Changing molecular epidemiology of methicillin-resistant Staphylococcus aureus in a small geographic area over an eight-year period

Abstract

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at an international level shows that most MRSA strains belong to a few pandemic clones. At the local level, a predominance of one or two clones was generally reported. However, the situation is evolving and new clones are emerging worldwide, some of them with specific biological characteristics, such as the presence of Panton-Valentine leucocidin (PVL). Understanding these changes at the local and international levels is of great importance. Our objective was to analyze the evolution of MRSA epidemiology at multiple sites on a local level (Western Switzerland) over a period of 8 years. Data were based on MRSA reports from seven sentinel laboratories and infection control programs covering different areas. Pulsed-field gel electrophoresis was used to type MRSA isolates. From 1997 to 2004, a total of 2,256 patients with MRSA were reported. Results showed the presence of four predominant clones (accounting for 86% of patients), which could be related to known international clones (Berlin, New York/Japan, Southern Germany, and Iberian clones). Within the small geographic region, the 8-year follow-up period in the different areas showed spacio-temporal differences in the relative proportions of the four clones. Other international MRSA clones, as well as clones showing genetic characteristics identical to those of community-acquired MRSA (SCCmec type IV and the presence of PVL genes), were also identified but presumably did not disseminate. Despite the worldwide predominance of a few MRSA clones, our data showed that at a local level, the epidemiology of MRSA might be different from one hospital to another. Moreover, MRSA clones were replaced by other emerging clones, suggesting a rapid change.

FIG. 1.

Similarities of PFGE patterns of clones A to H observed in Western Switzerland between 1997 to 2004 and of some European epidemic clones. ST, CC, and presence of PVL were also indicated when available. Based on the presence or absence of bands, the Dice coefficient was used to calculate the similarities between PFGE patterns.

FIG. 2.

Annual numbers of patients with MRSA reported from the seven sentinel laboratories serving different geographic areas in Western Switzerland. Patients harboring one of the four predominant clones (A, B, C, and D) are also indicated. Since there were large differences in numbers of patients between laboratories, the y-axis scale was adapted accordingly.