Ten-Year Prevalence Trends of Phenotypically Identified Community-Associated Methicillin-Resistant Staphylococcus aureus Strains in Clinical Specimens

Abstract

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains were first detected in hospitals in Korea between the late 2000s and early 2010s. However, there is limited information regarding the prevalence of CA-MRSA strains among hospital isolates and their phenotypic changes over the last decade. We investigated the prevalence trend of CA-MRSA strains isolated from different clinical specimens and their phenotypic changes between September 2009 and September 2019.

Methods: CA-MRSA strains were phenotypically identified by confirming their resistance to penicillin (PCN) and oxacillin (OXA) and evaluating their susceptibility to trimethoprim-sulfamethoxazole, rifampin, fusidic acid, tetracycline, and at least one of the following four antimicrobials: clindamycin (CLI), erythromycin (ERY), ciprofloxacin (CIP), and gentamicin (GEN). A CA-MRSA strain that exhibited resistance to ERY, CLI, CIP, or GEN was classified as having resistance pattern I, II, III, or IV, respectively, regardless of its resistance to other antimicrobial agents.

Results: Of the 8,278 MRSA isolates identified in specimens obtained two days after admission, 1,385 (16.73%) were CA-MRSA strains. The prevalence of CA-MRSA strains increased from 12.2% to 26.6% (3.21% per period, P=0.05). Resistance type analysis revealed an increasing trend in the prevalence of PCN/OXA-resistant (1.84%; P=0.049) and PCN/OXA/ERY/CLI/CIP-resistant (0.98%; P=0.04) CA-MRSA strains and in resistance pattern III strains (2.08%; P=0.004).

Conclusions: The prevalence of CA-MRSA strains in Korea has increased significantly over the last decade, and CA-MRSA strains have gained phenotypic diversity beyond PCN/OXA-resistance, including antimicrobial resistance to non-β-lactams, especially CIP.

Keywords: Antimicrobial resistance; Community-associated methicillin-resistant Staphylococcus aureus; Phenotypic changes; Prevalence.

Fig. 1

Prevalence trends of CA-MRSA strains according to resistance type (A) and specimen type (B), of PCN/OXA-resistant (C) and resistance pattern III (D) CA-MRSA strains according to specimen type, and of PCN/OXA/ERY/CLI/CIP-resistant CA-MRSA strains (E) according to specimen type, among HA-MRSA isolates. Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; CA-MRSA, community-associated MRSA; PCN, penicillin; OXA, oxacillin; ERY, erythromycin; CLI, clindamycin; CIP, ciprofloxacin; HA-MRSA, hospital-acquired MRSA; R1–4, resistance pattern I–IV; ENT, ear-nose-throat.