent cases of nosocomial bacteremia in Rotterdam with no apparent livestock contact (5). spa type t571 was the predominant (11%) MSSA type in patients at a Beijing, China, hospital (6). More recently, a study of t571 MSSA strains from cases of bloodstream infections in France determined that the isolates differed from pig-borne strains and shared similarities with strains from humans in China and virulent USA300 strains (7). These observations concur with a hypothesis that ST398 strains of diverse genotype and geographic origin may also be epidemiologically distinct (8), and livestock contact is a notably inconsistent feature of invasive ST398 infections (5,710).

The possibility that variants of the ST398 lineage may persist in human populations without livestock contact should not be dismissed. The incidence and severity of clinical infections with ST398 S. aureus in livestock workers as yet have been minimal. Understanding the public health implications of ST398 S. aureus requires systematic investigation of their epidemiology in animals and humans. Human clinical cases of ST398 S. aureus infection should not be indiscriminately attributed to livestock, particularly if isolates are genotypically dissimilar to those occurring commonly in animals.

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Peter R. Davies, Elizabeth A. Wagstrom, and Jeffrey B. Bender

Author affiliations: Author affiliation: University of Minnesota, St. Paul, Minnesota, USA

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References

  1. Rasigade  J-P, Laurent  F, Hubert  P, Vandenesch  F, Etienne  J. Lethal necrotizing pneumonia caused by an ST398 Staphylococcus aureus strain. Emerg Infect Dis. 2010;16:1330. DOIPubMed
  2. de Neeling  AJ, van den Broek  MJ, Spalburg  EC, van Santen-Verheuvel  MG, Dam-Deisz  WD, Boshuizen  HC, High prevalence of methicillin resistant Staphylococcus aureus in pigs. Vet Microbiol. 2007;122:36672. DOIPubMed
  3. Graveland  H, Wagenaar  JA, Heesterbeek  H, Mevius  D, van Duikeren  E, Heedrik  D. Methicillin resistant Staphylococcus aureus ST398 in veal calf farming: human MRSA carriage related with animal antimicrobial usage and farm hygiene. PLoS ONE. 2010;5:e10990. DOIPubMed
  4. Bhat  M, Dumortier  C, Taylor  B, Miller  M, Vasquez  G, Yunen  J, Staphylococcus aureus ST398, New York City and Dominican Republic. Emerg Infect Dis. 2009;15:2857. DOIPubMed
  5. van Belkum  A, Melles  DC, Peeters  JK, van Leeuwen  WB, van Duijkeren  E, Huijsdens  XW, Methicillin-resistant and -susceptible Staphylococcus aureus sequence type 398 in pigs and humans. Emerg Infect Dis. 2008;14:47983. DOIPubMed
  6. Chen  H, Liu  Y, Jiang  X, Chen  M, Wang  H. Rapid change of methicillin-resistant Staphylococcus aureus clones in a Chinese tertiary care hospital over a 15-year period. Antimicrob Agents Chemother. 2010;54:18427. DOIPubMed
  7. van der Mee-Marquet  N, François  P, Domelier-Valentin  AS, Coulomb  F, Decreux  C, Hombrock-Allet  C, Emergence of unusual bloodstream infections associated with pig-borne-like Staphylococcus aureus ST398 in France. Clin Infect Dis. 2011;52:1523. DOIPubMed
  8. Stegger  M, Lindsay  JA, Sørum  M, Gould  KA, Skov  R. Genetic diversity in CC398 methicillin-resistant Staphylococcus aureus isolates of different geographical origin. Clin Microbiol Infect. 2010;16:10179.PubMed
  9. Ekkelenkamp  MB, Sekkat  M, Carpaij  N, Troelstra  A, Bonten  MJ. Endocarditis due to methicillin-resistant Staphylococcus aureus originating from pigs. Ned Tijdschr Geneeskd. 2006;150:24427.PubMed
  10. Welinder-Olsson  C, Florén-Johansson  K, Larsson  L, Öberg  S, Karlsson  L, Åhrén  C. Infection with Panton-Valentine leukocidin–positive methicillin-resistant Staphylococcus aureus t034. Emerg Infect Dis. 2008;14:12712. DOIPubMed

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Cite This Article

DOI: 10.3201/eid1706.101394

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Table of Contents – Volume 17, Number 6—June 2011

Page created: September 01, 2011
Page updated: September 01, 2011
Page reviewed: September 01, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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