Clinical features and molecular characteristics of childhood community-associated methicillin-resistant Staphylococcus aureus infection in a medical center in northern Taiwan, 2012

Background: Since first reported in 2002, the rate of methicillin-resistant Staphylococcus aureus (MRSA) among childhood community-associated (CA) S. aureus infection in Taiwan increased significantly up to 2005. There have been no reports on this issue since then. Methods: We prospectively collected clinical S. aureus isolates from the patients < 19 years of age in a university-affiliated hospital in 2012. Only first isolate from each patient was included. The medical records were retrospectively reviewed and the patients were classified as CA or healthcare-associated (HA) by the standard epidemiologic criteria. Isolates as CA-MRSA were further characterized by pulsed-field gel electrophoresis, staphylococcal cassette chromosome (SCCmec) typing, and multilocus sequence typing. Results: A total of 409 S. aureus isolates were included, and 260 (63.6%) were MRSA. The proportion of MRSA among all S. aureus isolates in 2012 increased significantly (p < 0.001) compared to that in 2004-2005. Of the 181 CA-MRSA isolates, 86.2% were identified from pus or wound. Nine pulsotypes were identified with two major types (type D, 119 (65.7%); type C, 27 (14.9%). Most of the isolates carried either SCCmec IV (66 isolates, 36%) or VT (112 isolates, 62%). 128 isolates (71%) carried Panton-Valentine leukocidin (PVL) genes. Clonal complex (CC) 59 accounted for 146 isolates (80.7%) of two major pulsotypes, CC45 for 19 isolates, ST30 for 6 isolates and ST8 (USA 300) for 4 isolates. In addition to penicillin (100%), most isolates were resistant to erythromycin (81%) and clindamycin (79.3%). Conclusions: Around two-thirds of childhood community-associated S. aureus infections in northern Taiwan were MRSA. Though CC59 is still the prevalent community clone, several new clones emerged in northern Taiwan.