Volume 13, Number 10—October 2007
Research
Rapid Increase of Genetically Diverse Methicillin-Resistant Staphylococcus aureus, Copenhagen, Denmark
Table 1
Community onset, community risk | Community onset, no risk | Hospital acquired in Denmark | Community onset, healthcare associated | Imported | |
---|---|---|---|---|---|
No. cases | 30 | 35 | 37 | 36 | |
Male, % | 67 | 46 | 57 | 42 | |
Median age, y (range) | 27 (1–74) | 32 (0–90) | 80 (28–94) | 82 (6–95) | |
Carrier, no. |
8 |
1 |
2 |
2 |
4† |
Type of infection, no. | |||||
SSTI | 22 | 29 | 17 | 23 | |
Blood | 0 | 0 | 2 | 2 | |
Deep-seated abscess, no. | 0 | 1 | 5 | 3 | |
UTI | 0 | 4 | 8 | 5 | |
LRTI |
0 |
0 |
3 |
1 |
1† |
Four most common CCs (87% of all isolates) | |||||
CC 8, % | 23 | 34 | 81 | 69 | |
t008, no. | 3 | 7 | 0 | 2 | |
t024, no. | 3 | 5 | 28 | 20 | |
CC 80, % | 20 | 34 | 3 | 0 | |
CC 30, % | 50 | 6 | 0 | 0 | |
CC 5, % | 3 | 11 | 5 | 8 | |
Other MLST types,% | 4 | 15 | 11 | 23 | |
PVL positive, % | 83 | 80 | 8 | 17 | |
SCCmec IV, % | 93 | 89 | 89 | 81 |
*MRSA, methicillin-resistant Staphylococcus aureus; SSTI, skin and soft tissue infection; UTI, urinary tract infection; LRTI, lower respiratory tract infection; CC, clonal complex; MLST, multilocus sequence typing; PVL, Panton-Valentine leukocidin; SCC, staphylococcal chromosome cassette.
†A t037/ST239-III was imported from Greece, where this MRSA is common (20); ST239 is closely related to ST8 and is the well-known pandemic Brazilian/Hungarian clone (21); t041/ST111 was imported from an Italian hospital; t003/ST225-II (New York clone) was imported from Germany; t354/ST22-IV, a variant of EMRSA15, was imported from Lanzarote (Spain); and t067/ST125-I was imported from Spain.
References
- Chambers HF. The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis. 2001;7:178–82. DOIPubMedGoogle Scholar
- Udo EE, Pearman JW, Grubb WB. Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect. 1993;25:97–108. DOIPubMedGoogle Scholar
- Vandenesch F, Naimi T, Enright MC, Lina G, Nimmo GR, Heffernan H, Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:978–84.PubMedGoogle Scholar
- Baba T, Takeuchi F, Kuroda M, Yuzawa H, Aoki K, Oguchi A, Genome and virulence determinants of high virulence community-acquired MRSA. Lancet. 2002;359:1819–27. DOIPubMedGoogle Scholar
- King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. 2006;144:309–17.PubMedGoogle Scholar
- Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290:2976–84. DOIPubMedGoogle Scholar
- Ochoa TJ, Mohr J, Wanger A, Murphy JR, Heresi GP. Community-associated methicillin-resistant Staphylococcus aureus in pediatric patients. Emerg Infect Dis. 2005;11:966–8.PubMedGoogle Scholar
- Faria NA, Oliveira DC, Westh H, Monnet DL, Larsen AR, Skov R, Epidemiology of emerging methicillin-resistant Staphylococcus aureus (MRSA) in Denmark: a nationwide study in a country with low prevalence of MRSA infection. J Clin Microbiol. 2005;43:1836–42. DOIPubMedGoogle Scholar
- Rosdahl VT, Knudsen AM. The decline of methicillin resistance among Danish Staphylococcus aureus strains. Infect Control Hosp Epidemiol. 1991;12:83–8. DOIPubMedGoogle Scholar
- Skov R, Smyth R, Larsen AR, Frimodt-Moller N, Kahlmeter G. Evaluation of cefoxitin 5 and 10 microg discs for the detection of methicillin resistance in staphylococci. J Antimicrob Chemother. 2005;55:157–61. DOIPubMedGoogle Scholar
- Westh H, Hougaard DM, Vuust J, Rosdahl VT. Prevalence of erm gene classes in erythromycin-resistant Staphylococcus aureus strains isolated between 1959 and 1988. Antimicrob Agents Chemother. 1995;39:369–73.PubMedGoogle Scholar
- Oliveira DC, de Lencastre H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2002;46:2155–61. DOIPubMedGoogle Scholar
- Murchan S, Kaufmann ME, Deplano A, de Ryck R, Struelens M, Zinn CE, Harmonization of pulsed-field gel electrophoresis protocols for epidemiological typing of strains of methicillin-resistant Staphylococcus aureus: a single approach developed by consensus in 10 European laboratories and its application for tracing the spread of related strains. J Clin Microbiol. 2003;41:1574–85. DOIPubMedGoogle Scholar
- Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol. 2000;38:1008–15.PubMedGoogle Scholar
- Shopsin B, Gomez M, Montgomery SO, Smith DH, Waddington M, Dodge DE, Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol. 1999;37:3556–63.PubMedGoogle Scholar
