Emerging multidrug-resistant Bengal Bay clone ST772-MRSA-V in Norway: molecular epidemiology 2004–2014
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A multidrug-resistant, methicillin-resistant Staphylococcus aureus (MRSA) clone, PVL-positive ST772-MRSA-V, named the Bengal Bay clone, is emerging worldwide. In Norway, where MRSA prevalence is low, a sudden increase in ST772-MRSA-V initiated a nationwide molecular epidemiological study. Clinical data were obtained from the Norwegian Surveillance System for Communicable Diseases (MSIS). S. aureus isolates were characterised by antibiotic susceptibility profiles and comprehensive genotyping (spa typing, MLVA, DNA microarray). ST772-MRSA was detected in 145 individuals during 2004–2014, with 60% of cases occurring in 2013–2014. Median age was 31 years and male/female ratio 1.16. The majority had a family background from the Indian subcontinent (70%). MRSA acquisition was mainly reported as unknown (39%) or abroad (42%), the latter associated with a home-country visit (59%), tourism (16%), and immigration (13%). Clinical infection was present in 75%, predominantly by SSTI (83%), 18% were admitted to hospital and 42% were linked to small-scale outbreaks (n = 25). All isolates were multidrug-resistant. Most isolates were resistant to erythromycin, gentamicin and norfloxacin. Genotyping revealed a conserved clone predominated by spa type t657 (83%), MLVA-type 432 (67%) and the genes lukF/S, sea, sec/sel, egc, scn, cna, ccrAA/ccrC, agrII and cap5. A few untypical ccr gene combinations were detected. Bengal Bay isolates have likely been imported on several occasions and revision of infection control guidelines may prevent further spread.
We would like to thank Surendra Kumar Madhip (Dhulikel Hospital, Kathmandu University Hospital, Nepal), Gunnsteinn Haraldsson (Landspitali University Hospital, Reykjavik, Iceland) and Anders Rhod Larsen (Statens Serum Institut, Copenhagen, Denmark) for contributing control isolates. The authors thank Karin Helmersen (Akershus University Hospital) for technical assistance with spa typing and MLVA.
The work was carried out in Akershus University Hospital and the National Reference Laboratory for MRSA, St Olavs University Hospital.
Compliance with ethical standards
This research received no funding.
Conflicts of interest
The authors declare that they have no conflicts of interest.
The study was approved by the Norwegian Regional Ethics Committee South-East (2014/1710) and by the Data Protection Official at Akershus University Hospital (14-132).
Exemption from obtaining informed consent was given by the Norwegian Regional Ethics Committee South-East under Norwegian law due to use of health register data (MSIS).
- 5.D’Souza N, Rodrigues C, Mehta A (2010) Molecular characterization of methicillin-resistant Staphylococcus aureus with emergence of epidemic clones of sequence type (ST) 22 and ST 772 in Mumbai, India. J Clin Microbiol 48(5):1806–1811. doi: 10.1128/jcm.01867-09 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Bouchiat C, El-Zeenni N, Chakrakodi B, Nagaraj S, Arakere G, Etienne J (2015) Epidemiology of Staphylococcus aureus in Bangalore, India: emergence of the ST217 clone and high rate of resistance to erythromycin and ciprofloxacin in the community. New Micro New Infect 7:15–20. doi: 10.1016/j.nmni.2015.05.003 CrossRefGoogle Scholar
- 7.Goering RV, Shawar RM, Scangarella NE, O’Hara FP, Amrine-Madsen H, West JM, Dalessandro M, Becker JA, Walsh SL, Miller LA, van Horn SF, Thomas ES, Twynholm ME (2008) Molecular epidemiology of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates from global clinical trials. J Clin Microbiol 46(9):2842–2847. doi: 10.1128/jcm.00521-08 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Pokhrel RH, Aung MS, Thapa B, Chaudhary R, Mishra SK, Kawaguchiya M, Urushibara N, Kobayashi N (2016) Detection of ST772 Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (Bengal Bay clone) and ST22 S. aureus isolates with a genetic variant of elastin binding protein in Nepal. New Micro New Infect 11:20–27. doi: 10.1016/j.nmni.2016.02.001 CrossRefGoogle Scholar
- 11.Coombs GW, Monecke S, Pearson JC, Tan H-l, Chew Y-K, Wilson L, Ehricht R, O’Brien FG, Christiansen KJ (2011) Evolution and diversity of community-associated methicillin-resistant Staphylococcus aureus in a geographical region. BMC Microbiol 11(1):215. doi: 10.1186/1471-2180-11-215 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Udo EE, Al-Lawati BAH, Al-Muharmi Z, Thukral SS (2014) Genotyping of methicillin-resistant Staphylococcus aureus in the Sultan Qaboos University Hospital, Oman reveals the dominance of Panton–valentine leucocidin-negative ST6-IV/t304 clone. New Micro New Infect 2(4):100–105. doi: 10.1002/nmi2.47 CrossRefGoogle Scholar
