SpringerLink
Log in

Long-term persistence of a multi-resistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) clone at a university hospital in southeast Sweden, without further transmission within the region

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The objective of this study was to characterise isolates of methicillin-susceptible Staphylococcus aureus (MSSA) with resistance to clindamycin and/or tobramycin in southeast Sweden, including the previously described ECT-R clone (t002) found in Östergötland County, focusing on clonal relatedness, virulence determinants and existence of staphylococcal cassette chromosome (SCC) mec remnants. MSSA isolates with resistance to clindamycin and/or tobramycin were collected from the three county councils in southeast Sweden and investigated with spa ty**, polymerase chain reaction (PCR) targeting the SCCmec right extremity junction (MREJ) and DNA microarray technology. The 98 isolates were divided into 40 spa types, and by microarray clustered in 17 multi-locus sequence ty** (MLST) clonal complexes (MLST-CCs). All isolates with combined resistance to clindamycin and tobramycin (n = 12) from Östergötland County and two additional isolates (clindamycin-R) were designated as spa type t002, MREJ type ii and were clustered in CC5, together with a representative isolate of the ECT-R clone, indicating the clone’s persistence. These isolates also carried several genes encoding exotoxins, Q9XB68-dcs and qacC. Of the isolates in CC15, 83 % (25/30) were tobramycin-resistant and were designated spa type t084. Of these, 68 % (17/25) were isolated from new-borns in all three counties. The persistence of the ECT-R clone in Östergötland County, although not found in any other county in the region, carrying certain virulence factors that possibly enhance its survival in the hospital environment, highlights the fact that basic hygiene guidelines must be maintained even when MRSA prevalence is low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Grundmann H, Aanensen DM, van den Wijngaard CC, Spratt BG, Harmsen D, Friedrich AW; European Staphylococcal Reference Laboratory Working Group (2010) Geographic distribution of Staphylococcus aureus causing invasive infections in Europe: a molecular-epidemiological analysis. PLoS Med 7(1):e1000215. doi:10.1371/journal.pmed.1000215

    Article  PubMed Central  PubMed  Google Scholar 

  2. Wiese-Posselt M, Heuck D, Draeger A, Mielke M, Witte W, Ammon A, Hamouda O (2007) Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002–2005. Clin Infect Dis 44(11):e88–e95. doi:10.1086/517503

    Article  PubMed  Google Scholar 

  3. Grub C, Holberg-Petersen M, Medbø S, Andersen BM, Syversen G, Melby KK (2010) A multidrug-resistant, methicillin-susceptible strain of Staphylococcus aureus from a neonatal intensive care unit in Oslo, Norway. Scand J Infect Dis 42(2):148–151. doi:10.3109/00365540903334401

    Article  PubMed  Google Scholar 

  4. Boers SA, van Ess I, Euser SM, Jansen R, Tempelman FR, Diederen BM (2011) An outbreak of a multiresistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) strain in a burn centre: the importance of routine molecular ty**. Burns 37(5):808–813

    Article  CAS  PubMed  Google Scholar 

  5. Gasch O, Hornero A, Domínguez MA, Fernández A, Suárez C, Gómez S, Camoez M, Linares J, Ariza J, Pujol M (2012) Methicillin-susceptible Staphylococcus aureus clone related to the early pandemic phage type 80/81 causing an outbreak among residents of three occupational centres in Barcelona, Spain. Clin Microbiol Infect 18(7):662–667. doi:10.1111/j.1469-0691.2011.03663.x

    Article  CAS  PubMed  Google Scholar 

  6. Lindqvist M, Isaksson B, Samuelsson A, Nilsson LE, Hallgren A (2009) A clonal outbreak of methicillin-susceptible Staphylococcus aureus with concomitant resistance to erythromycin, clindamycin and tobramycin in a Swedish county. Scand J Infect Dis 41(5):324–333. doi:10.1080/00365540902801202

    Article  CAS  PubMed  Google Scholar 

  7. Lindqvist M, Isaksson B, Grub C, Jonassen TØ, Hällgren A (2012) Detection and characterisation of SCCmec remnants in multiresistant methicillin-susceptible Staphylococcus aureus causing a clonal outbreak in a Swedish county. Eur J Clin Microbiol Infect Dis 31(2):141–147. doi:10.1007/s10096-011-1286-y

    Article  CAS  PubMed  Google Scholar 

  8. Huang SS, Avery TR, Song Y, Elkins KR, Nguyen CC, Nutter SK, Nafday AA, Condon CJ, Chang MT, Chrest D, Boos J, Bobashev G, Wheaton W, Frank SA, Platt R, Lipsitch M, Bush RM, Eubank S, Burke DS, Lee BY (2010) Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 31(11):1160–1169. doi:10.1086/656747

