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. 2014 Mar 7:6:ecurrents.outbreaks.e4df88f057fc49e2560a235e0f8f9fea.
doi: 10.1371/currents.outbreaks.e4df88f057fc49e2560a235e0f8f9fea.

Outbreak of Skin Infections Due to Panton-Valentine Leukocidin-Positive Methicillin-Susceptible Staphylococcus aureus in a French Prison in 2010-2011

Céline Bourigault  1 , Stéphane Corvec  2 , Virginie Brulet  3 , Pierre-Yves Robert  3 , Olivier Mounoury  3 , Chloé Goubin  3 , David Boutoille  4 , Bruno Hubert  5 , Michèle Bes  6 , Anne Tristan  6 , Jérôme Etienne  6 , Didier Lepelletier  2
Affiliations

Outbreak of Skin Infections Due to Panton-Valentine Leukocidin-Positive Methicillin-Susceptible Staphylococcus aureus in a French Prison in 2010-2011

Céline Bourigault et al. PLoS Curr. .

Abstract

Background. An outbreak of PVL-positive MSSA skin and soft tissue-infections (SSTIs) was suspected in May 2010 when recurrent SSTI was diagnosed in an inmate of a large prison in Nantes, France. Methods and findings. Retrospective and prospective investigations were performed. Microbiological characterisation was by DNA microarray testing (S. aureus genotyping - Identibac, Alere). We identified 14 inmates meeting our clinical and microbiological case definition for PVL-MSSA SSTI between March 2010 and April 2011. The SSTIs developed in tattooed areas in 4 patients and in areas shaved daily with a mechanical razor in 4 other patients. All case isolates exhibited a similar SmaI pulsed-field gel electrophoresis pattern. Microarray analysis showed that all 14 isolates harboured genes encoding PVL and enterotoxins (A, H, K, and Q) and belonged to clonal complex 1 (CC1). Individual and collective hygiene measures, education delivered to inmates and prison employees, and antibiotic treatment of SSTIs were successful in controlling the outbreak. No new cases were identified after April 2011. Routine screening for PVL-positive MSSA carriage was not feasible. Conclusions. Our data suggest that tattooing and shaving with mechanical razors may constitute risk factors for SSTIs among previously colonised inmates and contribute to the PVL-MSSA outbreak in the prison. Allowing inmates access to professional tattooists and to the hygiene and safety conditions available to people in the community would help to prevent tattoo-related infections.

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Figures

Epidemic curve of a PVL-positive methicillin-susceptible (MSSA) skin and soft-tissue infection (SSTI) outbreak in a French prison.
Epidemic curve of a PVL-positive methicillin-susceptible (MSSA) skin and soft-tissue infection (SSTI) outbreak in a French prison.
*Index case **Inmate believed to have introduced the epidemic strain in the prison Microbiological alert : the infection control team was alerted by the bacteriology laboratory following the repeated isolation of PVL-positive MSSA isolates. The x axis represents the date of PVL-toxin MSSA isolation from SSTIs.
Banding patterns determined by pulsed-field electrophoresis (PFGE) and dendrogram showing the genetic relatedness of 24 MSSA isolates recovered from inmates of the Nantes prison, France, in 2008-2011 (numbers 1 to 6 and 21 to 24: PVL-negative MSSA non-epidemic strains; numbers 7 to 20: PVL-positive MSSA epidemic strain).
Banding patterns determined by pulsed-field electrophoresis (PFGE) and dendrogram showing the genetic relatedness of 24 MSSA isolates recovered from inmates of the Nantes prison, France, in 2008-2011 (numbers 1 to 6 and 21 to 24: PVL-negative MSSA non-epidemic strains; numbers 7 to 20: PVL-positive MSSA epidemic strain).
None
Table 1. Characteristics of the 14 inmates who experienced PVL-positive MSSA skin and soft-tissue infections during the outbreak at the Nantes prison, France, in 2010-2011.
See this image and copyright information in PMC

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