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JAC Advance Access published online on September 20, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm309
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea

Eu Suk Kim1,{dagger}, Jin Su Song2,{dagger}, Hye Jin Lee3, Pyoeng Gyun Choe2, Kyung Hwa Park2, Jae Hyun Cho2, Wan Beom Park2, Sung-Han Kim2, Ji-Hwan Bang2, Dong-Min Kim4, Kyoung Un Park5, Sue Shin5, Mi Suk Lee6, Hee Jung Choi7, Nam Joong Kim2, Eui-Chong Kim5, Myoung-don Oh2, Hong Bin Kim2,3,* and Kang Won Choe2

1 Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Republic of Korea 2 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea 4 Department of Internal Medicine, Chosun University College of Medicine, Gwang-ju, Republic of Korea 5 Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea 6 Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan, Republic of Korea 7 Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea

Received 27 February 2007; returned 8 May 2007; revised 22 June 2007; accepted 27 July 2007

* Correspondence address. Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 463-707, Republic of Korea. Tel: +82-31-787-7021; Fax: +82-31-787-4052; E-mail: hbkimmd{at}snu.ac.kr

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA), originally restricted to hospitals, has emerged as a significant pathogen in the community. Although MRSA accounts for over 60% of S. aureus in tertiary hospitals in Korea, little is known about the epidemiology of community-associated MRSA (CA-MRSA).

Methods: From January to July 2005, a hospital laboratory-based survey was conducted in seven community-based or tertiary hospitals. The medical records and Health Insurance Review Agency databases were reviewed and MRSA isolated from patients without apparent risk factors was defined as CA-MRSA. Susceptibilities to 12 antibiotics were tested by the disc diffusion method. SCCmec typing, Panton–Valentine leucocidin (PVL) gene detection and multilocus sequence typing (MLST) were performed according to published protocols.

Results: Of 3251 S. aureus, 1900 (58.4%) were MRSA. CA-MRSA accounted for 112 (5.9%) of the MRSA. Of the 112 CA-MRSA isolates, 27 and 33 were found to be pathogens and colonizers, respectively. Fifty-two isolates from the patients with chronic otitis media were classified as ‘undetermined’. Most of the 27 CA-MRSA patients had skin and soft tissue infections or acute ear infections. None of the patients died during the study period. Among 72 isolates tested, 64% were multidrug-resistant. SCCmec type IVa was the most common type among the colonizers and pathogens. On MLST analysis, ST72 was predominant, but ST5 and ST239 were prevalent in the ‘undetermined’ group. None possessed the PVL gene.

Conclusions: Despite MRSA-endemic hospital settings, CA-MRSA infections are not common in Korea. A new clone of CA-MRSA, ST72-SCCmec type IVa without the PVL gene, is the most common form.

Key Words: S. aureus , CA-MRSA , Panton–Valentine leucocidin , epidemiology

{dagger} These authors contributed equally to this work.


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