    Article  PubMed Central  PubMed  Google Scholar 

  9. Donker T, Wallinga J, Slack R, Grundmann H (2012) Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer. PLoS One 7(4):e35002. doi:10.1371/journal.pone.0035002

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Donker T, Wallinga J, Grundmann H (2014) Dispersal of antibiotic-resistant high-risk clones by hospital networks: changing the patient direction can make all the difference. J Hosp Infect 86(1):34–41. doi:10.1016/j.jhin.2013.06.021

    Article  CAS  PubMed  Google Scholar 

  11. Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH (2003) Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci. J Clin Microbiol 41(10):4740–4744

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Monecke S, Jatzwauk L, Weber S, Slickers P, Ehricht R (2008) DNA microarray-based genoty** of methicillin-resistant Staphylococcus aureus strains from Eastern Saxony. Clin Microbiol Infect 14(6):534–545. doi:10.1111/j.1469-0691.2008.01986.x

    Article  CAS  PubMed  Google Scholar 

  13. Monecke S, Slickers P, Ehricht R (2008) Assignment of Staphylococcus aureus isolates to clonal complexes based on microarray analysis and pattern recognition. FEMS Immunol Med Microbiol 53(2):237–251. doi:10.1111/j.1574-695X.2008.00426.x

    Article  CAS  PubMed  Google Scholar 

  14. Huletsky A, Giroux R, Rossbach V, Gagnon M, Vaillancourt M, Bernier M, Gagnon F, Truchon K, Bastien M, Picard FJ, van Belkum A, Ouellette M, Roy PH, Bergeron MG (2004) New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci. J Clin Microbiol 42(5):1875–1884

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Shore AC, Rossney AS, O’Connell B, Herra CM, Sullivan DJ, Humphreys H, Coleman DC (2008) Detection of staphylococcal cassette chromosome mec-associated DNA segments in multiresistant methicillin-susceptible Staphylococcus aureus (MSSA) and identification of Staphylococcus epidermidis ccrAB4 in both methicillin-resistant S. aureus and MSSA. Antimicrob Agents Chemother 52(12):4407–4419. doi:10.1128/AAC.00447-08

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Monecke S, Coombs G, Shore AC, Coleman DC, Akpaka P, Borg M, Chow H, Ip M, Jatzwauk L, Jonas D, Kadlec K, Kearns A, Laurent F, O’Brien FG, Pearson J, Ruppelt A, Schwarz S, Scicluna E, Slickers P, Tan HL, Weber S, Ehricht R (2011) A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus. PLoS One 6(4):e17936. doi:10.1371/journal.pone.0017936

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Smith K, Gemmell CG, Hunter IS (2008) The association between biocide tolerance and the presence or absence of qac genes among hospital-acquired and community-acquired MRSA isolates. J Antimicrob Chemother 61(1):78–84. doi:10.1093/jac/dkm395

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful for all the help from the people in the participating clinical microbiology laboratories, and especially Annika Wistedt, Kalmar County Hospital and Lennart E. Nilsson and Anita Johansson, Linkö** University and Linkö** University Hospital. This study was financially supported by the Östergötland County Council, Sweden, the Medical Research Council of Southeast Sweden (FORSS) and the Scandinavian Society for Antimicrobial Chemotherapy (SSAC)

Conflict of interest

The authors have no conflicts of interest to be declared.

Ethical statement

This study was approved by the Regional Ethical Review Board in Linkö**, Sweden (M164-09), who judged that there was no need for informed consent to be obtained is this study.

Author information

Authors and Affiliations

  1. Department of Infection Control, County Council of Östergötland, Linkö**, Sweden

    M. Lindqvist & B. Isaksson

  2. Division of Clinical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linkö** University, Linkö**, Sweden

    M. Lindqvist

  3. Clinical Microbiology Laboratory, Ryhov Hospital, Jönkö**, Sweden

    J. Swanberg

  4. Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark

    R. Skov, A. R. Larsen, J. Larsen & A. Petersen

  5. Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linkö** University, Linkö**, Sweden

    A. Hällgren

Authors
  1. M. Lindqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Isaksson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Swanberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Skov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. R. Larsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Larsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Hällgren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Hällgren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lindqvist, M., Isaksson, B., Swanberg, J. et al. Long-term persistence of a multi-resistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) clone at a university hospital in southeast Sweden, without further transmission within the region. Eur J Clin Microbiol Infect Dis 34, 1415–1422 (2015). https://doi.org/10.1007/s10096-015-2366-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-015-2366-1

Keywords

Search

Navigation