First outbreak of community-acquired MRSA USA300 in France: failure to suppress prolonged MRSA carriage despite decontamination procedures

Abstract

The first French outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) USA300 clone was investigated. After outbreak investigation, hygiene measures were implemented in all family households and childminders' homes. Several decontamination procedures were performed, which used a combination of topical mupirocin, total body application of chlorhexidine, chlorhexidine gargle (if >6 years old) and a course of antibiotic therapy in cases of infection or decontamination failure. Patients were followed up for MRSA skin and soft tissue infections (SSTIs) and carriage. Strains were characterised by antimicrobial drug resistance profile, pulsed-field gel electrophoresis (PFGE) and DNA microarrays. Between June 2011 and June 2012, six children and six adults among the ten corresponding relatives developed 28 SSTIs. None of the family members, including the index case, had any contact with foreigners or individuals known to have SSTIs. After infection control measures and prolonged decontamination have been implemented with a high adherence, six patients remained sustained CA-MRSA USA300 carriers, including one who developed mupirocin resistance and six who experienced minor CA-MRSA-related SSTIs. A baby was identified as an MRSA carrier 2 months after delivery. CA-MRSA decontamination using mupirocin and chlorhexidine in the community setting may also be a questionable strategy, associated with failure and resistance to both agents. Close monitoring of CA-MRSA SSTIs is required in France and in other European countries where MRSA USA300 has recently emerged. We showed that a closed management based on hygiene measures reinforcement, decolonisation and extended screening may fail to suppress CA-MRSA carriage and subsequent infections.

Distribution and antimicrobial susceptibility of bacteria from adults with community-acquired pneumonia or complicated skin and soft tissue infections in France: the nationwide French PREMIUM study

“…As reported in a national prospective study performed in 2006 concerning CA SSTIs in France, resistance to fluoroquinolones was identified among threequarters of MRSA isolates: this supported our previous finding based on genetic background (agr typing) and toxin screening that CA MRSA has not spread in France (Lamy et al, 2012). However, the genetic characterization of MRSA is required: after our first description of an intrafamilial autochthonous cluster due to USA300 in 2008 (Traore et al, 2014), an outbreak was reported in 2011-2012 (Baud et al, 2014). The MIC 90 of the major anti-MRSA compounds was 1 mg/L (vancomycin, teicoplanin, daptomycin, and ceftaroline), except for linezolid (2 mg/L); only 2 strains exhibited a ceftaroline of MIC of 2 mg/L.…”

Prevalence of Multidrug-Resistant Organisms in Hospitalized Pediatric Refugees in an University Children’s Hospital in Germany 2015–2016

“…13 Still, data are conflicting regarding whether MRSA screening effectively can prevent or stop outbreaks or hinder further spread of this pathogen. [14][15][16] Two recent publications have described the prevalence of MDROs among refugees. In a study by Reinheimer et al 119 unaccompanied refugee minors, colonization with MRGN bacteria was more frequent than in the general German population.…”

Comparative Evaluation of Two PCR-Based Methods for Detection of Methicillin-Resistant Staphylococcus aureus (MRSA): Xpert MRSA Gen 3 and BD-Max MRSA XT

“…The performances of the assays of the previous generations have recently been found to be similar (13), but the release of updated versions warrants a renewed comparison. Moreover, the MRSA clones isolated in Europe and the United States are epidemiologically different and assay performances could be different (14,15).We evaluated the performances of early-release versions of Xpert MRSA Gen3 and BD-Max MRSA XT in Hospital Raymond Poincaré, Garches, France, a teaching hospital in the Paris public hospital system (Assistance Publique-Hôpitaux de Paris) affiliated with the Université de Versailles St. Quentin. At the time of the study, Xpert MRSA Gen3 was designated "research use only" (RUO) whereas BD-Max MRSA XT was CE-In Vitro Diagnostics (CE-IVD) marked.…”

“…The performances of the assays of the previous generations have recently been found to be similar (13), but the release of updated versions warrants a renewed comparison. Moreover, the MRSA clones isolated in Europe and the United States are epidemiologically different and assay performances could be different (14,15).…”