Advanced search
Publication Cover
Expert Review of Anti-infective Therapy Volume 14, 2016 - Issue 2
Submit an article Journal homepage
199
Views
2
CrossRef citations to date
0
Altmetric
Special Report

MRSA in Croatia: prevalence and management

Ana BudimirDepartment of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Zagreb, CroatiaCorrespondence[email protected]
Pages 167-176 | Received 31 Aug 2015, Accepted 02 Nov 2015, Published online: 26 Nov 2015

References

  • Papers of special note have been highlighted as:
  • • of interest
  • •• of considerable interest
  • den Heijer CD, van Bijnen EM, Paget WJ, et al., APRES Study Team. Prevalence and resistance of commensal Staphylococcus aureus, including methicillin-resistant S. aureus, in nine European countries: a cross-sectional study. Lancet Infect Dis. 2013;13(5):409–415. DOI:10.1016/S1473-3099(13)70036-7. Epub 2013 Mar 6.

•• Cross-sectional study where nasal swabs were obtained from 32,206 patients recruited by family doctors networks in Austria, Belgium, Croatia, France, Hungary, Spain, Sweden, the Netherlands and UK. Staphylococcus aureus was isolated from 21.6% of patients. Adjusted prevalence for patients older than 18 years was 2% in all S. aureus strains of 0.4% in total study population. All 15 of MRSA strains had different spa types

  • Lasseter G, Charlett A, Lewis D, et al. Staphylococcus aureus carriage in care homes: identification of risk factors, including the role of dementia. Epidemiol Infect. 2010;138(5):686–696. DOI:10.1017/S0950268810000233. Epub 2010 Feb 11.
  • Köck R, Becker K, Cookson B, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010;15(41):pii=19688.
  • Skov R, Jensen KS. Community associated methicillin-resistant Staphylococcus aureus as a cause of hospital-acquired infections. J Hosp Infect. 2009;73(4):364–370.
  • van Rijen MM, Van Keulen PH, Kluytmans JA. Increase in a Dutch hospital of methicillin-resistant Staphylococcus aureus related to animal farming. Clin Infect Dis. 2008;46(2):261–263.
  • Jevons MP. Celbenin-resistant staphylococci. BMJ. 1961;1:124–125.
  • van Cleef BAGL, Monnet DL, Voss A, et al. Livestock-associated methicillin-resistant Staphylococcus aureus in humans, Europe. Emerg Infect Dis. 2011;17(3):502–505. DOI:10.3201/eid1703.101036.
  • Weese JS, Dick H, Willey BM, et al. Suspected transmission of methicillin-resistant Staphylococcus aureus between domestic pets and humans in veterinary clinics and in the household. Vet Microbiol. 2006;115:148–155.
  • Shore AC, Deasy EC, Slickers P, et al. Detection of staphylococcal cassette chromosome mec type XI carrying highly divergent mecA, mecI, mecR1, blaZ, and ccr genes in human clinical isolates of clonal complex 130 methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2011;55:3765–3773. DOI:10.1128/AAC.00187-11.
  • Deurenberg RH, Vink C, Kalenic S, et al. The molecular evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect. 2007;13(3):222–235.

• The epidemiology of MRSA has been investigated by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), spa typing and SCCmec typing. Numerous MRSA clones have emerged and disseminated worldwide. SCCmec has been acquired on at least 20 occasions by different lineages of methicillin-sensitive S. aureus. Although most MRSA strains are hospital-acquired (HA-MRSA), community-acquired MRSA (CA-MRSA) strains have now been recognized. CA-MRSA is both phenotypically and genotypically different from HA-MRSA. CA-MRSA harbors SCCmec types IV or V, and is associated with the genes encoding Panton-Valentine leukocidin. The prevalence of MRSA ranges from 0.6% in the Netherlands to 66.8% in Japan

  • Becker K, Ballhausen B, Köck R, et al. Methicillin resistance in Staphylococcus isolates: the “mec alphabet” with specific consideration of mecC, a mec homolog associated with zoonotic S. aureus lineages. Int J Med Microbiol. 2014;304(7):794–804. DOI:10.1016/j.ijmm.2014.06.007. Epub 2014 Jun 28. Review.
  • Budimir A, Bošnjak Z, Kalenić S. Methicillin-resistant Staphylococcus aureus (MRSA) in Croatia. Croat J Infect. 2012;32(2):59–66.

