Dissemination of the Methicillin Resistant Staphylococcus aureus (MRSA) Pediatric Clone (ST5-T002-IV-Pvl+) as a Major Cause of Community Associated (CA) Staphylococcal Infections in Bedouin Children, Southern Israel

Abstract

BackgroundPediatric CA-MRSA infections are emerging worldwide. High CA-MRSA carriage rates were previously described in healthy Bedouin children (Adler et al, J Clin Microbiol 2009). We assessed demographic, clinical and molecular characteristics of MRSA infections in children in southern Israel.MethodsSoroka University Medical Center microbiology laboratory serves the entire population of southern Israel, divided into two ethnic groups, Bedouin and Jews. All in-hospital MRSA isolates from children 0–18 years, obtained in 2016 were included.Clinical data were recorded from the hospital’s computerized records. Health-care associated (HA) and community-associated infections were defined according to the US Center for Disease Control and Prevention. All isolates were evaluated for staphylococcal cassette chromosome (SCCmec), Panton–Valentine leucocidin (PVL), Staphylococcus aureus protein A (spa) type as well as by pulsed-field-gel-electrophoresis (PFGE) and antimicrobial susceptibility testing.ResultsOverall 95 (18%) of S. aureus isolates were MRSA (Table 1). Twenty-five different MRSA strains were identified. 28 isolates (29.5% of all MRSA) belonged to a pediatric clone, rarely observed in Israel (SCC IV, PVL positive, spa type 002; all demonstrate identical PFGE fingerprints). 82% of infections caused by this clone were community-acquired and were mainly observed in young Bedouin children, causing skin and soft-tissue infections (SSTI). Comparisons between the new clone and other CA-MRSA and HA-MRSA strains are shown in Table 1. All isolates of the pediatric clone were susceptible to TMP/SMX, ciprofloxacin, gentamicin, tetracycline, rifampicin and vancomycin; 17.8% were nonsusceptible to erythromycin and clindamycin (Table 2).ConclusionThe pediatric CA-MRSA clone, previously described only in sporadic cases in Israel, is emerging among previously healthy, young Bedouin children, typically causing SSTI. Isolates are susceptible to a variety of non-β lactam antibiotics.Disclosures All authors: No reported disclosures.