Zusammenfassung
HINTERGRUND: Die ambulant erworbene ("community acquired") Methicillin resistente Infektion mit Staphylococcus aureus (CA-MRSA) unterscheidet sich von der nosokomialen ("health care associated") MRSA (HA-MRSA) sowohl in ihren molekularen als auch in ihren mikrobiologischen Eigenschaften. MATERIAL UND METHODEN: Sechs regionale und nationale Institute des öffentlichen Gesundheitswesen nahmen an der Erfassung von CA-MRSA Infektionen in Slowenien teil. Isolate, die gegenüber Oxacillin resistent und mindestens auf zwei der Antibiotika Ciproflaxin, Erythromycin, Clindamycin und Gentamycin empfindlich waren, wurden als CA-MRSA definiert und weiter analysiert. Das Vorkommen des Gens für Panton–Valentin Leukocidin (PVL) wurde durch Polymerase-Kettenreaktion (PCR) gesichert. Der Typ des SCCmec wurde durch multiplex PCR erhoben. Die Makrorestriktions-Analyse der chromosomalen DNA erfolgte durch Pulsfeld-Gelelektrophorese (PFGE). ERGEBNISSE: In einem Zeitraum von 21 Monaten analysierten wir 31 Infektionen mit CA-MRSA bei 31 Patienten. 23 Proben waren von Spitälern eingesandt worden, 6 aus der Primärversorgung und 2 aus der Langzeitversorgung. Alle 31 Isolate enthielten das mecA Gen. 16 (51,6%) Isolate wurden als SCCmec Typ IV identifiziert, 3 Isolate waren PVL positiv. Die CA-MRSA Stämme wurden mit Hilfe von PGFE in 15 Ähnlichkeitsgruppen klassifiziert. Bezüglich der Empfindlichkeit auf Antibiotika fanden wir in den 31 Kolonien 5 verschiedene Resistenzmuster. Eine gleichzeitige Resistenz gegenüber Ciprofloxacin und Gentamycin war oft mit dem Vorkommen des SCCmec Typ 1 – ähnlich wie bei der HA-MRSA – vergesellschaftet. SCHLUSSFOLGERUNGEN: PVL positive CA-MRSA Stämme konnten in Slowenien nur selten isoliert werden. Um das komplette mikrobiologische und epidemiologische Verhaltensmuster der CA-MRSA zu erfassen, werden wir die MRSA Stämme weiter genau beobachten und monitorisieren.
Summary
BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) differs from healthcare-associated MRSA (HA-MRSA) in its molecular and microbiological characteristics. MATERIALS AND METHODS: Six Slovenian regional public health institutes and the National Institute of Public Health took part in monitoring CA-MRSA infections. S. aureus isolates resistant to oxacillin and susceptible to ≥ two of the four antibiotics ciprofloxacin, erythromycin, clindamycin or gentamicin were defined as CA-MRSA and further analyzed. The presence of the gene for Panton–Valentine leukocidin (PVL) was confirmed using PCR, the type of staphylococcal cassette chromosome (SCCmec) using multiplex PCR, and macrorestriction analysis of chromosomal DNA using pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 31 strains from 31 patients were analyzed during a period of 21 months: 23 specimens were sent from hospitals, six from primary care, two from a long-term care facility. All 31 isolates contained the gene mecA. Sixteen (51.6%) isolates were identified as SCCmec type IV, three isolates were PVL positive. Using PFGE, the CA-MRSA strains were classified into 15 similarity groups. Results of antibiotic susceptibility showed there were five resistance types among the 31 strains. Simultaneous resistance against ciprofloxacin and gentamicin was often associated with the presence of SCCmec type I, strongly resembling HA-MRSA. CONCLUSIONS: PVL-positive strains of CA-MRSA have been isolated in Slovenia only rarely. We will continue to monitor strains of MRSA in order to obtain the complete microbiological and epidemiological features.
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Grmek-Kosnik, I., Dermota, U., Ribic, H. et al. Analysis of Slovenian MRSA strains with susceptibility patterns suggestive of CA-MRSA. Wien Klin Wochenschr 121, 552–557 (2009). https://doi.org/10.1007/s00508-009-1178-7
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DOI: https://doi.org/10.1007/s00508-009-1178-7