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Previous healthcare exposure is the main antecedent for methicillin-resistant Staphylococcus aureus carriage on hospital admission in Belgium

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Abstract

This study aimed to estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage upon hospital admission and to study the molecular epidemiology of MRSA in order to assess the proportion of Panton–Valentine leukocidin (PVL)-positive community-associated (CA) and livestock-associated (LA) MRSA strains. Epidemiological data on MRSA carriage upon hospital admission (2006–2009) were collected in a compulsory, continuous, national MRSA surveillance in Belgian acute-care hospitals. Additionally, 328 MRSA strains in 2005 and 314 strains in 2008 were collected in a separate, multicenter microbiological survey. Spa-typing, SCCmec-typing and MLST were performed; toxin genes were detected by PCR. The overall prevalence of MRSA carriage upon hospital admission was 8.9 cases/1,000 admissions between 2006 and 2009. Of MRSA carriers, 37.5% had a known MRSA history, 39.4% had stayed in a care facility, 12.2% reported no contact with healthcare. Over 90% of MRSA belonged to five healthcare-associated clones. Of these, MRSA spa-CC038-ST45-IV was in decline, mainly in favor of spa-CC008-ST8-IV. MRSA spa-CC002-ST5-IV, spa-CC002-ST5-II and spa-CC032-ST22-IV remained relatively stable. The proportion of PVL-positive CA-MRSA and LA-MRSA ST398 was below 2% of all MRSA. The extra-hospital MRSA reservoir in Belgium mainly consists of persons with previous healthcare exposure. PVL-positive CA-MRSA and LA-MRSA strains remained infrequent among hospitalized patients.

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Acknowledgements

We thank our microbiologist colleagues for participation in this surveillance program: Sylvianne Rotthiers and Emilie Vandaele for performing PCR analysis; and Christine Thiroux, Geneviève Hay, Pascale Buidin and Nathalie Legros for performing phenotypic tests. We thank Wannes Vanderhaeghen for a critical review of the manuscript and Yves Dupont for explaining the Mapinfo Professional 11.0 software. This study was part of a surveillance program organized under the auspices of the Belgian Infection Control Society (BICS, formerly GDEPIH-GOSPIZ). This work was supported by grants from the Belgian Antibiotic Policy Coordination Committee (BAPCOP), Ministry of Public Health, Belgium, and Pfizer Inc (Belgium). Stien Vandendriessche received a grant from the Belgian Federal Public Service of Public Health, Food Chain Safety and Environment, project RF6189 MRSA.

Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

  1. M. J. Struelens

    Present address: Microbiology Coordination Section, European Centre for Disease Prevention and Control (ECDC), 17183, Stockholm, Sweden

Authors and Affiliations

  1. Laboratoire de Référence MRSA - Staphylocoques, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium

    S. Vandendriessche, M. Hallin, A. Deplano, C. Nonhoff, S. Roisin, R. De Mendonça, M. J. Struelens & O. Denis

  2. Veterinary and Agrochemical Research Center, CODA-CERVA-VAR, Groeselenberg 99, 1180, Brussels, Belgium

    S. Vandendriessche

  3. Healthcare Associated Infections, Scientific Institute of Public Health, WIV-ISP, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium

    B. Catry & B. Jans

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  1. S. Vandendriessche
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Correspondence to O. Denis.

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Supplemental data Fig. 1

Indications for MRSA screening upon hospital admission (DOC 29 kb)

Supplemental data Fig. 2

The frequency of MRSA screening within 48 h of hospital admission. Out of 1,595,254 patients admitted over the 4-year period to the hospitals reporting the data, 179,912 were screened upon hospital admission; of 122,107 patients admitted to 17 hospitals in 2006/1, 4,617 were screened upon admission; of 148,835 patients admitted to 18 hospitals in 2006/2, 12,832 were screened upon admission; of 176,105 patients admitted to 20 hospitals in 2007/1, 18,152 were screened upon admission; of 203,534 patients admitted to 26 hospitals in 2007/2, 23,519 were screened upon admission; of 239,826 patients admitted to 27 hospitals in 2008/1, 26,235 were screened upon admission; of 199,515 patients admitted to 26 hospitals in 2008/2, 29,821 were screened upon admission; of 265,564 patients admitted to 35 hospitals in 2009/1, 32,934 were screened upon admission; of 239,768 patients admitted to 33 hospitals in 2009/2, 31,802 were screened upon admission (DOC 23 kb)

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Vandendriessche, S., Hallin, M., Catry, B. et al. Previous healthcare exposure is the main antecedent for methicillin-resistant Staphylococcus aureus carriage on hospital admission in Belgium. Eur J Clin Microbiol Infect Dis 31, 2283–2292 (2012). https://doi.org/10.1007/s10096-012-1567-0

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