- Harmsen D, Claus H, Witte W, Rothgänger J, Claus H, Turnwald D, Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41:5442–8. DOIPubMedGoogle Scholar
- Boye K, Bartels MD, Andersen IS, Moller JA, Westh H. A new multiplex PCR for easy screening of methicillin-resistant Staphylococcus aureus SCCmec types I–V. Clin Microbiol Infect. 2007;13:725–7. DOIPubMedGoogle Scholar
- Johnsson D, Molling P, Stralin K, Soderquist B. Detection of Panton-Valentine leukocidin gene in Staphylococcus aureus by LightCycler PCR: clinical and epidemiological aspects. Clin Microbiol Infect. 2004;10:884–9. DOIPubMedGoogle Scholar
- Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis. 1999;29:1128–32. DOIPubMedGoogle Scholar
- Aires de Sousa M, Bartzavali C, Spiliopoulou I, Sanches IS, Crisostomo MI, de Lencastre H. Two international methicillin-resistant Staphylococcus aureus clones endemic in a university hospital in Patras, Greece. J Clin Microbiol. 2003;41:2027–32. DOIPubMedGoogle Scholar
- Aires de Ssousa M, de Lencastre H. Evolution of sporadic isolates of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and their similarities to isolates of community-acquired MRSA. J Clin Microbiol. 2003;41:3806–15. DOIPubMedGoogle Scholar
- Robinson DA, Enright MC. Evolutionary models of the emergence of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2003;47:3926–34. DOIPubMedGoogle Scholar
- Crisostomo MI, Westh H, Tomasz A, Chung M, Oliveira DC, de Lencastre H. The evolution of methicillin resistance in Staphylococcus aureus: similarity of genetic backgrounds in historically early methicillin-susceptible and -resistant isolates and contemporary epidemic clones. Proc Natl Acad Sci U S A. 2001;98:9865–70. DOIPubMedGoogle Scholar
- Seybold U, Kourbatova EV, Johnson JG, Halvosa SJ, Wang YF, King MD, Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis. 2006;42:647–56. DOIPubMedGoogle Scholar
- Larsen A, Stegger M, Goering R, Sorum M, Skov R. Emergence and dissemination of the methicillin resistant Staphylococcus aureus USA300 clone in Denmark (2000–2005). [PMID: 17370986]. Euro Surveill. 2007;12.
- Holmes A, Ganner M, McGuane S, Pitt TL, Cookson BD, Kearns AM. Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency, characterization, and association with clinical disease. J Clin Microbiol. 2005;43:2384–90. DOIPubMedGoogle Scholar
- Diederen BM, Kluytmans JA. The emergence of infections with community-associated methicillin resistant Staphylococcus aureus. J Infect. 2006;52:157–68. Epub 2005 Nov 9. DOIPubMedGoogle Scholar
- Dufour P, Gillet Y, Bes M, Lina G, Vandenesch F, Floret D, Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis. 2002;35:819–24. DOIPubMedGoogle Scholar
- Wannet WJ, Spalburg E, Heck ME, Pluister GN, Tiemersma E, Willems RJ, Emergence of virulent methicillin-resistant Staphylococcus aureus strains carrying Panton-Valentine leucocidin genes in The Netherlands. J Clin Microbiol. 2005;43:3341–5. DOIPubMedGoogle Scholar
- Goossens H, Ferech M, Coenen S, Stephens P. Comparison of outpatient systemic antibacterial use in 2004 in the United States and 27 European countries. Clin Infect Dis. 2007;44:1091–5. DOIPubMedGoogle Scholar
- Kampf G, Kramer A. Eradication of methicillin-resistant Staphylococcus aureus with an antiseptic soap and nasal mupirocin among colonized patients—an open uncontrolled clinical trial. Ann Clin Microbiol Antimicrob. 2004;3:9. DOIPubMedGoogle Scholar
- Kotilainen P, Routamaa M, Peltonen R, Evesti P, Eerola E, Salmenlinna S, Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med. 2001;161:859–63. DOIPubMedGoogle Scholar
- Mody L, Kauffman CA, McNeil SA, Galecki AT, Bradley SF. Mupirocin-based decolonization of Staphylococcus aureus carriers in residents of 2 long-term care facilities: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2003;37:1467–74. DOIPubMedGoogle Scholar
- Berglund C, Molling P, Sjoberg L, Soderquist B. Multilocus sequence typing of methicillin-resistant Staphylococcus aureus from an area of low endemicity by real-time PCR. J Clin Microbiol. 2005;43:4448–54. DOIPubMedGoogle Scholar
- Larssen KW, Jacobsen T, Bergh K, Tvete P, Kvello E, Scheel O. Outbreak of methicillin-resistant Staphylococcus aureus in two nursing homes in Central Norway. J Hosp Infect. 2005;60:312–6. DOIPubMedGoogle Scholar
Page created: July 02, 2010
Page updated: July 02, 2010
Page reviewed: July 02, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.