Methicillin-ResistantStaphylococcus aureus in Europe

  • A. Voss
  • D. Milatovic
  • C. Wallrauch-Schwarz
  • V. T. Rosdahl
  • I. Braveny
Article

Abstract

In order to obtain pan-European data on methicillin-resistantStaphylococcus aureus (MRSA), 43 laboratories from ten European countries each screened 200 consecutiveStaphylococcus aureus isolates for methicillin resistance. Only one isolate per patient was permitted. All participants used a uniform oxacillin-supplemented screening plate. MRSA isolates were sent to Munich for reconfirmation and further susceptibility testing. Phage typing of the MRSA strains was performed in Denmark. Of the 7,333Staphylococcus aureus strains screened, 936 (12.8%) were methicillin resistant. The proportion of MRSA in the various European countries ranged from <1% in Scandinavia to > 30% in Spain, France and Italy. Rates of resistance to the non-glycopeptide antibiotics were lowest for rifampin and highest for ciprofloxacin. Sixty percent of the methicillin-resistant strains originated from patients in surgical and medical departments, with wounds being the most common isolation source. MRSA was found more frequently in intensive care patients. Only 13% of the strains were non-typable, and 76% of the isolates belonged to phage group III. For each area phage typing detected one or a few dominating (epidemic) types, but 46% of the strains did not belong to these types; the MRSA population is thus a mixture of epidemic and non-epidemic strains. MRSA seems to be a growing problem, especially in southern Europe, where incidence and rates of antibiotic resistance are alarmingly high.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jevons MP Celebin-resistant staphylococci. British Medical Journal 1961, 1: 124–125.Google Scholar
  2. 2.
    Brumfitt W, Hamilton-Miller J Methicillin-resistantStaphylococcus aureus. New England Journal of Medicine 1989, 320: 1188–1196.PubMedCrossRefGoogle Scholar
  3. 3.
    Casewell MW Epidemiology and control of the “modern” methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1986, 7: 1–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Boyce JM Increasing prevalence of methicillin-resistantStaphylococcus aureus in the United States. Infection Control and Hospital Epidemiology 1990, 11: 639–642.PubMedGoogle Scholar
  5. 5.
    Thompson RL, Wenzel RP International recognition of methicillin-resistantStaphylococcus aureus. Annals of Internal Medicine 1982, 97: 925–926.PubMedGoogle Scholar
  6. 6.
    Panlilio AL, Culver DH, Gaynes RP, Banerjee S, Henderson TS, Tolson JS, Martone WJ Methicillin-resistantStaphylococcus aureus in U.S. hospitals, 1975–1991. Infection Control and Hospital Epidemiology 1992, 13: 582–586.PubMedGoogle Scholar
  7. 7.
    Kimura A, Igarashi H, Ushioda H, Okuzuki K, Kobayashi H, Otsuka T Epidemiological study ofStaphylococcus aureus isolated from Japanese national university and medical college hospitals. Kansenshogaku-Zasshi 1992, 66: 1543–1549.PubMedGoogle Scholar
  8. 8.
    Aparicio P, Richardson J, Martin S, Vindel A An epidemic methicillin- resistant strainof Staphylococcus aureus in Spain. Epidemiology and Infection 1992, 108: 287–289.PubMedCrossRefGoogle Scholar
  9. 9.
    Struelens MJ, Deplano A, Godard C, Maes N, Serruys E Epidemiologic typing and delineation of genetic relatedness of methicillin-resistantStaphylococcus aureus by macrorestriction analysis of genomic DNA by using pulsed-field gel electrophoresis. Journal of Clinical Microbiology 1992, 30: 2599–2605.PubMedGoogle Scholar
  10. 10.
    Gaspar MC, Uribe P, Sanchez P, Coello R, Cruzet F Hospital personnel who are nasal carriers of methicillin-resistantStaphylococcus aureus. Usefulness of treatment with mupirocin. Enfermedades Infecciosasy Microbiologia Clinica 1992, 10: 107–110.Google Scholar
  11. 11.
    Farrington M, Brenwald N, Haines D, Walpole E Resistance to desiccation and skin fatty acids in outbreak strains of methicillin-resistantStaphylococcus aureus. Journal of Medical Microbiology 1992, 36: 56–60.PubMedGoogle Scholar
  12. 12.
    Moore EP, Williams EW A maternity hospital outbreak of methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1991, 19: 5–16.CrossRefPubMedGoogle Scholar
  13. 13.
    Parras F, Rodriguez M, Bouza E, Munoz P Epidemic outbreak of methicillin-resistantStaphylococcus aureus in a general hospital. Preliminary report. Enfermedades Infecciosasy Microbiologia Clinica 1991, 9: 200–207.Google Scholar
  14. 14.
