MRSA in Croatia: prevalence and management

ABSTRACT

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with increased morbidity, mortality and length of hospital stay. MRSA is a major pathogen in hospitals and an important pathogen in community infections with few severe and fatal cases. However, MRSA causes the majority of skin and soft tissue infections in the US. The burden of community MRSA is much smaller in Europe, but there are reports of livestock-associated MRSA (LA-MRSA) isolated from pigs and cattle causing significant infections in the people who are connected to these farms. MRSA has been present in Croatia for more than 45 years, and it exerts a different impact on health-care infections. A remarkable increase in MRSA percentage was noted in primarily sterile samples in 2002 (37%) in comparison to 2001 (31%). This percentage remained quite high until 2008, when the first signs of a reduced trend were observed. The lowest percentage was 22% in 2012.

KEYWORDS:

• MRSA
• prevalence
• primarily sterile samples
• resistance
• treatment

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in hospital settings, and it is becoming more important in outpatient settings, long-term care facili ties and nursing homes (NHs).

• The estimated number of infections caused by MRSA is 171,200 annually in the European Union, Iceland and Norway. This number represents 44% of all infections associated with health care in these countries.

• There are 11 described types of SCCmec and numerous subtypes. The first three types (I, II and III) are predominantly found in HA MRSA, and types IV and V are primarily found in community strains, which is similar to types VI–XI.

• MRSA percentage in primarily sterile samples was 24% in 2013 and the percentage in total sample isolates was 12%.

• Annual reports of clinical hospitals in 2013 revealed that the percentage of MRSA in SA isolates varied from 0 to 37.7% (mean 15.3, median 13). The percentage of MRSA varied from 7.6 to 88% (mean 33.7, median 31) in the same hospitals in 2005.

• MRSA was investigated in seven Croatian NHs in a multicenter study in 2010. The mean MRSA prevalence in nasal swabs was 7.1% (range 0–28.8%)

• MRSA is present in many pig farms in Croatia, and research should be continued with further tests on animals and people in contact with pigs to obtain a better picture of the incidence of MRSA infection in pigs and humans.

• The first community-acquired (CA) MRSA isolate was identified in 2006, and a systematic analysis of MRSA strains revealed that the prevalence of CA MRSA was 0.03% in 2004.

• Further analysis of 3960 nasal swabs from healthy individuals in 2011 revealed that the percentage of MRSA in SA carriers was 2%, and 0.4% in total study population.