• Staphylococcus aureus is a respectable community-acquired pathogen and one of the most frequent pathogens of health-care-associated infections. Resistance to methicillin in Europe is predominantly a feature of nosocomial strains, although methicillin-resistant isolates are becoming increasingly prevalent in the community. The rate of MRSA began to decrease in Croatia in 2010, and this trend has continued. Results presented in this paper are extracted from annual reports on hospital-acquired infections in acute hospitals

  • Croatian Academy of medical sciences. Public health collegium, Committee for antibiotic resistance surveillance in Croatia [Internet]. Antibiotic resistance in Croatia, 2013. [cited 2015 Aug 17]. Zagreb: The Croatian Academy of Medical Sciences; 2014. ISSN 1846-1654. Available from: http://iskra.bfm.hr/hrv/Resistance.aspx?id=66

•• This is an official annual publication of Croatian Committee for Antibiotic Resistance Surveillance of the Croatian Academy of Medical Sciences (CAMS) and the Reference Centre for Antibiotic Resistance Surveillance of the Croatian Ministry for Health (MH). This surveillance data should enable rational use of antibiotics in empirical therapy and will help to raise awareness about resistance and antibiotic consumption rates in different regions of Croatia

  • Budimir A, Payerl Pal M, Bošnjak Z, et al. Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus strains isolated in a multicenter study of nursing home residents in Croatia. Am J Infect Control. 2014;42(11):1197–1202. Epub 2014 Sep 17. DOI:10.1016/j.ajic.2014.07.032.

• The paper is describing a cross-sectional study performed among 877 residents and staff of 7 nursing homes representing 3 major Croatian regions. The overall prevalence of MRSA colonization was 7.1%, ranging from 0% to 28.8%

  • Wertheim HF, Vos MC, Boelens HA, et al. Low prevalence of methicillin resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect. 2004;56:321–325.
  • Köck R, Harlizius J, Bressan N, et al. Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among pigs on German farms and import of livestock-related MRSA into hospitals. Eur J Clin Microbiol Infect Dis [Internet]. 2009. [cited 2015 Aug 20]. Available from: http://www.springerlink.com/content/d07291v16185374t/
  • Armand-Lefevre L, Ruimy R, Andermont A. Clonal comparison of Staphylococcus aureus isolates from healthy pig farmers, human controls and pigs. Emerg Infect Dis. 2005;11:711–714.
  • Habrun B, Račić I, Beck R, et al. The presence of methicillin-resistant Staphylococcus aureus on large pig breeding farms in Croatia. Acta Vet Hung. 2011;59(4):419–425.

• This paper presents the first report of the presence of MRSA at large pig breeding farms in Croatia, the determination of mecA gene, spa typing and determination of susceptibility to commonly used antimicrobials. Dust samples were collected from eight large pig farms in Croatia. On each farm, between 7 and 11 samples were taken. Of the total 68 swabs, the mecA gene was detected in 24 isolates growing on the MRSA agar

  • Pfaller MA, Caliendo AM, Versalovic J. Molecular methods for epidemiologic typing of microorganisms. In: Isenberg HD, editor. Clinical microbiology procedures handbook. 2nd ed. Washington (DC): ASM Press; 2004. ISBN 10: 1555812902/ISBN 13: 9781555812904.
  • Goering RV. Pulsed-field gel electrophoresis. In: Persing DH, editor. Molecular microbiology: diagnostic principles and practice. Washington (DC): ASM Press; 2004. p. 185–196.
  • Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33(9):2233–2239.
  • Sabat AJ, Budimir A, Nashev D, et al. Overview of molecular typing methods for outbreak detection and epidemiological surveillance. ESCMID Study Group of Epidemiological Markers (ESGEM). Euro Surveill. 2013;18(4):20380. Review.
  • Budimir A, Deurenberg RH, Plecko V, et al. Molecular characterization of methicillin-resistant Staphylococcus aureus bloodstream isolates from Croatia. J Antimicrob Chemother. 2006;57(2):331–334. Epub 2005 Dec 9.

