Changing patterns in frequency of recovery of five methicillin-resistant Staphylococcus aureus clones in Portuguese hospitals: surveillance over a 16-year period

Abstract

A total of 629 nonduplicate methicillin-resistant Staphylococcus aureus MRSA isolates were recovered between June and November 2006 from 11 hospitals located in different areas of Portugal. Selected isolates (n = 271, 43%) were typed by pulsed-field gel electrophoresis (PFGE), representatives of which were additionally characterized by spa typing, multilocus sequence typing, staphylococcal cassette chromosome mec (SCCmec) typing, and the presence of Panton-Valentine leukocidin (PVL). The 271 isolates were classified into 13 different clonal types. Three pandemic clones included the majority (n = 241, 88%) of the isolates and were observed in several hospitals: (i) EMRSA-15 (54%)-PFGE type A, ST22, spa type t022, SCCmec IV-was found in the 11 hospitals studied and was identified as the major clone in seven of them; (ii) the New York/Japan clone (17%)-PFGE B, ST5, spa type t067, SCCmec II-was identified in nine hospitals and represented the major clone in four; and (iii) the Brazilian MRSA (17%)-PFGE C, ST239, spa type t037, SCCmec IIIA-was also detected in nine hospitals but never as the main clone. All isolates tested were PVL negative. Clone EMRSA-15 is currently the predominant MRSA clonal type circulating in Portuguese hospitals, but a new wave of MRSA has emerged in the country with the recent introduction and spread of the New York/Japan clone. The Brazilian MRSA that was the leading clone in Portugal in the late 1990s is declining and being progressively replaced by the two former clones. We report the first isolate SCCmec type V (ST45) in Portugal.

FIG. 1.

Geographic location of the hospitals and clonal type distribution. In the “No. of isolates” column, the first number refers to the number of isolates studied, while the second number refers the total number of isolates recovered from the particular hospital. Abbreviations: HSMB, Hospital de São Marcos Braga, Braga; HPH, Hospital Pedro Hispano, Matosinhos; IPOP, Instituto Português de Oncologia do Porto Francisco Gentil, Oporto; HUC, Hospitais da Universidade de Coimbra, Coimbra; HSJ, Hospital de São José, Lisbon; HDE, Hospital D. Estefânia, Lisbon; IPO, Instituto Português de Oncologia de Francisco Gentil, Lisbon; SAMS, Hospital do SAMS, Lisbon; HFF, Hospital Dr. Fernando da Fonseca, Amadora; HBR, Hospital Nossa Senhora do Rosário, Barreiro; HBA, Centro Hospitalar do Barlavento Algarvio, Portimão. Underlined numbers represent the major clonal types in each hospital. Clones harboring a maximum of two isolates were grouped in “other” clonal types and include clones ST45-V variant, ST247-IA, ST5-IV, ST72-IV, ST34-II, ST228-I, ST88-IV, and ST1-IV.

FIG. 2.

Evolution of the clonal profile of MRSA in Portuguese hospitals between 1990 and 2006. The ST and SCCmec type are indicated under the clonal type current name. The data before 2000 were adapted from Aires de Sousa and de Lencastre (2).