{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:22:27Z","timestamp":1787761347992,"version":"build-2784847793"},"reference-count":34,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T00:00:00Z","timestamp":1501545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Skin and soft tissue infections (SSTIs) caused by mupirocin-resistant\n            <jats:named-content content-type=\"genus-species\">Staphylococcus aureus<\/jats:named-content>\n            strains have recently increased in number in our settings. We sought to evaluate the characteristics of these cases over a 43-month period. Data for all community-acquired staphylococcal infections caused by mupirocin-resistant strains were retrospectively reviewed. Genes encoding products producing high-level resistance (HLR) to mupirocin (\n            <jats:italic>mupA<\/jats:italic>\n            ), fusidic acid resistance (\n            <jats:italic>fusB<\/jats:italic>\n            ), resistance to macrolides and lincosamides (\n            <jats:italic>ermC<\/jats:italic>\n            and\n            <jats:italic>ermA<\/jats:italic>\n            ), Panton-Valentine leukocidin (PVL) (\n            <jats:italic>lukS\/lukF<\/jats:italic>\n            -PV), exfoliative toxins (\n            <jats:italic>eta<\/jats:italic>\n            and\n            <jats:italic>etb<\/jats:italic>\n            ), and fibronectin binding protein A (\n            <jats:italic>fnbA<\/jats:italic>\n            ) were investigated by PCRs in 102 selected preserved strains. Genotyping was performed by SCC\n            <jats:italic>mec<\/jats:italic>\n            and\n            <jats:italic>agr<\/jats:italic>\n            typing, whereas clonality was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 437 cases among 2,137 staphylococcal infections were recorded in 2013 to 2016; they were all SSTIs with the exception of 1 case of primary bacteremia. Impetigo was the predominant clinical entity (371 cases [84.9%]), followed by staphylococcal scalded skin syndrome (21 cases [4.8%]), and there were no abscesses. The number of infections detected annually increased during the study years. All except 3 isolates were methicillin susceptible. The rates of HLR to mupirocin and constitutive resistance to clindamycin were 99% and 20.1%, respectively. Among the 102 tested strains, 100 (98%) were\n            <jats:italic>mupA<\/jats:italic>\n            positive and 97 (95%) were\n            <jats:italic>fusB<\/jats:italic>\n            positive, 26\/27 clindamycin-resistant strains (96.3%) were\n            <jats:italic>ermA<\/jats:italic>\n            positive, 83 strains (81.4%) were\n            <jats:italic>lukS\/lukF<\/jats:italic>\n            positive, 95 (93%) carried both\n            <jats:italic>eta<\/jats:italic>\n            and\n            <jats:italic>etb<\/jats:italic>\n            genes, and 99 (97%) were\n            <jats:italic>fnbA<\/jats:italic>\n            positive. Genotyping of methicillin-sensitive\n            <jats:named-content content-type=\"genus-species\">S. aureus<\/jats:named-content>\n            (MSSA) strains revealed that 96\/99 (96.7%) belonged to one main pulsotype, pulsotype 1, classified as sequence type 121 (ST121). The emergence of a single MSSA clone (ST121) causing impetigo was documented. Resistance to topical antimicrobials and a rich toxinogenic profile confer to this clone adaptability for spread in the community.\n          <\/jats:p>","DOI":"10.1128\/jcm.00406-17","type":"journal-article","created":{"date-parts":[[2017,6,8]],"date-time":"2017-06-08T00:40:33Z","timestamp":1496882433000},"page":"2529-2537","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":36,"title":["Emergence of a Staphylococcus aureus Clone Resistant to Mupirocin and Fusidic Acid Carrying Exotoxin Genes and Causing Mainly Skin Infections"],"prefix":"10.1128","volume":"55","author":[{"given":"Anastassios","family":"Doudoulakakis","sequence":"first","affiliation":[{"name":"Department of Microbiology, P. &amp; A. Kyriakou Children's Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Spiliopoulou","sequence":"additional","affiliation":[{"name":"National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Spyridis","sequence":"additional","affiliation":[{"name":"Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P. &amp; A. Kyriakou Children's Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Giormezis","sequence":"additional","affiliation":[{"name":"National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kopsidas","sequence":"additional","affiliation":[{"name":"Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P. &amp; A. Kyriakou Children's Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Militsopoulou","sequence":"additional","affiliation":[{"name":"National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Lebessi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, P. &amp; A. Kyriakou Children's Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tsolia","sequence":"additional","affiliation":[{"name":"Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P. &amp; A. Kyriakou Children's Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.meegid.2013.03.013"},{"key":"e_1_3_2_3_2","first-page":"2222","volume-title":"Nelson textbook of pediatrics","author":"Darmstadt GL","year":"2004","unstructured":"Darmstadt GL, Sidbury R. 2004. Cutaneous bacterial infections, p 2222\u20132227. In Behrman RE, Kliegman RM, Jenson HB (ed), Nelson textbook of pediatrics, 17th ed. Saunders, Philadelphia, PA.","edition":"17"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68231-7"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800029939"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00079-15"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12624"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-008-0513-7"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.9.3594-3597.2004"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr102"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a025437"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh028"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-011-1441-5"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1086\/605495"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins2051148"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3109\/00365548.2014.947317"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0058155"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01587-10"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0025716"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2012.03955.x"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/9.Supplement_4.S341"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.04.017"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.00112-12"},{"key":"e_1_3_2_24_2","first-page":"643","volume-title":"Koneman's color atlas and textbook of diagnostic microbiology","author":"Winn W","year":"2006","unstructured":"Winn W, Jr, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, Woods G. 2006. Koneman's color atlas and textbook of diagnostic microbiology, 6th ed, p 643\u2013648. Lippincott Williams and Wilkins, Philadelphia, PA.","edition":"6"},{"key":"e_1_3_2_25_2","volume-title":"CLSI document M100-S22","author":"Clinical and Laboratory Standards Institute","year":"2012","unstructured":"Clinical and Laboratory Standards Institute. 2012. Performance standards for antimicrobial susceptibility testing; 22nd informational supplement. CLSI document M100-S22. Clinical and Laboratory Standards Institute, Wayne, PA."},{"key":"e_1_3_2_26_2","unstructured":"EUCAST. 2010. European Committee on Antimicrobial Susceptibility Testing breakpoint tables for interpretation of MICs and zone diameters version 1.1. http:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Disk_test_documents\/EUCAST_breakpoints_v1.1.pdf."},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.11.4947-4955.2004"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.70.2.631-641.2002"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0143106"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/143872"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh197"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.33.9.2233-2239.1995"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01685-07"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.7.2155-2161.2002"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00759-10"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/JCM.00406-17","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/JCM.00406-17","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T10:09:37Z","timestamp":1646474977000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/JCM.00406-17"}},"subtitle":[],"editor":[{"given":"Robin","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":34,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1128\/JCM.00406-17"],"URL":"https:\/\/doi.org\/10.1128\/jcm.00406-17","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8]]},"assertion":[{"value":"2017-03-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-05-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-07-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}