Increasing incidence and widespread dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in central Europe, with special reference to German hospitals

Abstract

OBJECTIVE: to present data on prevalence and interregional spread of methicillin-resistant Staphylococcus aureus (MRSA) in Germany. METHODS: A nationwide collection of MRSA isolates from nosocomial infections in 143 hospitals was established from isolates (n=4368) sent to a microbiological reference center during 1993--95. As chosen by distinguishable resistance phenotypes at each time of occurrence during the study period, 1830 isolates were subjected to molecular typing by means of Smal macrorestriction patterns, PCR for RNA gene spacer patterns, and PCR for patterns of DNA stretches flanked by the ERIC-2 sequence and flanked by Tn916 and ribosomal binding site. In addition, data from a multicenter study on the incidence of antibiotic resistance have been analyzed (32 centers, 637 S. aureus isolates). RESULTS: In 1995 the prevalence of MRSA among S. aureus isolates was 8.7% overall in central Europe (including Germany), in comparison to 1.7% in 1990. From 1993 until now, a continuous interregional dissemination of six epidemic strains, which were identified by molecular typing, was recorded. Besides these epidemic strains, 15 MRSA strains were identified which could not be allocated to the epidemic MRSA or to the known clonal groups of the species S. aureus. MRSA from three cases of sporadic nosocomial infections exhibited characteristics of the clonal group of S. aureus with the capacity for toxic shock syndrome formation. The pattern of one MRSA corresponded to those of the S. aureus group exhibiting phage pattern 94,96. CONCLUSIONS: The prevalence of MRSA has increased in central Europe (and Germany) during the last 5 years, to 8.7%. The main source of infection with MRSA is obviously interregional dissemination of epidemic strains. At the same time, the mecA gene has been acquired by strains previously sensitive to methicillin.

Changing Patterns in Frequency of Recovery of Five Methicillin-Resistant Staphylococcus aureus Clones in Portuguese Hospitals: Surveillance over a 16-Year Period

“…Besides having been detected in several countries (http://saureus.mlst.net), EMRSA-15 is replacing previous established clones in different regions of the world. In Europe, it was found in a number of hospitals throughout Germany (53), and it is currently established as the major clone in the Czech Republic (33) and in the Majorcan islands (7). A recent study performed in a hospital in Oporto, Portugal, showed that clone EMRSA-15, which might have been introduced in the hospital in 2001, represents the overwhelming majority (79%) of the isolates collected between 2003 and 2005 (8).…”

Methicillin-Resistant, Quinupristin-Dalfopristin-Resistant Staphylococcus aureus with Reduced Sensitivity to Glycopeptides

“…SmaI macrorestriction patterns were obtained as described previously (24). The CHEF-III apparatus from Bio-Rad (Munich, Germany) was used with the following conditions: a charge of 6 V/cm, pulse times of 5 to 15 s for 7 h and 15 to 60 s for 19 h, an angle of 120°, and a temperature of 14°C.…”

Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a University Hospital from 1991 to 2001

“…In England, the percentage increased from 1.5 to 13.2% between 1989 and 1995 (8)(9)(10)(11)(12)(13). In Brazil, the prevalence of MRSA is high, especially in large and teaching hospitals, ranging from 26.6 to 70%, and MRSA is considered to be the main pathogen causing hospital outbreaks (14)(15)(16)(17)(18).…”