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Journal of Clinical Microbiology, June 2007, p. 1798-1803, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.01747-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Differences in Clinical and Molecular Characteristics of Skin and Soft Tissue Methicillin-Resistant Staphylococcus aureus Isolates between Two Hospitals in Northern California{triangledown}

Debika Bhattacharya,1,{dagger} Heather Carleton,2 Chiaojung J. Tsai,1,{ddagger} Ellen Jo Baron,1 and Françoise Perdreau-Remington2*

Stanford University, Stanford, California,1 University of California—San Francisco, San Francisco, California2

Received 23 August 2006/ Returned for modification 5 October 2006/ Accepted 26 March 2007

Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) skin and soft tissue infections (SSTI) are associated with SCCmec IV and Panton-Valentine leukocidin (PVL) genes. CO-MRSA epidemiologic studies suggest that genotypic variation exists within one geographic region. We compared MRSA genotypes and demographic and clinical characteristics of patients with CO-MRSA SSTI between two regional medical centers. We also examined factors associated with SCCmec IV and PVL carriage. A total of 279 MRSA SSTI isolates from 2000 to 2002 at San Francisco General Hospital (SFGH) and Stanford University Hospital (SUH) were genotyped by pulsed-field gel electrophoresis and PCR for SCCmec and PVL genes. Medical records were reviewed for clinical characteristics. Ninety-three percent and 69% of MRSA SSTI were caused by CO-MRSA at SFGH and SUH, respectively. Patients with CO-MRSA SSTI at SFGH were more likely to be nonwhite, younger, homeless, and have no previous exposure to health care (P < 0.01). SFGH CO-MRSA strains were more likely to carry SCCmec type IV and PVL genes (90% and 55%, respectively) than SUH strains (29% and 16%, respectively). In multivariate analyses, nonwhite ethnicity was associated with both SCCmec type IV and PVL carriage (odds ratio [OR] of 2.65 and 95% confidence interval [CI] of 1.19 to 5.95 and OR of 1.94 and 95% CI of 1.03 to 3.65, respectively). ST8:USA300:IV became the dominant clone at SFGH, but not at SUH, by 2002. Despite geographic proximity, CO-MRSA SSTI exhibited differing SCCmec types, PVL carriage, and clonal dynamics. CO-MRSA SSTI at SUH were more likely to represent feral isolates of nosocomial origin. Clinicians should assess for nosocomial and community risk factors, realizing that different populations with CO-MRSA SSTI may require separate antimicrobial strategies.

* Corresponding author. Mailing address: Dept. of Medicine, Division of Infectious Diseases, University of California—San Francisco, San Francisco General Hospital, 1001 Potrero Ave., UCSF 1372, Bldg. 30, Room 330, San Francisco, CA 94110. Phone: (415) 206-5438. Fax: (415) 648-8425. E-mail: fpr{at}epi-center.ucsf.edu

{triangledown} Published ahead of print on 4 April 2007.

{dagger} Present address: Dept. of Medicine, University of California, Los Angeles, CA.

{ddagger} Present address: Dept. of Medicine, Vanderbilt University, Nashville, TN.

Journal of Clinical Microbiology, June 2007, p. 1798-1803, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.01747-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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