Clinical Impact and Prevalence of MRSA CC398 and differences between MRSA-Tet(R) and MRSA-Tet(S) in an area of Spain with a high density of pig farming: a prospective cohort study.

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Clinical Impact and Prevalence of MRSA CC398 and differences between MRSA-Tet(R) and MRSA-Tet(S) in an area of Spain with a high density of pig farming: a prospective cohort study.

Clin Microbiol Infect. 2017 Mar 29;:

Authors: Reynaga E, Torres C, Garcia-Nuñez M, Navarro M, Vilamala A, Puigoriol E, Lucchetti GE, Sabrià M

Abstract
OBJETIVES: Tetracycline-resistance (Tet(R)) is a phenotypic marker of the livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) CC398 clone. The aim of this study was to analyze the prevalence of MRSA CC398 in patients in contact with healthcare facilities and differences between patients with MRSA-Tet(R) and MRSA tetracycline-susceptible (Tet(S)) strains.
METHODS: Patients diagnosed with MRSA from January-2012 until December-2015 were divided into two groups, MRSA-Tet(R) and MRSA-Tet(S). Epidemiological and clinical data were evaluated. Molecular analysis was performed (MLST, spa-typing) on MRSA-Tet(R) strains.
RESULTS: 288 MRSA patients were obtained, and 106 (36.8%) carried MRSA-Tet(R) [93 typed as CC398 (87.7%), with the remaining 13 isolates ascribed to CC9, CC1, CC121, CC30, CC97, CC146 and CC152]. The most frequent spa-type was t011 (56.6%; 61/106). Detection of MRSA-Tet(R) increased over the years (21.9% (16/73) in 2012, 50.7%; (36/71) in 2015; p<0.001). Hospital-acquisition was found in 16.7% (19/114) of MRSA-Tet(R) patients vs 83.3%(95/114) in MRSA-Tet(S) patients (p<0.001). Frequency of MRSA-Tet(R) patients in nursing homes was lower than in MRSA-Tet(S) patients (4.7%(5/106) versus 27.5%(50/182), p<0.001). MRSA-Tet(R) as distinct from MRSA-Tet(S) was associated with pig-farm workers (49.0%(52/106) vs 1.0%(2/182); p<0.001), fewer admissions to hospital (46.2%(49/106) vs 68.1%(124/182); p<0.001) and fewer comorbidities (81.1%(86/106) vs 59.9%(109/182); p<0.001). Sixty cases of MRSA-CC398 infection were diagnosed, including among others endocarditis, septic arthritis, prosthetic-joint infection, pneumonia and bacteremia.
CONCLUSIONS: Prevalence of MRSA-Tet(R) (especially CC398) at hospital-level in a Spanish region with intensive-pig-farming activity is high and is responsible for severe infections. Significant differences were detected in clinical and epidemiological characteristics among MRSA-Tet(R) and MRSA-Tet(S) patients.

PMID: 28365311 [PubMed - as supplied by publisher]

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