    Vandenbroucke-Grauls CM, Frenay HM, von Klingeren B, Savelkoul TF, Verhoef J Control of epidemic methicillin-resistantStaphylococcus aureus in a Dutch university hospital. European Journal of Clinical Microbiology and Infectious Diseases 1991, 10: 6–11.CrossRefGoogle Scholar
  15. 15.
    Voss A, Machka K, Lenz W, Milatovic D Vorkommen, Häufigkeit und Resistenzverhalten von Methicillin-Oxacillin-resistentenStaphylococcus-aureus-Stämmen in Deutschland. Medizinische Wochenzeitschrift 1992, 117: 1907–1912.CrossRefGoogle Scholar
  16. 16.
    Marples RR, Richardson JF, de Saxe MJ Bacteriological characteristics of strains ofStaphylococcus aureus submitted to a reference laboratory related to methicillin resistance. Journal of Hygiene 1986, 96: 217–223.PubMedCrossRefGoogle Scholar
  17. 17.
    Mackintosh CA, Marples RR, Kerr GE, Bannister BA Surveillance of methicillin-resistantStaphylococcus aureus in England and Wales, 1986–1990. Journal of Hospital Infection 1991, 18: 278–292.CrossRefGoogle Scholar
  18. 18.
    Rosdahl VT, Knudsen AM The decline of methicillin resistance among DanishStaphylococcus aureus strains. Infection Control and Hospital Epidemiology 1991, 12: 83–88.PubMedCrossRefGoogle Scholar
  19. 19.
    Schito GC, Varaldo PE Trends in the epidemiology and antibiotic resistance of clinicalStaphylococcus strains in Italy — a review. Journal of Antimicrobial Chemotherapy 1988, 21, Supplement C: 67–78.PubMedGoogle Scholar
  20. 20.
    National Committee for Clinical Laboratory Standards Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard M7-A2.NCCLS, Villanova, PA, 1990.Google Scholar
  21. 21.
    Richardson JF, Chittasobhon N, Marples RR A supplementary phage set for the investigation of methicillin-resistant strains ofStaphylococcus aureus. Journal of Medical Microbiology 1988, 25: 67–74.PubMedCrossRefGoogle Scholar
  22. 22.
    Cookson BD MRSA: major problem or minor threat? Journal of Medical Microbiology 1993, 38: 309–310.PubMedGoogle Scholar
  23. 23.
    Bradley SF, Terpenning MS, Ramsey MA, Zarins LT, Jorgensen KA, Sottile WS, Schaberg DR, Kauffman CA Methicillin-resistantStaphylococcus aureus: colonization and infection in a long-term care facility. Annals of Internal Medicine 1991, 115: 417–427.PubMedGoogle Scholar
  24. 24.
    Muder RR, Brennen C, Wagener MM, Vickers RM, Rihs JD, Hancock GA, Yee YC, Miller JM, Yu VL Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Annals of Internal Medicine 1991, 114: 107–112.PubMedGoogle Scholar
  25. 25.
    Peacock JF, Moorman DR, Wenzel RP, Mandell GL Methicillin-resistantStaphylococcus aureus: microbiological characteristics, antimicrobial susceptibilities, and assessment of virulence of an epidemic strain. Journal of Infectious Diseases 1981, 144: 575–582.PubMedGoogle Scholar
  26. 26.
    Boyce JM Nosocomial staphylococcal infections. Annals of Internal Medicine 1981, 95: 241–242.PubMedGoogle Scholar
  27. 27.
    Isaacs RD, Kunke PJ, Cohen RL, Smith JW Ciprofloxacin resistance in epidemic methicillin-resistantStaphylococcus aureus. Lancet 1988, ii: 843.CrossRefGoogle Scholar
  28. 28.
    Smith SM, Eng RHK, Bais P, Fan-Harvard P, Tecson-Tumang F Epidemiology of ciprofloxacin resistance among patients with methicillin-resistantStaphylococcus aureus. Journal of Antimicrobial Chemotherapy 1990, 26: 567–572.PubMedGoogle Scholar
  29. 29.
    Aldridge KE, Gelfand MS, Schiro DD, Barg NL The rapid emergence of fluoroquinolone-methicillin-resistantStaphylococcus aureus infections in a community hospital. An in vitro look at alternative antimicrobial agents. Diagnostic Microbiology and Infectious Diseases 1992, 15: 601–608.CrossRefGoogle Scholar
  30. 30.
    Daum TE, Schaberg DR, Terpenning MS, Sottile WS, Kaufmann CA Increasing resistance ofStaphylococcus aureus to ciprofloxacin. Antimicrobial Agents and Chemotherapy 1990, 34: 1862–1863.PubMedGoogle Scholar
  31. 31.
    Smith SM, Eng RHK, Tecson-Tumang F Ciprofloxacin therapy for methicillin-resistantStaphylococcus aureus infections or colonization. Antimicrobial Agents and Chemotherapy 1989, 33: 181–184.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1994

Authors and Affiliations

  • A. Voss
    • 1
  • D. Milatovic
    • 1
  • C. Wallrauch-Schwarz
    • 1
  • V. T. Rosdahl
    • 2
  • I. Braveny
    • 1
  1. 1.Institute of Medical MicrobiologyTechnical University of MunichMunichGermany
  2. 2.Slaphylococcus LaboratoryStatens SeruminstitutCopenhagen SDenmark

Personalised recommendations