• Eighty-two hospital-acquired MRSA bloodstream isolates, collected in 2001 and 2002 in Croatia, were characterized by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST). The presence of genes encoding PVL and TSST-1 was investigated by real-time PCR. All strains were multiresistant and were distributed among 16 different similarity groups as determined by PFGE. The predominant SCCmec type found among the isolates was type I (89%)

  • Budimir A, Deurenberg RH, Bosnjak Z, et al. A variant of the Southern German clone of methicillin-resistant Staphylococcus aureus is predominant in Croatia. Clin Microbiol Infect. 2010;16(8):1077–1083. Epub 2009 Sep 2.
  • Krzyszton-Russjan J, Tambic –Andrasevic A, Bukovski S, et al. First community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in Croatia. Clin Microbiol Infect. 2006;12(7):697–698.

• The letter describes three isolates recovered from the two outpatients shared PFGE type G1, clonal typeST80-IV and agr type 3, and harbored Panton–Valentine leukocidin genes. Only spa typing showed a slight genetic differentiation, reflected in spa types t044, t376 and t131, but there was a clear relationship among the isolates. According to molecular epidemiological definitions, these three isolates were classified as CA-MRSA because they possessed SCCmec IV

  • Kalenić S, Pal MP, Palcevski VV, et al. Guidelines for prevention, control and treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Lijec Vjesn. 2008;130(Suppl 1):7–32. Croatian.

•• Guidelines were created with aim to reduce the number of patients infected/colonized with MRSA in health-care facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. Guidelines include recommendations for measures in prevention of MRSA spread, role of hospital management, rational use of antibiotics, measures in a case of outbreak, treatment of infections and brief review of community-acquired MRSA. At the end, appendices concerning hospital audit, algorithms of laboratory diagnosis, patient information and form for national MRSA surveillance were added

