Epidemiology of Staphylococcus aureus harboring the mecA or Panton-Valentine leukocidin genes in hospitals in Java and Bali, Indonesia

Abstract

Data of Staphylococcus aureus carriage in Indonesian hospitals are scarce. Therefore, the epidemiology of S. aureus among surgery patients in three academic hospitals in Indonesia was studied. In total, 366 of 1,502 (24.4%) patients carried S. aureus. The methicillin-resistant S. aureus (MRSA) carriage rate was 4.3%, whereas 1.5% of the patients carried Panton-Valentine leukocidin (PVL)-positive methicillin-sensitive S. aureus (MSSA). Semarang and Malang city (odds ratio [OR] 9.4 and OR 9.0), being male (OR 2.4), hospitalization for more than 5 days (OR 11.708), and antibiotic therapy during hospitalization (OR 2.6) were independent determinants for MRSA carriage, whereas prior hospitalization (OR 2.5) was the only one risk factor for PVL-positive MSSA carriage. Typing of MRSA strains by Raman spectroscopy showed three large clusters assigned type 21, 24, and 38, all corresponding to ST239-MRSA-SCCmec type III. In conclusion, MRSA and PVL-positive MSSA are present among patients in surgical wards in Indonesian academic hospitals.

Figures

Figure 1.

Clustering of methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive methicillin-sensitive S. aureus (MSSA) isolates from discharge patients in three hospitals in Indonesia as determined by Raman spectroscopy (RT: Raman type). Note: Figure displays a correlation matrix used to analyze Raman spectral relatedness between isolates. Red clusters indicate isolates that are indistinguishable based on the cut-off value. The grey areas indicate isolates that are non-related based on the similarity threshold. The potentially related isolates are shown by yellow areas to orange areas gradually. Cluster 21 includes MRSA isolates from Semarang: 5 isolates from discharge patients and 2 isolates from contact patients. Cluster 24 contains MRSA isolates from Semarang and Malang: 40 isolates from discharge patients, 18 isolates from contact patients, 1 isolate from hospital environment, 2 isolates from household members. In addition, this cluster contains PVL-positive MSSA Semarang isolates: 7 isolates from discharge patients, 1 isolate from contact patient, and 6 isolates from health care workers. Cluster 38 is consisted of MRSA isolates from Semarang and Malang: 21 isolates from discharge patients and 4 isolates from contact patients. One PVL-positive MSSA isolate belongs to cluster 38.

Figure 2.

Endemicity profile of Raman type 24 MRSA among discharge patients, contact patients, and hospital environment in a surgery ward in Dr. Kariadi hospital, Semarang, Indonesia.