To the Editor: Community strains of methicillin-resistant Staphylococcus aureus (MRSA) are increasingly seen in Australia, particularly in certain population subgroups, such as Pacific Islander1 and Aboriginal2 people. We report the case of an African with community MRSA to highlight its existence in yet another subgroup. Given the increase in people arriving in Australia from Africa under the Humanitarian Program (with around 8500 arrivals from Africa in 2004–2005)3 and their wide dispersal around the country, it is possible that African community MRSA will be seen increasingly in Australia.

A 53-year-old Burundi refugee presented with an infected wound overlying the left lateral malleolus after laceration 6 weeks previously in a Tanzanian refugee camp. An unknown antibiotic was given for 2 weeks before travel to Australia. On the patient’s arrival in this country, the wound appeared purulent, erythrocyte sedimentation rate was 82 mm/h (reference range [RR] < 10 mm/h), and C-reactive protein level was 9 IU/L (RR < 5 IU/L). Plain x-rays and bone scans suggested osteomyelitis.

A wound swab grew S. aureus, Streptococcus pyogenes and Pseudomonas species. The patient was initially given intravenous cefazolin, and then definitive therapy (for MRSA and S. pyogenes, ignoring the colonising pseudomonad) with oral clindamycin (450 mg three times daily). Clinical resolution was complete, and levels of acute-phase reactants returned to normal.

The antibiotic sensitivity pattern of the S. aureus isolate raised suspicion that it might be an unusual strain: it was resistant to methicillin, tetracycline and trimethoprim–sulfamethoxazole, but sensitive to erythromycin, clindamycin, ciprofloxacin, gentamicin, vancomycin, linezolid, mupirocin, rifampicin, fusidic acid and chloramphenicol.

The mecA gene was detected by polymerase chain reaction testing, confirming methicillin resistance. The organism possessed staphylococcal cassette chromosome mec (SCCmec) element type IV. The Panton–Valentine leukocidin gene, staphylococcal enterotoxins A to E and toxic shock syndrome toxin-1 were not detected. As DNA fingerprinting with standard pulsed-field gel electrophoresis showed a novel banding pattern, the “gold standard” of multilocus sequence typing was used for identification. This confirmed an ST140 allelic profile, which has not been seen previously in Australia.4 On the balance of probabilities, the isolate represents an African community MRSA strain, not previously detected in Australia.

Non-multiresistant community MRSA is not widely recognised in African countries. Hospital MRSA rates vary widely in Africa (eg, between 21% and 30% of all S. aureus isolates in Nigeria, Kenya and Cameroon, and fewer than 10% in Tunisia and Algeria5), but most are multiresistant.

Medical practitioners in Australia who treat African refugees need to be aware that pyogenic soft tissue infections could be caused by community MRSA, and these MRSA strains may have a different antibiotic sensitivity profile to Australian community MRSA strains. It is essential to take appropriate specimens for microbiological analysis (wound swabs and possibly blood cultures and/or tissue samples), as antibiotic susceptibility profiles are increasingly unpredictable.