Abstract
All notified MRSA cases in Skåne County have been followed since 2000. We have investigated the MRSA epidemiology over time, method of acquisition, whether some spa types are more prone to spread, and/or cause more infections, and the connection between spa type and country of acquisition/origin. All cases between 2000 and 2010 were included. Infection or colonization and the presence of PVL genes were noted. The spa types of the index cases were correlated with community or healthcare acquisition, proportion of MRSA-positive household contacts, country of origin of families and country of acquisition of MRSA. The number of cases increased from 31 in 2000 to 315 in 2010. Most cases were community-acquired and the median age was 30 years. Thirty-two per cent of the MRSA cases were found because of a clinical infection. Of the household contacts 35 % were MRSA-positive. Only 24 % of the MRSA cases were both of Swedish origin and had contracted MRSA in Sweden. An association between spa type and certain regions of acquisition/origin was noted. Spa types t044, t002 and t008 were the most predominant strains. PVL-positive spa types t008, t019 and t044 caused more skin infections than the other spa types. Our results support screening for MRSA in patients with health care contacts abroad, culturing of patients with skin infections contracted outside Sweden and performing contact tracing among household members. Knowledge of spa type might give guidance in the process of contact tracing. Eradication treatment of MRSA spa types causing more skin infections may be warranted.
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References
http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx
Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, Mielke M, Peters G, Skov RL, Struelens MJ, Tacconelli E, Navarro Torne A, Witte W, Friedrich AW (2010) Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 15(41):19688
http://www.smittskyddsinstitutet.se/upload/Publikationer/swedres-2010-figures-and-tables.pdf
Bocher S, Gervelmeyer A, Monnet DL, Molbak K, Skov RL (2008) Methicillin-resistant Staphylococcus aureus: risk factors associated with community-onset infections in Denmark. Clin Microbiol Infect 14(10):942–948
Ringberg H, Cathrine Petersson A, Walder M, Hugo Johansson PJ (2006) The throat: an important site for MRSA colonization. Scand J Infect Dis 38(10):888–893
Petersson AC, Olsson-Liljequist B, Miorner H, Haeggman S (2010) Evaluating the usefulness of spa typing, in comparison with pulsed-field gel electrophoresis, for epidemiological typing of methicillin-resistant Staphylococcus aureus in a low-prevalence region in Sweden 2000–2004. Clin Microbiol Infect 16(5):456–462
Hothorn T, Bretz F, Westfall P (2008) Simultaneous inference in general parametric models. Biom J 50(3):346–363
Deurenberg RH, Stobberingh EE (2008) The evolution of Staphylococcus aureus. Infect Genet Evol 8(6):747–763
Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK (2007) Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 298(15):1763–1771
Rolo J, Miragaia M, Turlej-Rogacka A, Empel J, Bouchami O, Faria NA, Tavares A, Hryniewicz W, Fluit AC, de Lencastre H (2012) High genetic diversity among community-associated Staphylococcus aureus in Europe: results from a multicenter study. PLoS One 7(4):e34768
David MZ, Daum RS (2010) Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 23(3):616–687
Bartels MD, Boye K, Rhod Larsen A, Skov R, Westh H (2007) Rapid increase of genetically diverse methicillin-resistant Staphylococcus aureus, Copenhagen, Denmark. Emerg Infect Dis 13(10):1533–1540
Elstrom P, Kacelnik O, Bruun T, Iversen B, Hauge SH, Aavitsland P (2012) Meticillin-resistant Staphylococcus aureus in Norway, a low-incidence country, 2006–2010. J Hosp Infect 80(1):36–40
Kock R, Mellmann A, Schaumburg F, Friedrich AW, Kipp F, Becker K (2011) The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Germany. Dtsch Arztebl Int 108(45):761–767
Stenhem M, Ortqvist A, Ringberg H, Larsson L, Olsson Liljequist B, Haeggman S, Kalin M, Ekdahl K (2010) Imported methicillin-resistant Staphylococcus aureus, Sweden. Emerg Infect Dis 16(2):189–196
Van Cleef BA, Monnet DL, Voss A, Krziwanek K, Allerberger F, Struelens M, Zemlickova H, Skov RL, Vuopio-Varkila J, Cuny C, Friedrich AW, Spiliopoulou I, Paszti J, Hardardottir H, Rossney A, Pan A, Pantosti A, Borg M, Grundmann H, Mueller-Premru M, Olsson-Liljequist B, Widmer A, Harbarth S, Schweiger A, Unal S, Kluytmans JA (2011) Livestock-associated methicillin-resistant Staphylococcus aureus in humans, Europe. Emerg Infect Dis 17(3):502–505
Johansson PJ, Gustafsson EB, Ringberg H (2007) High prevalence of MRSA in household contacts. Scand J Infect Dis 39(9):764–768
Rafee Y, Abdel-Haq N, Asmar B, Salimnia T, Pharm CV, Rybak Pharm MJ, Amjad M (2012) Increased prevalence of methicillin-resistant Staphylococcus aureus nasal colonization in household contacts of children with community acquired disease. BMC Infect Dis 12:45
Miller LG, Eells SJ, Taylor AR, David MZ, Ortiz N, Zychowski D, Kumar N, Cruz D, Boyle-Vavra S, Daum RS (2012) Staphylococcus aureus colonization among household contacts of patients with skin infections: risk factors, strain discordance, and complex ecology. Clin Infect Dis 54(11):1523–1535
Ghaznavi-Rad E, Nor Shamsudin M, Sekawi Z, Khoon LY, Aziz MN, Hamat RA, Othman N, Chong PP, van Belkum A, Ghasemzadeh-Moghaddam H, Neela V (2010) Predominance and emergence of clones of hospital-acquired methicillin-resistant Staphylococcus aureus in Malaysia. J Clin Microbiol 48(3):867–872
Khandavilli S, Wilson P, Cookson B, Cepeda J, Bellingan G, Brown J (2009) Utility of spa typing for investigating the local epidemiology of MRSA on a UK intensive care ward. J Hosp Infect 71(1):29–35
Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J (1999) Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 29(5):1128–1132
Schmid D, Simons E, Ruppitsch W, Hrivniakova L, Stoeger A, Wechsler-Fordos A, Peter L, Geppert F, Allerberger F (2013) Limited value of routine spa typing: a cross-sectional study of methicillin-resistant Staphylococcus aureus-positive patients in an Austrian hospital. Am J Infect Control 41:617–624
Acknowledgments
We are grateful to Fredrik Nilsson statistician, PhD, Centre for Clinical Research, Lund, for statistical advice and calculations. We thank the physicians and nurses at the four infectious diseases departments in Skåne County (Helsingborg, Kristianstad, Lund and Malmö) and the staff at the clinical microbiology laboratories for their excellent work and collaboration. We are also grateful to Associate Professor Ingrid Nilsson-Ehle for her valuable views in the process of writing. This study was supported financially by the Thelma Zoégas Fund and Gorthon Fund.
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Larsson, AK., Gustafsson, E., Johansson, P.J.H. et al. Epidemiology of MRSA in southern Sweden: strong relation to foreign country of origin, health care abroad and foreign travel. Eur J Clin Microbiol Infect Dis 33, 61–68 (2014). https://doi.org/10.1007/s10096-013-1929-2
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DOI: https://doi.org/10.1007/s10096-013-1929-2