The molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in the Czech Republic

Abstract

Objectives To gain data on the current molecular epidemiology and resistance of MRSA in the Czech Republic. Methods Between September 2017 and January 2018, a total of 441 single-patient MRSA isolates were collected from 11 Czech hospitals and analysed by spa typing, SCCmec typing, antibiotic susceptibility testing, detection of the PVL toxin and the arcA gene. Results Of all MRSA isolates, 81.41% (n = 359) belonged to the CC5-MRSA clone represented by the spa types t003 (n = 136), t586 (n = 92), t014 (n = 81), t002 (n = 20) and other spa types (n = 30); a majority of the CC5 isolates (n = 348, 96.94%) carried SCCmec type II. The occurrence of CC5-MRSA was more likely in older inpatients and associated with a healthcare origin (P < 0.001). The CC5-MRSA isolates were resistant to more antimicrobial drugs compared with the other MRSAs (P < 0.001). Interestingly, t586 was detected in blood samples more often than the other spa types and, contrary to other spa types belonging to CC5-MRSA, t586 was not associated with patients of advanced age. Other frequently found lineages were CC8 (n = 17), CC398 (n = 11) and CC59 (n = 10). The presence of the PVL was detected in 8.62% (n = 38) of the MRSA isolates. Conclusions The healthcare-associated CC5-MRSA-II lineage (t003, t586, t014) was found to be predominant in the Czech Republic. t586 is a newly emerging spa type in the Czech Republic, yet reported rarely in other countries. Our observations stress the need for MRSA surveillance in the Czech Republic in order to monitor changes in MRSA epidemiology.

Antibiotic Resistance, spa Typing and Clonal Analysis of Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates from Blood of Patients Hospitalized in the Czech Republic

“…t586 isolates were frequently isolated from northwestern, southwestern and middle western part of the country (Liberec, Prague, Central Bohemian and South Bohemian regions). Our results corroborate the observation of the recent study conducted by Tkadlec et al [11] They typed MRSA isolated from various infection sites (or asymptomatic colonization) from 11 Czech hospitals. It is important to note that the dominance of just one spa type (or few) in some regions (our study) does not mean that the other spa types are not present in these parts of the country.…”

“…Our result concerning the high abundance of t003, t002 and t014 is in concordance with the multicentric European study that spa-typed MRSA blood isolates collected in 25 European countries, where t003 was reported to be the second most common, t002 the fourth and t014 the twentieth most common spa type [3]. High prevalence of t003, t586 and t014 was also detected in a recent Czech study investigating MRSA strains originating from various infections [11]. Neradova et al detected a high proportion of t003, t002 and t014 from BSI from the Czech university hospital [12].…”

“…We demonstrate that the majority of MRSA strains in our study are resistant to erythromycin, clindamycin and ciprofloxacin. A recent study from the Czech Republic also confirmed the high frequency of MRSA isolates resistant to antibiotics from the same classes (erythromycin, clindamycin and ofloxacin); however, only 4.5% of the studied MRSA isolates were derived from bloodstream infections (BSI) [11]. The earlier study concerning the antibiotic resistance of blood isolates from the Czech Republic (collection of MRSA blood isolates from 20 hospitals from the 2000-2002 period) reported resistance to more antibiotics (also gentamicin and rifampicin) [6].…”

“…According to the Ridom Spa server database [14], this spa type has been reported in many European countries (e.g., Germany, Netherlands, France, Belgium, Croatia, Norway, Spain); however, to our knowledge, there has not been any other country detecting such a high proportion of it. MRSA strains typed as t586 were isolated from blood of patients hospitalized in the Czech Republic [11]; however, this is the first study detecting it from blood on a nationwide scale.…”

“…The majority of isolates belonged to ST398 and were clustered into spa CC011. Tkadlec et al [11] showed that 2.5% of the MRSA strains isolated from the various infections were of CC398. The results of our study show that LA-MRSA are also able to cause serious infections (bloodstream); however, the prevalence of these strains among MRSA isolated from blood remains low (2.3%).…”