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Eurosurveillance, Volume 7, Issue 10, 06 March 2003
Articles

Citation style for this article: Wannet WJ. Virulent MRSA strains containing the Panton Valentine Leukocidin gene in the Netherlands. Euro Surveill. 2003;7(10):pii=2173. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2173

Virulent MRSA strains containing the Panton Valentine Leukocidin gene in the Netherlands

Wim Wannet (wim.wannet@rivm.nl), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.

Methicillin resistant Staphylococcus aureus (MRSA) strains possessing the Panton Valentine Leukocidin (PVL) gene have been detected in the Netherlands recently. The PVL gene encodes a highly potent toxin, which is involved in severe skin infections and necrotising pneumonia. PVL positive MRSA strains have also been noted in France (in healthy individuals; mean age 14 years), in the United States (for example, in the Los Angeles gay community, and in a large prison), and in Scotland (small outbreaks of skin abscesses in healthcare staff. The Scottish MRSA reference laboratory is now routinely screening both methicillin susceptible S. aureus (MSSA) and MRSA for the PVL gene). It has been suggested that the PVL MRSA is acquired in the community (1-3).

The PVL gene was detected by polymerase chain reaction (PCR) (1) in approximately 10% of all MRSA isolates sent to the Dutch institute of Public Health and the Environment (RIVM) national surveillance programme in the period 2000-2003. Molecular subtyping by pulsed field gel electrophoresis (PFGE) on the Dutch strains has shown a predominant clone, PFGE cluster 28. Although this clone is known to be epidemic in the Netherlands, it has not caused large outbreaks so far. The PFGE pattern of cluster 28 appears to be identical to the pattern of the French PVL MRSA clone.

Identical PVL MRSA isolates (PFGE cluster 206) were found recently in two Dutch HIV positive homosexual men. It is not yet known whether there is a link with the PVL MRSA strains isolated from men who have sex with men in the US.

About 90% of the PVL positive MRSA isolates in the Netherlands have been obtained from soft tissue infections and (deep) purulent wound infections, compared with 30% for PVL negative MRSA isolates. This significant increase in the seriousness of infections caused by PVL MRSA is a finding shared by the French group (1). The predominant Dutch clone (cluster 28) has so far been shown to be 100% resistant to fusidic acid, neomycin, and tetracycline. When testing all the PVL strains (cluster 28 plus others) the resistance percentages are approximately 60, 70, and 70, respectively. The cluster 28 clone in particular has a characteristic antibiotic resistance profile, which can be of use in the clinical laboratory.

Further studies will be performed in order to gain more insight into the microbiological and epidemiological background of these virulent MRSA strains. The combination of the PVL gene (virulence) and MecA gene (resistance) and proven epidemicity (cluster 28) makes this a well adapted pathogen, which can have severe implications, especially if further resistance markers are acquired.

References :
  1. Dufour P, Gillet Y, Bes M, Lina G, Vandenesch F, Floret D, et al. Community-acquired methicillin resistant Staphylococcus aureus in France: emergence of a single clone that produces Panton Valentine Leukocidin. Clin Infect Dis 2002; 35: 819-24.
  2. Gonzalez-Zorn B, Courvalin P. VanA-mediated high level glycopeptide resistance in MRSA. Lancet Infect Dis 2003; 3: 67-8.
  3. SCIEH. Community MRSA and Panton-Valentin leukocidin. SCIEH Weekly Report 2002; 36: 298.(http://www.show.scot.nhs.uk/scieh/PDF/pdf2002/0246.pdf)

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