Characteristics of MRSA clones isolated from children with community onset MRSA infections (CO-MRSA), Argentina.

<p><i>agr</i> type, type of accessory gene regulator, ST: Sequence Type, SCC<i>mec</i>: Staphylococcal Cassette Chromosome <i>mec</i>, PFGE, Pulsed Field Gel Electrophoresis; RIDOM <i>spa</i> type: staphylococcal protein A (<i>spa</i>) type assigned through the RIDOM databases (<a href="http://spaserver.ridom.de" target="_blank">http://spaserver.ridom.de</a>).</p>a<p>n (%), total number and % of strains with this molecular characteristic [PFGE subtype (only those more frequent are indicated) or ST or <i>spa</i> type or <i>SCCmec</i> type]. % is not expressed when only one isolate with this characteristic was detected.</p>b<p><i>pvl</i>, Panton-Valentine leukocidin genes (<i>lukS</i>-PV-<i>lukF</i>-PV); indicated as number and % of isolates harboring (PVl⁺) or not (PVL⁻) <i>pvl</i> genes.</p>c<p>virulence genes profile: From all virulence genes analyzed, only those detected are indicated (number and % of positive isolates is expressed when not all isolates harbor this virulence factor).</p>d<p>Drug resistance to non-β-Lactams (%), is indicated as follows: Gentamicin (GEN), Ciprofloxacin (CIP), Erythromycin (ERY), Clindamycin (CLIc and CLIi: constitutive and inducible resistance to macrolides, lincosamide and streptogramine B, respectively), rifampin (RIF), chloramphenicol (CHL), trimethoprim/sulfamethoxazole (SXT) and minocycline (MIN) (%) of strains resistant to these antibiotics within each pulsotype is indicated when more than one isolate was detected. h-VISA (1): means one isolate belonging to this clone with phenotype h-VISA.</p>e<p>IV NT: SCC<i>mec</i> type IV non typable.</p>f<p>Vr: SCC<i>mec</i> related to V.</p

Evolution of community-associated <i>Staphylococcus aureus</i> infections from children in Cordoba-Argentina, 2003–2008.

<p>Evolution of the rates of all community-associated <i>Staphylococcus aureus</i> infections: <i>i)</i> methicillin-resistant <i>S. aureus</i> (CA-MRSA) infections [total (squares) and invasive-INVI (circles)], and <i>ii)</i> total methicillin-susceptible <i>S. aureus</i> (CA-MSSA) infections (triangles) in Córdoba children's hospitals, [H1 (CBAH1): 2003–2008: filled figures, and in H1, H2 and H3 (CBAH1-3): 2005 vs 2007–2008: empty figures] <i>iii)</i> methicillin-resistant community-associated <i>Staphylococcus aureus</i> infections caused by the ST5-IV-PVL⁺clone [total (gray squares) and invasive (INVI) (gray circles)] in H1 (CBAH1): 2003–2008.</p

Genotypes of methicillin resistant <i>S. aureus</i> (MRSA) isolates recovered from children with Community-onset infections (invasive and non-invasive) in central, northen and eastern regions of Argentina, by epidemiologic case classification.

<p><b>INVI</b>: Invasive infections.</p>a<p>CBAH1-H3: Prospective surveillance of CO-<i>S. aureus</i> infections in children from three children's hospitals of Córdoba (CBAH1, CBAH2 and CBAH3) 2007 and 2008.</p>b<p>CSACHARG and: Prospective surveillance of CO-<i>S. aureus</i> infections in children from Argentina, 2007 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030487#pone.0030487-Paganini1" target="_blank">[16]</a>.</p>c<p>Genotypes are denoted as: type (by PFGE)-Sequence Type (ST by MLST)-SCC<i>mec</i> type.</p

Characteristics, incidence of CA-MRSA infections and location of children's hospitals of northern, eastern and central of Argentina, 2007.

a<p>Number of all CA-MRSA isolates detected in the three Cordoba children's hospitals during 2007 and those recovered in each hospital from the surveillance study for community onset <i>S. aureus</i> infections in children from Argentina-(CSACHARG) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030487#pone.0030487-Paganini1" target="_blank">[16]</a>.</p>b<p>annual visits: include outpatient facility and emergency service.</p>c<p>Incidence: Number of cases/100,000 annual visits.</p

Molecular characteristics and proportion from different regions of Argentina of dominant community methicillin-resistant-<i>Staphylococcus aureus</i> clones.

<p><b>A</b>. PFGE pattern analysis for representative isolates belonging to the most prevalent subtypes of community-onset-MRSA clones (CA-MRSA and HA-MRSA) detected in central, eastern and northern regions of Argentina during 2007–2008. The schematic presentation of <i>SmaI</i> restriction patterns (middle) and dendrogram (left) by the unweighted-pair group method using average linkage clusterings are shown. Genotypes are denoted as subtype (by PFGE)-ST (by MLST)-SCC<i>mec</i> type-<i>spa</i> type (right). CA-MRSA clones appear in gray. The presence (+) or absence (−) of <i>pvl</i> genes (by PCR) is also indicated for each subtype; strains with and other without <i>pvl</i> genes belonging to the same PFGE subtype (I9) are indicated as +/−. The PFGE pattern of USA300-0114 (ST8-IVa-<i>t008</i>-ACME+) is shown for comparison purposes. The first (A1-ST5-I-t149-Cordobes/Chilean), second (B1-ST239-IIIA-t037-Brazilian) and third (C1-ST100-IVNv-t002-Pediatric) more frequent HA-MRSA clones in our country, detected among community-onset MRSA infections, are also shown (dotted gray). <b>B</b>: Proportion of CA-MRSA clones among representative isolates from different regions of Argentina in 2007.</p

Demographic and clinical characteristics of children with Community-onset methicillin resistant <i>S. aureus</i> infections in central, northern and eastern regions of Argentina.

<p>CA-MRSA: Community-associated methicillin resistant <i>Staphylococcus aureus</i>, HACO-MRSA: Healthcare-associated community-onset methicillin resistant <i>Staphylococcus aureus</i> infections.</p>a<p>CBAH1-H3: Prospective surveillance of CO-<i>S. aureus</i> infections in children from three children's hospitals of Córdoba (CBAH1, CBAH2 and CBAH3), 2007 and 2008.</p>b<p>CSACHARG: Prospective surveillance of CO-<i>S. aureus</i> infections in children from Argentina, 2007 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030487#pone.0030487-Paganini1" target="_blank">[16]</a>.</p>c<p><i>P</i> values are based on chi-square test or Fisher's exact test, as appropriate, for CA-MRSA,CBAH1-H3 vs. CA-MRSA, CSACHARG and total CA-MRSA vs. HACO-MRSA comparisons by each of categorical variables (males and infection type); <i>p</i><0.05 was considered statistically significant.</p>d<p>Values are number of patients and the percentages are indicated in parentheses. [n]: number of patients with this secondary infection focus (CA-MRSA: 342 infections in 312 patients).</p>e<p>Abscess and cellulites: include 9 cases of impetigo(1 from CBAH1-H3 and 8 cases from CSACHARG).</p>f<p>Deep abscess included: breast (2 cases), psoas (4 cases), liver and renal (1 case each one) abscesses.</p