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Risk Factors and Molecular Analysis of Panton-Valentine Leukocidin-Positive Methicillin-Resistant Staphylococcus aureus Colonization in Healthy Children

Lo, Wen-Tsung MD, PhD; Lin, Wei-Jen MD; Tseng, Min-Hua MD; Wang, Sheng-Ru MD; Chu, Mong-Ling MD; Wang, Chih-Chien MD, PhD

The Pediatric Infectious Disease Journal: August 2008 - Volume 27 - Issue 8 - p 713-718
doi: 10.1097/INF.0b013e31816f63b5
Original Studies

Background: Nasal carriage of Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) is associated with community associated disease. The risk factors for and characteristics of PVL-positive MRSA colonization in the healthy pediatric population are not well understood.

Methods: Anterior nares cultures were obtained from healthy children ≤14 years of age presenting for health maintenance visits or attending 1 of 8 kindergartens during a 3-year period. A case-control study and molecular typing studies were performed.

Results: A total of 131 (8.1%) of 1615 children had nares cultures positive for MRSA, and 25 (1.5%) were colonized with PVL-positive MRSA. Nasal colonization of PVL-positive MRSA was significantly higher in 2006 than in 2004 (2.8% versus 0.7%; P = 0.006). By multivariate analysis, antibiotic use during the past 12 months (odds ratio, 29.37; 95% confidence interval, 10.72–80.50; P < 0.001) was the major risk factor associated with PVL-positive MRSA colonization in healthy children. Comparison of hospital MRSA strains with the community colonization strains by antimicrobial susceptibility testing, macrolide-lincosamide-streptogramin resistance gene testing, staphylococcal cassette chromosome mec typing, exotoxin profiling, and pulsed-field gel electrophoresis typing revealed that clonal spread of PVL-positive MRSA distinct from clinical hospital strains contributed to the high PVL-positive MRSA burden in the community.

Conclusions: Nasal PVL-positive MRSA colonization in healthy children with no relationship to the hospital setting has increased significantly in the past 3 years, suggesting that it may be a major factor in the emergence of community-acquired MRSA disease in Taiwan. Previous antibiotic use was associated with PVL-positive MRSA colonization.

From the Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Accepted for publication February 20, 2008.

This study was supported by the National Science Council (grant NSC94-2314-B-016-029) and Tri-Service General Hospital (grant TSGH-C94-12 and TSGH-C95-11-S01).

Address for correspondence: Dr. Chih-Chien Wang, Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Section 2, Nei-hu 114, Taipei, Taiwan. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.