Background
MRSA is a major cause of skin and soft tissue infections (SSTIs) in healthcare and community settings globally. Community-acquired (CA)-MRSA has been reported sporadically in Israel but its role in SSTI is not clear.
Results
A total of 332 MRSA isolated from SSTI patients in 17 healthcare centers were analysed. All were mecA positive and the PVL toxin gene was found in 97 (29%). The average age of patients with PVL-positive strains was 32±24 years compared with 62±25 years for PVL-negative isolates (p<0.001). The most common spa types among PVL-positive isolates were t008 (51%), t019 (10%) and t044 (5%). The predominant PVL-positive molecular type was ST8-SCCmec IVa-USA300 (54%). ST30-SCCmec IVc-USA1100 (south west pacific clone) was the second most prevalent CA-MRSA (19% of PVL-positive strains; isolated in 9 laboratories). The European clone ST80-SCCmec IVa-t044 accounted for 5% of PVL-positive MRSA. The spread of the latter pandemic CA-MRSA clones in Israel has not yet been reported.
Antibiotic resistance among PVL-positive isolates was noted for ciprofloxacin (59%), erythromycin (46%), clindamycin (9%), fusidic acid (7%), gentamicin (4%), and trimethoprim/sulfamethoxazole (3%). The mupA gene (high level mupirocin resistance) was present in 31% of PVL-positive strains and in 16% of PVL-negative strains (20% in total).
Conclusions
Pandemic clones of CA-MRSA are a significant cause of MRSA SSTI in Israel. The predominant CA-MRSA clones were USA300 (ST8-IVa), USA1100 (ST30-IVc) and the European clone (ST80-IVa). USA300 strains, which seldom have been reported in Israel, were isolated from 16% of SSTI in this study.
