Staphylococcal scalded skin syndrome in an extremely low-birth-weight neonate: molecular characterization and rapid detection by multiplex and real-time PCR of methicillin-resistant Staphylococcus aureus.

Abstract

BACKGROUND:

  Staphylococcal scalded skin syndrome (SSSS), caused by methicillin-resistant Staphylococcus aureus (MRSA) producing exfoliative toxin (ET), is a life-threatening infection for neonates in neonatal intensive care units (NICUs). SSSS in extremely low-birth-weight (ELBW) neonates is rare. A new class of MRSA (community-acquired MRSA, CA-MRSA) has been emerging in the community. The aim of this study was to characterize MRSA from an ELBW neonate with SSSS, and to develop rapid detection methods for SSSS-associated and emerging pediatric MRSA.

METHODS:

  An ELBW infant in the NICU developed SSSS on day 16 after birth. Isolated MRSA was genetically characterized and compared with CA-MRSA from bullous impetigo (biCA-MRSA), which is positive for the ET and collagen-adhesin (CNA) genes in many cases, and the Panton-Valentine leucocidin (PVL) gene rarely. Specific primers and probes for five virulence genes (for ETA, ETB, ETD, PVL, CNA) were designed for multiplex polymerase chain reaction (PCR) and real-time PCR.

RESULTS:

  MRSA strain H5 from SSSS exhibited the genotype (ST91, spa416[t375], agr3, SCCmecIVa, CoaI), and possessed the ETB and CNA genes, similar to ST91 biCA-MRSA (albeit with a divergence). Multiplex PCR detected the ETB and CNA genes of strain H5, and real-time PCR detected strain H5 at as low as 10(2)  CFU/mL. The assays were 100% specific and 100% sensitive, for the five virulence genes.

CONCLUSION:

  ETB-positive ST91 MRSA, which was very similar to ST91 biCA-MRSA, was isolated from an ELBW infant with SSSS. The multiplex and real-time PCR assays specifically or quantitatively detected SSSS-associated and emerging pediatric MRSA.

• Authors: Da Shi, Shiro Ishii, Takashi Sato, Hajime Yamazaki, Masamichi Matsunaga, Wataru Higuchi, Tomomi Takano, Shizuka Yabe, Kenichi Tanaka, Tatsuo Yamamoto
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 53 Issue 2 Pg. 211-7 (Apr 2011) ISSN: 1442-200X [Electronic] Australia
• PMID: 20831651 (Publication Type: Journal Article)
• Copyright: © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

Chemical References

• Anti-Infective Agents
• Immunoglobulin G
• Immunologic Factors
• Dibekacin
• arbekacin

Topics

• Anti-Infective Agents (therapeutic use)
• Dibekacin (analogs & derivatives, therapeutic use)
• Humans
• Immunoglobulin G (therapeutic use)
• Immunologic Factors (therapeutic use)
• Infant, Extremely Low Birth Weight
• Infant, Newborn
• Infant, Premature
• Infant, Premature, Diseases (diagnosis, microbiology)
• Methicillin-Resistant Staphylococcus aureus (genetics)
• Polymerase Chain Reaction
• Staphylococcal Scalded Skin Syndrome (diagnosis, drug therapy, microbiology)