- 16.Madzgalla S, Syed MA, Khan MA, Rehman SS, Müller E, Reissig A, Ehricht R, Monecke S (2016) Molecular characterization of Staphylococcus aureus isolates causing skin and soft tissue infections in patients from Malakand. Pakistan Eur J Clin Microbiol Infect Dis:1–7. doi: 10.1007/s10096-016-2695-8
- 17.Hon PY, Koh TH, Tan TY, Krishnan P, Leong JW-Y, Jureen R, Chan J, Tee NW-S, Murugesh J, Chan KS, Hsu LY (2014) Changing molecular epidemiology and high rates of mupirocin resistance among meticillin-resistant Staphylococcus aureus in Singaporean hospitals. J Glob Antimicrob Resist 2(1):53–55. doi: 10.1016/j.jgar.2013.10.002 CrossRefPubMedGoogle Scholar
- 18.Nurjadi D, Friedrich-Jänicke B, Schäfer J, Van Genderen PJJ, Goorhuis A, Perignon A, Neumayr A, Mueller A, Kantele A, Schunk M, Gascon J, Stich A, Hatz C, Caumes E, Grobusch MP, Fleck R, Mockenhaupt FP, Zanger P (2015) Skin and soft tissue infections in intercontinental travellers and the import of multi-resistant Staphylococcus aureus to Europe. Clin Microbiol Infect 21(6):567.e561–567.e510. doi: 10.1016/j.cmi.2015.01.016 CrossRefGoogle Scholar
- 19.Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281. doi: 10.1111/j.1469-0691.2011.03570.x CrossRefPubMedGoogle Scholar
- 20.Rajan V, Schoenfelder SMK, Ziebuhr W, Gopal S (2015) Genotyping of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) in a tertiary care centre in Mysore, South India: ST2371-SCCmec IV emerges as the major clone. Infect Genet Evol 34:230–235. doi: 10.1016/j.meegid.2015.05.032 CrossRefPubMedGoogle Scholar
- 21.Brennan GI, Shore AC, Corcoran S, Tecklenborg S, Coleman DC, O’Connell B (2012) Emergence of hospital- and community-associated Panton-Valentineleukocidin-positive methicillin-resistant Staphylococcus aureus genotype ST772-MRSA-V in Ireland and detailed investigation of an ST772-MRSA-V cluster in a neonatal intensive care unit. J Clin Microbiol 50(3):841–847. doi: 10.1128/jcm.06354-11 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Blomfeldt A, Larssen KW, Moghen A, Haugum K, Steen TW, Jørgensen SB, Aamot HV (2016) Bengal Bay clone ST772-MRSA-V outbreak—conserved clone causes investigation challenges. J Hosp Infect. doi: 10.1016/j.jhin.2016.12.006
- 26.Mellmann A, Weniger T, Berssenbrugge C, Rothganger J, Sammeth M, Stoye J, Harmsen D (2007) Based upon repeat pattern (BURP): an algorithm to characterize the long-term evolution of Staphylococcus aureus populations based on spa polymorphisms. BMC Microbiol 7:98. doi: 10.1186/1471-2180-7-98 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Monecke S, Coombs G, Shore AC, Coleman DC, Akpaka P, Borg M, Chow H, Ip M, Jatzwauk L, Jonas D, Kadlec K, Kearns A, Laurent F, O’Brien FG, Pearson J, Ruppelt A, Schwarz S, Scicluna E, Slickers P, Tan HL, Weber S, Ehricht R (2011) A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus. PLoS One 6(4):e17936CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Song J-H, Hsueh P-R, Chung DR, Ko KS, Kang C-I, Peck KR, Yeom J-S, Kim S-W, Chang H-H, Kim Y-S, Jung S-I, Son JS, So TM-K, Lalitha MK, Yang Y, Huang S-G, Wang H, Lu Q, Carlos CC, Perera JA, Chiu C-H, Liu J-W, Chongthaleong A, Thamlikitkul V, Van PH, Song J-H, Chung DR, Yeom J-S, Lee H, Kim S-W, Chang H-H, Kim Y-S, Jung S-I, Son JS, So TMK, Thamlikitkul V, Chongthaleong A, Hsueh P-R, Chiu C-H, Liu DJ-W, Lalitha MK, Mathai D, Perera J, Hung Van P, Van Ngoc T, Carlos CC (2011) Spread of methicillin-resistant Staphylococcus aureus between the community and the hospitals in Asian countries: an ANSORP study. J Antimicrob Chemother 66(5):1061–1069. doi: 10.1093/jac/dkr024 CrossRefPubMedGoogle Scholar
- 30.Dhawan B, Rao C, Udo EE, Gadepalli R, Vishnubhatla S, Kapil A (2015) Dissemination of methicillin-resistant Staphylococcus aureus SCCmec type IV and SCCmec type V epidemic clones in a tertiary hospital: challenge to infection control. Epidemiol Infect 143(02):343–353. doi: 10.1017/S095026881400065X CrossRefPubMedGoogle Scholar
- 31.Manoharan A, Zhang L, Poojary A, Bhandarkar L, Koppikar G, Robinson DA (2012) An outbreak of post-partum breast abscesses in Mumbai, India caused by ST22-MRSA-IV: genetic characteristics and epidemiological implications. Epidemiol Infect 140(10):1809–1812. doi: 10.1017/S0950268812000593 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Kalenic S, Cookson B, Gallagher R, Popp W, Asensio-Vegas A, Assadian O, Blok A, Brusaferro S, Eastaway A, Elstrom P (2010) Comparison of recommendations in national/regional guidelines for prevention and control of MRSA in thirteen European countries. Int J Infect Control 6(2):1–10CrossRefGoogle Scholar
- 33.Shore AC, Tecklenborg SC, Brennan GI, Ehricht R, Monecke S, Coleman DC (2014) Panton-Valentine leukocidin-positive Staphylococcus aureus in Ireland from 2002 to 2011: 21 clones, frequent importation of clones, temporal shifts of predominant methicillin-resistant S. aureus clones, and increasing multiresistance. J Clin Microbiol 52(3):859–870. doi: 10.1128/jcm.02799-13 CrossRefPubMedPubMedCentralGoogle Scholar