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BackgroundUSA300 produces Panton-Valentin leucocidin (PVL) and is known as a predominant community-associated methicillin-resistant Staphylococcus aureus (MRSA) strain in the United States, but it was extremely rare in Japan. We report here an outbreak of USA300 in people with HIV (PWH) in Tokyo, Japan.MethodsWe analyzed the cases of PVL-MRSA infection between 2010 and 2020 and screened for nasal colonization of PVL-MRSA in PWH who visited an HIV/AIDS referral hospital from December 2019 to March 2020. Whole-genome sequencing-based single nucleotide polymorphism (SNP) analysis was performed on these isolates.ResultsDuring the study period, a total of 21 PVL-MRSA infections in 14 patients were identified after 2014. The carriage prevalence was 4.3% (12/277) and PVL-MRSA carriers were more likely to have sexually transmitted infections (STIs) within a year compared with patients who had neither a history of PVL-MRSA infection nor colonization (33.3% [4/12] vs 10.1% [26/258]; P = .03). SNP analysis showed that all 26 isolates were ST8-SCCmecIVa-USA300. Twenty-four isolates were closely related (≤100 SNP differences) and had the nonsynonymous SNPs associated with carbohydrate metabolism and antimicrobial tolerance.ConclusionsAn outbreak of USA300 has been occurring among PWH in Tokyo and a history of STI was a risk of colonization.

Original publication





The Journal of infectious diseases

Publication Date





610 - 620


IMSUT Hospital, The University of Tokyo, Minato-ku, Tokyo, Japan.


Nose, Humans, Staphylococcal Infections, Sexually Transmitted Diseases, HIV Infections, Virulence Factors, Anti-Bacterial Agents, Prevalence, Retrospective Studies, Homosexuality, Male, Carrier State, Disease Outbreaks, Phylogeny, Drug Resistance, Multiple, Bacterial, Polymorphism, Single Nucleotide, Genome, Bacterial, Adult, Aged, Aged, 80 and over, Middle Aged, Tokyo, Male, Methicillin-Resistant Staphylococcus aureus, Young Adult, Molecular Typing, Whole Genome Sequencing