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Original Article

Nationwide surveillance of resistance rates of Staphylococcus aureus clinical isolates from Greek hospitals, 2012–2013

Maria Souli4th Department of Internal Medicine, Athens University School of Medicine, University General Hospital ‘Attikon’, Chaidari, Athens, Greece; Correspondence[email protected]

Ilias Karaiskos6th Department of Internal Medicine, Hygeia Hospital, Marousi, Athens, Greece;

Lambrini Galani6th Department of Internal Medicine, Hygeia Hospital, Marousi, Athens, Greece;

Sofia MarakiDepartment of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Crete;

Efstathia PerivoliotiDepartment of Clinical Microbiology, Evaggelismos Hospital, Athens, Greece;

Athina ArgyropoulouDepartment of Clinical Microbiology, Evaggelismos Hospital, Athens, Greece;

Athina CharissiadouMicrobiology Department, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece;

Levantia ZachariadouMicrobiology Department, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece;

Sofia TsiplakouMicrobiology Department, ‘KAT’ Hospital, Kifissia, Athens, Greece;

Vassiliki PapaioannouMicrobiology Department, ‘KAT’ Hospital, Kifissia, Athens, Greece;

Helen TsorliniMicrobiological Laboratory, Bacteriology Department, ‘G.Papanikolaou’ General Hospital of Thessaloniki, Thessaloniki, Greece;

Helen KatsifaMicrobiological Laboratory, Bacteriology Department, ‘G.Papanikolaou’ General Hospital of Thessaloniki, Thessaloniki, Greece;

Vasiliki BakaMicrobiology Department, ‘Korgialenio-Benakio’ Hellenic Red Cross Hospital, Athens, Greece;

Paraskevi PantaziMicrobiology Department, ‘Korgialenio-Benakio’ Hellenic Red Cross Hospital, Athens, Greece;

Angeliki PaschaliMicrobiology Department, General Hospital of Corfu, Corfu, Greece;

Anna KyratsaMicrobiology Department, General Hospital of Corfu, Corfu, Greece;

Eleftheria Trikka-GraphakosDepartment of Clinical Microbiology, ‘Thriassio’ General Hospital, Elefsina, Greece;

Panagiota GiannopoulouDepartment of Clinical Microbiology, ‘Thriassio’ General Hospital, Elefsina, Greece;

Evangelos VogiatzakisMicrobiology–Biochemistry Laboratory and National Reference Laboratory for Mycobacteria, ‘Sotiria’ Chest Diseases Hospital of Athens, Athens, Greece;

Helen MoraitouMicrobiology–Biochemistry Laboratory and National Reference Laboratory for Mycobacteria, ‘Sotiria’ Chest Diseases Hospital of Athens, Athens, Greece;

Helen PapadogeorgakiMicrobiology Department, ‘A.Syggros’ University Hospital for Skin and Venereal Diseases, Athens, Greece;

Helen AvgerinouMicrobiology Department, ‘A.Syggros’ University Hospital for Skin and Venereal Diseases, Athens, Greece;

Theofano PanageaMicrobiology Department, Sismanogleio-A. Fleming General Hospital, Vrilissia, Athens, Greece;

Angeliki PantazatouDepartment of Microbiology, ‘Laikon’ General Hospital, Athens, Greece;

Efthymia PetinakiDepartment of Microbiology, University Hospital of Larissa, Larissa, Thessalia, Greece;

Giannoula StamatopoulouMicrobiology Laboratory, General Hospital of Xanthi, Xanthi, Thrace, Greece;

Marina ToutouzaDepartment of Microbiology, ‘Hippokration’ General Hospital of Athens, Athens, Greece;

Ioanna KaratzoglouDepartment of Microbiology, General Hospital of Kavala, Kavala, Greece;

Konstantina KontopoulouDepartment of Microbiology, ‘G. Gennimatas’ General Hospital of Thessaloniki, Thessaloniki, Greece;

Maria OrfanidouMicrobiology Laboratory, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece;

Irene KarantaniMicrobiology Laboratory, Hygeia Hospital, Marousi, Athens, Greece;

Panteleimon FytasMicrobiology Laboratory, ‘Agios Pavlos’ General Hospital of Thessaloniki, Thessaloniki, Greece;

Konstantina TzanetouMicrobiology Department, ‘Alexandra’ General Hospital of Athens, Athens, Greece;

Evangelia PlatsoukaDepartment of Microbiology, General Hospital of Nea Ionia-Konstantopouleio – Patision, Athens, Greece;

Polyzo KazilaMicrobiology Department, ‘Theageneio’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece;

Anastasia ChliLaboratory of Microbiology, General Hospital of Drama, Drama, Greece;

Ntina StatiriDepartment of Microbiology, General Hospital of Rhodes, Rhodes, Greece

Helen Giamarellou6th Department of Internal Medicine, Hygeia Hospital, Marousi, Athens, Greece;

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Abstract

Purpose To evaluate the in vitro efficacy of several anti-staphylococcal agents against a nationwide collection of contemporary Staphylococcus aureus clinical isolates from several healthcare centres in Greece. Methods Thirty hospitals throughout Greece (18 in Attica) provided all clinical isolates of S.aureus from April 2012 to May 2013 to a central lab to be re-submitted to susceptibility testing. The MICs were evaluated by Vitek® 2 with the exception of ceftaroline (OXOID M.I.C. Evaluator™). Vancomycin and daptomycin MICs were also evaluated by Etest®. Heterogeneously vancomycin-intermediate strains (hVISA) were detected by the Etest® GRD. VISA phenotype was confirmed by PAP-AUC. Results A total of 1005 isolates (39% MRSA) were studied. Susceptibility rates were: erythromycin 66.5%, clindamycin 79.2%, SXT 98.9%, rifampicin 97.3%, fusidic acid 67%, moxifloxacin 78.8%, vancomycin 99.9%, ceftaroline 92.9% and linezolid, tigecycline and daptomycin 100%. For mupirocin, high level resistance could be excluded for 98.9% of isolates. Vancomycin Etest® MIC_50/90 were 1.5/1.5 mg/L, 58.5% of isolates exhibited a MIC > 1 and 8.7% a MIC of 2 mg/L, while Vitek® MIC_50/90 were 1/1 and 3.1% showed MIC > 1 mg/L. One VISA strain was detected. Among the selected 175 isolates that were screened for hVISA phenotype, six (3.4%) were positive. In 315 bloodstream isolates, 64.1% had a vancomycin Etest® MIC > 1 mg/L. Conclusions This multi-centre surveillance study revealed that a significant percentage of contemporary S.aureus isolates from Greek patients have a vancomycin MIC (> 1 mg/L) that may compromise the clinical efficacy of the drug for the treatment of serious infections. The in vitro activity of SXT, rifampicin, mupirocin, linezolid, tigecycline, daptomycin and ceftaroline remains excellent.

Keywords:

Acknowledgements

The authors wish to thank Grigorios Totos, Aliki Vogiatzi, Christina Vogiatzi, Antoula Kandyli, Efstratios Psomas and Christina Ramfou for their contribution. Part of these data was presented in 23rd European Congress of Clinical Microbiology and Infectious Diseases, 2013, Berlin, Germany (absrt. P1506). The study received funding from the Hellenic Society of Chemotherapy.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Nationwide surveillance of resistance rates of Staphylococcus aureus clinical isolates from Greek hospitals, 2012–2013

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Nationwide surveillance of resistance rates of Staphylococcus aureus clinical isolates from Greek hospitals, 2012–2013

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