Style B 36 by 48 wide

1
MRSA and the Cook County Jail Analysis of
Isolates That May Be From a Reservoir of
Community- Associated Infections Lena Kuo, MD,
Robert Daum, MD, Susan Boyle, PhD, Michael David,
MD, Daniel Kim Department of Pediatric Infectious
Disease
Introduction
Hypothesis
Results
Results
Conclusions

• Staphylococcus aureus is a common cause of skin
  and soft tissue infections, pneumonia, septic
  arthritis, osteomyelitis, and sepsis
• Methicillin-resistant Staph aureus (MRSA) has
  become an increasingly prevalent threat to public
  health in the US and worldwide
• MRSA was originally confined to hospitals, health
  care institutions
• Increasingly, MRSA isolates with distinct
  genotypes have caused community- associated
  infections and outbreaks, notably in populations
  without traditional risk factors
• Reservoirs for community- associated MRSA have
  yet to be identified
• Outbreaks of CA- MRSA have been identified in
  multiple settings with crowding and/ or poor
  hygienic conditions, including athletic teams,
  daycare, military, jails/prison
• Detainees in prisons and jails are
  well-recognized reservoirs for tuberculosis
• Infectious agents that are spread by casual
  contact, frequently isolated in asymptomatic
  carriers, and difficult to eradicate may spread
  among the prison and jail population and then
  into the community (such as MRSA)
• Detainment at a jail or prison has become
  increasingly prevalent in the adult population 1
  in 110 and 1 in 1656 women have been in jail or
  prison 10.4 of black men between 25-29 were
  imprisoned
• Monitoring of etiologic agents of skin infections
  at the Cook County Jail between March 2004 and
  August 2004 70.9 (122/ 172) skin infections
  grew MRSA

Jail serves as a reservoir for CA- MRSA in the
community of Chicago
Of the jail isolates molecularly characterized,
the majority are Resistant to
erythromycin and ß-lactam antibiotics
MLST sequence type 8 SCCmec type IV 1.
Antibiotic resistance profile is in concordance
with the antibiotic resistance profile found in
CA-MRSA strains 2. ST-8 is a very common sequence
type found in CA-MRSA infections 3. ST-1 has been
associated with severe staphylococcal sepsis in
children (MW2 CA-MRSA in North Dakota, 1999) 4.
SCCmec type IV is commonly found in CA-MRSA
isolates 5. Initial results of molecular
characterization of jail isolates suggest that
MRSA strains found in the jail represent the
same, or closely related, strains found in the
community of Chicago
III. SCCmec Typing (9 isolates)

• Antibiotic Resistance Profiles (18 isolates)
• 72 were resistant to only erythromycin and
  ß-lactams
• 11 were resistant to ß- lactams only
• 17 were were multi- drug resistant
• Multilocus Sequence Typing (37 isolates)

Specific Aims
mecA ccr 1-3 mecR1/PB PVL

• By multilocus sequence typing (MLST), SCCmec
  typing, and toxin gene identification (PVL),
  preliminarily determine
• The colonizing clones of MRSA found within the
  Cook County Jail
• Compare predominant clones found in the jail to
  those found in the community

Materials
61 MRSA isolates from infected detainees at the
Cook County Jail, collected between March-
December, 2004
Methods
Future Directions

• I. Antibiotic Resistance Profiling
• II. Multilocus Sequence Typing (MLST)
• Characterization of bacterial isolates using
  internal fragment sequences of seven housekeeping
  genes
• Sequences are between 450-500 bp long
• Different sequences are assigned as different
  alleles, determined by comparing sequences to
  known alleles in the MLST database
• Alleles at the 7 loci define the allelic profile,
  or sequence type
• Unambiguous descriptor for the S. aureus genotype
• Secondary to the nature of the housekeeping gene,
  allelic profile of isolates change very slowly
  over time
• MLST can identify relatedness of isolates and
  identify clones with serious disease
• III. SCCmec Typing
• SCCmec Staphylococcal chromosomal cassette
  mec, a mobile genetic element that contains the
  mecA region
• mecA gene encodes PBP2a, a penicillin binding
  protein that has decreased affinity for ß-lactam
  antibiotics
• SCCmec are classified into 5 types based on
  polymorphisms on conserved genes

Determine MRSA and MSSA new colonization rate of
detainees at the Cook County Jail Determine risk
factors associated with new MRSA or MSSA
colonization at the Cook County
Jail Characterize the clones associated with new
colonization
MLST typing of jail isolates P11- P17
confirmation gel electrophoresis of PCR product
Of the 37 isolates characterized, MLST were
as follows 86.5 (32/37) were type 8
8.1 (3/37) were type 5 2.7 (1/37) were type
1 2.7 (1/37) were type 474
Summary of Culture Results Cermak Health
Services March- August 2004
References
C P3 P4 P5 P27 C P57 P58 P59 P60
P61
Adcock P, Pastor P, Medley F, Patterson J, Murphy
T. Methicillin-Resistant Staphylococcal aureus in
Two Daycare Centers. J Infect Dis 1998 178
577-80. Baillargeon J, Kelley MF, Leach CT,
Baillargeon G, Pollack BH. Methicillin-Resistant
Staphylococcal aureus Infection in the Texas
Prison System. Clin Infect Dis 2004
38e92-95. Bonczar TP and Beck AJ. Lifetime
Likelihood of Going to State or Federal Prison.
Bureau of Justice Statistics, Office of Justice
Programs, 1997. Daum R, Ito T, Hiramatsu K,
Hussain F, Mongkolrattanothai K, Jamklang M,
Boyle-Vavra S. A Novel Methicillin-Resistance
Cassette in Community-Acquired Methicillin-Resista
nt Staphylococcus aureus Isolates of Diverse
Genetic Backgrounds. JID 2002 186 1344-7. Ma
XX, Ito T, Tiensasitorn C, Jamklnag M,
Chongtrakool P, Boyle-Vavra S, Daum RS, Hiramatsu
K. A Novel Type of Staphylococcal Chromosome mec
(SCCmec) Identified in Community-acquired
methicillin-resistant Staphylococcal aureus
strains of Chicago area. Antimicrob Agents and
Chemother 2002 46 1147-52. Mongkolrattanothai
K, Boyle-Vavra S, Kahana MD, Daum RS. Severe
Staphylococcal aureus Infections Caused By
Clonally-related Community- qcquired
Methicillin-suseptible and Methicillin-Resistant
Isolates. Clin Inf Dis 2003 37 1050-8.
SCCmec typing of jail isolates P3-P5, P27, P57-61
(from left to right ladder, positive control,
isolates P3-5, P27, positive control, P57-61)
Of the 9 isolates characterized by SCCmec typing,
89 (8/9) were SCCmec type IV 89 (8/9) were
PVL positive
Daum et al. JID 2002 186 1344-7
Cermak Health Services, March-August 2004