Skin and soft tissue infections in intercontinental travellers and the import of multi-resistant Staphylococcus aureus to Europe

Abstract

Staphylococcus aureus is emerging globally. Treatment of infections is complicated by increasing antibiotic resistance. We collected clinical data and swabs of returnees with skin and soft tissue infections (SSTI) at 13 travel-clinics in Europe (www.staphtrav.eu). Sixty-two percent (196/318) SSTI patients had S. aureus-positive lesions, of which almost two-thirds (122/196) were Panton-Valentine leukocidin (PVL) positive. PVL was associated with disease severity, including hospitalization for SSTI (OR 5.2, 95% CI 1.5-18.2). In returnees with SSTI, longer travel and more intense population contact were risk factors for nasal colonization with PVL-positive S. aureus. Imported S. aureus frequently proved resistant to trimethoprim-sulfamethoxazole (21%), erythromycin (21%), tetracycline (20%), ciprofloxacin (13%), methicillin (12%) and clindamycin (8%). Place of exposure was significantly (p < 0.05) associated with predominant resistance phenotypes and spa genotypes: Latin America (methicillin; t008/CC24/304), Africa (tetracycline, trimethoprim-sulfamethoxazole; t084/CC84, t314/singleton, t355/CC355), South Asia (trimethoprim-sulfamethoxazole, ciprofloxacin; t021/CC21/318), South-East Asia (clindamycin; t159/CC272). USA300-like isolates accounted for 30% of all methicillin-resistant S. aureus imported to Europe and were predominantly (71%) acquired in Latin America. Multi-resistance to non-β-lactams were present in 24% of imports and associated with travel to South Asia (ORcrude 5.3, 95% CI 2.4-11.8), even after adjusting for confounding by genotype (ORadjusted 3.8, 95% 1.5-9.5). Choosing randomly from compounds recommended for the empiric treatment of severe S. aureus SSTI, 15% of cases would have received ineffective antimicrobial therapy. These findings call for the development of regionally stratified guidance on the antibiotic management of severe imported S. aureus disease and put the infected and colonized traveller at the centre of interventions against the global spread of multi-resistant S. aureus.

MRSA Isolates from United States Hospitals Carry dfrG and dfrK Resistance Genes and Succumb to Propargyl-Linked Antifolates

“…Reports of contemporary TMP-SMX resistance vary regionally: 21 % of resistance is reported in travel clinics in Europe (Nurjadi et al, 2015), whereas ~3 % has been reported in a group of US hospitals (Sader et al, 2015). TMP-SMX resistance is on the rise according to a survey of 2193 isolates showing that TMP-SMX resistance rose from 3.4 % in 2007 to 6 % in 2012 (Pate et al, 2015).…”

Management of infections in critically ill returning travellers in the intensive care unit—I: considerations on infection control and transmission of resistance

“…As has been clearly documented, the transmission of MRSA has increased with the growth of international travel, resulting in either asymptomatic colonization or clinically significant MRSA infections. 3,4 Some evidence is also available for the international dissemination of VRE via transfer/ repatriation of patients from hospitals located in endemic areas. 5 Concerning Gram-negative organisms, the impact of international travel has been firmly established in the dissemination of MDR Enterobacteriaceae, including high-risk clones producing ESBLs (especially enzymes of the CTX-M type) and/or carbapenemases of various types (e.g., KPC, OXA-48, NDM, VIM).…”

Europe importation of Panton–Valentine leukocidin‐positive Staphylococcus aureus: a case report of recurrent furunculosis

“…3 This virulence factor is mainly community-acquired and can lead to recurrent and potentially serious skin and soft tissue infections and necrotising pneumonia in otherwise healthy young people. 4,5 A 46-year-old Portuguese man was admitted with fever and extremely painful deep nodular inflammatory lesions on his thighs, chest and armpits ( Fig. 1).…”