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Prevalence, risk factors, and epidemiology of methicillin-resistantStaphylococcus aureus carried by adults over 60 years of age

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Abstract

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in the community in Portugal is not completely understood. To evaluate S. aureus and MRSA carriage among the elderly, we conducted a large cross-sectional study between April 2010 and December 2012. A total of 3,361 adults over 60 years of age were screened for S. aureus nasopharyngeal and oropharyngeal carriage. MRSA were characterized by staphylococcal cassette chromosome mec (SCCmec) typing, spa typing, multilocus sequence typing (MLST), and tested for the presence of Panton–Valentine leukocidin (PVL). Risk factors for MRSA carriage were identified by multiple logistic regression analysis. The prevalence of S. aureus and MRSA carriage among the elderly was 20.1 % and 1.8 %, respectively. The risk of being an MRSA carrier was higher among the elderly living in retirement homes [odds ratio (OR) = 2.90, 95 % confidence interval (CI): 1.48–5.48] and those that had been hospitalized in the previous year (OR = 2.64, 95 % CI: 1.47–4.58). Among the 62 MRSA isolates, 64.5 % were multidrug-resistant and none carried PVL. Most MRSA (82.3 %) were related to three hospital-associated (HA-MRSA) clones disseminated in Portugal: ST105-II (New York/Japan clone; 43.5 %), ST5-IVc (Pediatric clone; 19.4 %), and ST22-IVh (EMRSA-15 clone; 19.4 %). The New York/Japan and Pediatric clones were significantly associated with carriers living in retirement homes, while the EMRSA-15 clone was associated with carriers that had been hospitalized. We conclude that the elderly population in Portugal is essentially free of MRSA. Given the current European societal challenges for a healthy active aging, these results are of importance to healthcare professionals and public authorities to decide on strategies to promote health in this age group.

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Acknowledgments

The authors are grateful to the participants that collaborated in the study. We thank Ana Paula Ribeiro from Câmara Municipal de Montemor-o-Novo for her extraordinary support in the implementation of fieldwork in Montemor-o-Novo. We thank the excellent skills of nurses Anabela Gonçalves and Pedro Fonseca.

Conflict of interest

The authors declare that they have no conflict of interest.

Financial disclosure

This work was partially supported by grants PTDC/BIA-BEC/098289/2008 (to RS-L) and PEst-OE/EQB/LA0004/2011 (to the Oeiras Associated Laboratory) from Fundação para a Ciência e a Tecnologia (FCT), Portugal. NAF was supported by post-doctoral grant SFRH/BPD/66514/2009 from FCT.

Authorship/contribution

Conceived and designed the experiments: RS-L, HdL. Acquired data and performed experiments: STA, SN, RS-L. Analyzed the data: STA, SN, ACSP, NAF, RS-L. Contributed reagents/materials/analysis tools: RS-L, HdL. Wrote the paper: STA, RS-L. Critically revised the manuscript and approved the final version: all authors.

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Authors and Affiliations

  1. Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier (ITQB), Universidade Nova de Lisboa (UNL), Av. da República, 2780-157, Oeiras, Portugal

    S. T. Almeida, S. Nunes, A. C. S. Paulo & R. Sá-Leão

  2. Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB), Universidade Nova de Lisboa (UNL), Oeiras, Portugal

    N. A. Faria & H. de Lencastre

  3. Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY, USA

    H. de Lencastre

Authors
  1. S. T. Almeida
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  2. S. Nunes
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  3. A. C. S. Paulo
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  4. N. A. Faria
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  5. H. de Lencastre
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  6. R. Sá-Leão
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Corresponding author

Correspondence to R. Sá-Leão.

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Almeida, S.T., Nunes, S., Paulo, A.C.S. et al. Prevalence, risk factors, and epidemiology of methicillin-resistantStaphylococcus aureus carried by adults over 60 years of age. Eur J Clin Microbiol Infect Dis 34, 593–600 (2015). https://doi.org/10.1007/s10096-014-2267-8

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  • DOI: https://doi.org/10.1007/s10096-014-2267-8

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