Outbreak of Skin Infections Due to Panton-Valentine Leukocidin-Positive Methicillin-Susceptible Staphylococcus aureus in a French Prison in 2010-2011

Céline Bourigault,Anne Tristan,Didier Lepelletier,Bruno Hubert,David Boutoille,Michèle Bes,Jérôme Etienne,Pierre-Yves Robert,Virginie Brulet,Olivier Mounoury,Stéphane Corvec,Chloé Goubin

doi:10.1371/currents.outbreaks.e4df88f057fc49e2560a235e0f8f9fea

Abstract

Background. An outbreak of PVL-positive MSSA skin and soft tissue-infections (SSTIs) was suspected in May 2010 when recurrent SSTI was diagnosed in an inmate of a large prison in Nantes, France. Methods and findings. Retrospective and prospective investigations were performed. Microbiological characterisation was by DNA microarray testing (S. aureus genotyping - Identibac, Alere). We identified 14 inmates meeting our clinical and microbiological case definition for PVL-MSSA SSTI between March 2010 and April 2011. The SSTIs developed in tattooed areas in 4 patients and in areas shaved daily with a mechanical razor in 4 other patients. All case isolates exhibited a similar SmaI pulsed-field gel electrophoresis pattern. Microarray analysis showed that all 14 isolates harboured genes encoding PVL and enterotoxins (A, H, K, and Q) and belonged to clonal complex 1 (CC1). Individual and collective hygiene measures, education delivered to inmates and prison employees, and antibiotic treatment of SSTIs were successful in controlling the outbreak. No new cases were identified after April 2011. Routine screening for PVL-positive MSSA carriage was not feasible. Conclusions. Our data suggest that tattooing and shaving with mechanical razors may constitute risk factors for SSTIs among previously colonised inmates and contribute to the PVL-MSSA outbreak in the prison. Allowing inmates access to professional tattooists and to the hygiene and safety conditions available to people in the community would help to prevent tattoo-related infections.

Highlights

Staphylococcus aureus commonly resides as a commensal on human skin and mucous membranes
Our data suggest that tattooing and shaving with mechanical razors may constitute risk factors for soft-tissue infections (SSTIs) among previously colonised inmates and contribute to the Panton-Valentine leukocidin (PVL)-methicillin-susceptible S. aureus (MSSA) outbreak in the prison
Panton-Valentine leukocidin (PVL) production by S. aureus is associated with both SSTIs and severe infections such as necrotizing pneumonia. 2,3,4 PVL can be produced by both methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains

Summary

Introduction

Staphylococcus aureus commonly resides as a commensal on human skin and mucous membranes. S. aureus can cause infections ranging from minor skin and soft-tissue infections (SSTIs) to lifethreatening pneumonia or toxin-mediated diseases. PVLproducing S. aureus strains are typically acquired in the community by healthy young children or adults. Community-acquired infections with PVL-producing S. aureus, most notably MRSA strains, have been documented in a broad range of defined populations such as children, native Americans, members of athletic teams, military recruits, and prison inmates.. In May 2010, a PVL-MSSA strain was identified at the Nantes University Hospital laboratory in an inmate of the Nantes prison evaluated for recurrent SSTI. An outbreak of PVL-positive MSSA skin and soft tissue-infections (SSTIs) was suspected in May 2010 when recurrent SSTI was diagnosed in an inmate of a large prison in Nantes, France

Methods

Results

Conclusion