  • Kalenić S, Pal MP, Palcevski VV, et al. Guidelines for prevention, control and treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA): changes and updates of chapter 7.0: treatment of patients with MRSA infection. Lijec Vjesn. 2010;132(11–12):340–344. Croatian.
  • Guidelines for the control of methicillin-resistant Staphylococcus aureus in New Zealand. Wellington: The Ministry of Health; 2002. ISBN 0-478-27066-6
  • Muto CA, Jernigan JA, Ostrowsky BE, et al. SHEA. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24(5):362–386.
  • Working Party for Infection Prevention. Management policy for methicillin-resistant Staphylococcus aureus guideline [Internet]. No 35a. [cited 2015 Jul 13]. Leyden: Stichting Werkgroep Infectie Preventie; 2005. Available from: http://www.wip.nl
  • Coia JE, Duckworth GJ, Edwards DI, et al. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006;63(Suppl.1):S1–S44. Epub 2006 Apr 3.
  • Siegel JD, Rhinehart E, Jackson M, et al. CDC Management of multidrug-resistant organisms in healthcare settings [Internet]. 2006. [cited 2015 Aug 20]. Available from: http://www.cdc.gov/hicpac/pdf/guidelines/MDROGuideline2006.pdf
  • Gould FK, Brindle R, Chadwick PR, et al. Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. J Antimicrob Chemother. 2009;63:849–861.
  • Ruhe JJ, Menon A. Tetracyclines as an oral treatment option for patients with community onset skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2007;51(9):3298–3303.
  • Khawcharoenporn T, Alan T. Oral antibiotic treatment for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: review of the literature. Hawaii Med J. 2006;65(10):290–293. Review.
  • Szumowski JD, Cohen DE, Kanaya F, et al. Treatment and outcomes of infections by methicillin-resistant Staphylococcus aureus at an ambulatory clinic. Antimicrob Agents Chemother. 2007;51(2):423–428.
  • Gemmell CG, Edwards DI, Fraise AP, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK, Joint BSAC/HIS/ICNA Working party on MRSA UK. J Antimicrob Chemother. 2006;57(4):589–608.
  • Weaving P, Cox F, Milton S. Infection prevention and control in the operating theatre: reducing the risk of surgical site infections (SSIs). J Perioper Pract. 2008;18(5):199–204.
  • Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350(14):1422–1429.
  • Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–1654.
  • Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37:S59–S66.
  • Betsch BY, Eggli S, Siebenrock KA, et al. Treatment of joint prosthesis infection in accordance with current recommendations improves outcome. Clin Infect Dis. 2008;46:1221–1226.
  • Aslam S, Darouiche RO. Antimicrobial therapy for bone and joint infections. Curr Infect Dis Rep. 2009;11(1):7–13.
  • Zimmerli W, Widmer AF, Blatter M, et al. Role of rifampin for treatment of orthopedic implant–related staphylococcal infections. JAMA. 1998;279:1537–1541.
  • Lopes JA, Fernandes P, Jorge S, et al. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care. 2008;12:R110.
  • Beibei L, Yun C, Mengli C, et al. Linezolid versus vancomycin for the treatment of gram-positive bacterial infections: meta-analysis of randomised controlled trials. Int J Antimicrob Agents. 2010;35:3–12.
  • Falagas ME, Siempos II, Vardakas KZ. Linezolid versus glycopeptide or ß-lactam for treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials. Lancet Infect Dis. 2008;8:53–66.
  • Stevens DL, Herr D, Lampiris H, et al. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2002;34(11):1481–1490.
  • Grossi PA. Early appropriate therapy of Gram-positive bloodstream infections: the conservative use of new drugs. Int J Antimicrob Agents. 2009;34(Suppl 4):S31–S34.
  • Fowler VG Jr, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. NEJM. 2006;355:653–665.
  • Tom TSM, Kruse MW, Reichman RT. Update: methicillin-resistant Staphylococcus aureus screening and decolonization in cardiac surgery. Ann Thorac Surg. 2009;88(2):695–702.
  • Moise PA, Hershberger E, Amodio-Groton MI, et al. Safety and clinical outcomes when utilizing high-dose (> or =8 mg/kg) daptomycin therapy. Ann Pharmacother. 2009;43(7):1211–1219.
  • Gilligan PH, Gage PA, Welch DF, et al. Prevalence of thymidine-dependent Staphylococcus aureus in patients with cystic fibrosis. J Clin Microbiol. 1987;25:1258–1261.
  • Stein GE, Wells EM. The importance of tissue penetration in achieving successful antimicrobial treatment of nosocomial pneumonia and complicated skin and soft tissue infection caused by methicillin-resistant Staphylococcus aureus: vancomycin and linezolid. Curr Med Res Opin. 2010;26(3):571–588. doi:10.1185/03007990903512057.
  • Wunderink RG, Mendelson MH, Somero MS, et al. Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus. Chest. 2008;134:1200–1207.
  • Naesens R, Ronsyn M, Druwé P, et al. Central nervous system invasion by community-acquired methicillin-resistant Staphylococcus aureus. J Med Microbiol. 2009;58(Pt 9):1247–1251.
  • Roche M, Humphreys H, Smyth E, et al. A twelve-year review of central nervous bacterial abscesses: presentation and aetiology. Clin Microbiol Infect. 2003;9:803–809.
  • Budimir A, Kalenić S. Community-associated methicillin-resistant Staphylococcus aureus–molecular evolution, characteristics and significance. Lijec Vjesn. 2007;129(10–11):355–363. Review. Croatian.
  • Russell JA, Singer J, Bernard GR, et al. Changing pattern of organ dysfunction in early human sepsis is related to mortality. Crit Care Med. 2000;28:3405–3411.
  • Kalenić S, Budimir A, Bosnjak Z, et al. Guidelines on hand hygiene in health care institutions. Lijec Vjesn. 2011;133(5–6):155–170. Review. Croatian.

• These Guidelines are meant for all health-care workers and other hospital staff who come to the direct contact with patients. Categorization is based on existing data, theoretical basis, applicability and economic impact. Guidelines include recommendations for hand hygiene indications, hand hygiene technique, surgical hand preparation, choosing hand hygiene preparations, skin care, nails, glove use, patients and visitors hand hygiene, role of education, as well as role of health-care institution and role of government. Furthermore, in the Guidelines the concept of ‘Five moments for hand hygiene‘ is explained in detail, and main literature data are presented

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Order Reprints Request Corporate Permissions

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

Request Academic Permissions

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.

Related research

People also read lists articles that other readers of this article have read.

Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine.

Cited by lists all citing articles based on Crossref citations.
Articles with the Crossref icon will open in a new tab.