Summary data for antimicrobial susceptibility profiles of 17 CA-MRSA isolates.

<p>Summary data for antimicrobial susceptibility profiles of 17 CA-MRSA isolates.</p

Map of Cambodia showing location of residence for 17 children with CA-MRSA infection presenting to the Angkor Hospital for Children in Siem Reap (A).

<p>Zoomed image of the three affected provinces. Numbers in brackets denote the number of children affected in each village (B).</p

Higher all-cause mortality associated with methicillin-resistant <i>S. aureus</i> (MRSA) but not with Panton-Valentine Leukocidin (PVL).

<p>Patients infected by MRSA had a greater all-cause mortality compared with patients infected by methicillin-susceptible <i>S. aureus</i> (MSSA) (p<0.001). Conversely, patients infected by PVL gene-positive <i>S. aureus</i> had a lower all-cause mortality compared with patients infected by PVL gene-negative <i>S. aureus</i> (p<0.001), an association that remained after adjustment for MRSA (p = 0.001).</p

Association between patient characteristics and outcome for 270 patients with <i>S. aureus</i> infection.

<p>Data are number (%) unless otherwise stated.</p>*<p>¹p value for the comparison between all-cause deaths and survivors.</p>*<p>²Denominator for occupation is number of patients over the age of 16 years which is given in each square.</p>*<p>³Past medical history of any underlying chronic medical conditions reported by the patient/relative or recorded in the medical notes.</p>*<p>⁴Immunosuppression from HIV (5 untreated, 3 on anti-retroviral therapy), chemotherapy (n = 3), untreated leukaemia (n = 1), radiotherapy (n = 1) or immunosuppressive medication including prednisolone more than 30 mg/day for more than 1 week (n = 17).</p>*<p>⁵Renal disease included end stage renal failure on long-term dialysis (n = 3; 2 on haemodialysis, 1 on peritoneal dialysis) and chronic renal failure (not on dialysis) due to diabetes mellitus (n = 14), systemic lupus erythematosus (n = 1), multiple myeloma (n = 1), glomerulonephritis (n = 1) or an unknown aetiology (n = 5).</p>*<p>⁶Cardiac disease comprised congenital heart disease (n = 4), valvular heart disease including rheumatic heart disease (n = 8), ischaemic heart disease (n = 8), or arrhythmias including heart block requiring pacemaker (n = 4).</p>*<p>⁷Lung disease comprised previously treated tuberculosis (n = 9), previous empyema (n = 1), lung cancer (n = 2), long-term tracheostomy (n = 1), chronic obstructive pulmonary disease (n = 2) or asthma (n = 1).</p

Discriminatory ability of two genotyping schemes and their respective loci.

#<p>p distances were estimated based on the Kimura Two Parameter nucleotide substitution model.</p><p>*dN/dS were estimated based on the Modified Nei-Gojobori Method with Jukes Cantor correction using MEGA 4. The values shown represent a combined value for <i>L. interrogans</i> and <i>L. kirschneri</i>. dN/dS was not estimated for <i>rrs2</i> as this does not encode a protein.</p

The range of sites of infection in patients and outcome associated with each clinical presentation.

*<p>¹p value for the comparison between all-cause deaths and survivors.</p>*<p>²Site of deep abscesses were muscle (n = 20), retroperitoneal space (n = 7), parotid gland (n = 7), liver (n = 3), lung (n = 2), epidural space (n = 2), eye (n = 2), oropharynx (n = 2) and spleen (n = 1).</p>*<p>³Other skin and soft tissue infections includes: necrotising fasciitis (n = 9), bedsore(s) (n = 6), pustules and carbuncles (n = 5), infected wound from trauma (n = 3), infected wound from tophi (n = 2), gangrene (n = 2), cellulitis (without other skin or soft tissue lesion) (n = 2) and infection of exfoliated skin following a severe drug reaction (n = 2).</p>*<p>⁴Orthopaedic material includes: internal fixation metalwork (n = 8) and a hip replacement (n = 1).</p>*<p>⁵Intravenous devices were peripheral cannulas (n = 4), central catheters (n = 3) and an umbilical catheter (n = 1).</p>*<p>⁶Endocarditis from transthoracic echocardiographic evidence of vegetations (n = 7); 1 case clinically but died prior to echocardiogram.</p>*<p>⁷Other infections include: urinary tract infection (n = 3), tenosynovitis (n = 2), Lemierre's syndrome (n = 1) and corneal ulcer (n = 1).</p>*<p>⁸Post-operative infections include: mediastinitis (n = 4; 3 following mitral valve replacement and 1 after coronary artery bypass graft), meningitis from infected bone flap surgical wound (n = 1) and abdominal wound (n = 1).</p

Neighbor joining trees of the 7L scheme and the 6 loci scheme.

<p>Neighbor joining trees reconstructed based on concatenated sequences of the 7L scheme (3,165 bp) (A), and the 6 loci scheme (2,844 bp) (B). Each bacterial strain is labeled by the following string: abbreviation of species name (Lint- <i>L. interrogans</i>, Lkir- <i>L. kirschneri</i>), strain name, and (for the 7L scheme only) sequence type (ST).</p

Timely effective antibiotic therapy and procedures for infectious source control significantly improved outcome.

<p>Administration of an effective antibiotic on the same day as the positive culture was taken significantly reduced all-cause mortality (p<0.001), as did undergoing a procedure for infectious source control (p<0.001).</p

Sliding window analysis of concatenated sequence of all 13 loci.

<p>Sliding window analysis of concatenated sequence of all 13 loci, carried out using DNAsp v 5 using a window size of 400-bp, a step size of 50-bp, and points based on the mid-point of each window (i.e. the first point is at position 200). The names of the individual loci are shown. Three plots are given to represent the level of polymorphism within each of the two species, and the level of diversity between them. In terms of the within species variation, there is little difference between the two schemes and both point to generally higher levels of variation within <i>L. kirschneri</i> than <i>L. interrogans</i>. However, there are two loci used in the 6L scheme that are highly conserved between species (<i>lipL32</i> and <i>rrs2</i>), which means that in general the 7L scheme provides better between-species resolution.</p

Primers for 6 locus genotyping scheme used during this study [39].

<p>Primers for 6 locus genotyping scheme used during this study <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001374#pntd.0001374-Thaipadungpanit1" target="_blank">[39]</a>.</p