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. 2025 Dec 5;7(6):dlaf229.
doi: 10.1093/jacamr/dlaf229. eCollection 2025 Dec.

Increasing trend in fusidic acid resistance among MRSA isolates in the Netherlands, 2016-23

F Velthuis  1 , I M Nauta  1 , W Altorf-van der Kuil  1 , D W Notermans  1 , R D Zwittink  1 , A F Schoffelen  1 , S C de Greeff  1 ; Infectious Diseases Surveillance Information System–Antimicrobial Resistance (ISIS–AR) Study Group
Collaborators, Affiliations

Increasing trend in fusidic acid resistance among MRSA isolates in the Netherlands, 2016-23

F Velthuis et al. JAC Antimicrob Resist. .

Abstract

Objectives: Recently, several MRSA community outbreaks occurred in the Netherlands, including one caused by an impetigo-causing MRSA strain resistant to fusidic acid. Since fusidic acid and flucloxacillin are the main treatment options for impetigo, increasing resistance limits treatment possibilities. We examined trends in fusidic acid resistance percentages among MRSA isolates in the Netherlands.

Materials and methods: Data on routine bacteriological cultures between 2016 and 2023 from 30 laboratories were extracted from the national surveillance system on antimicrobial resistance (ISIS-AR). Fusidic acid resistance percentages per year were calculated both overall and per age group for all MRSA isolates, and more specific, for the subset of MRSA isolates from wound/pus/skin samples collected by general practitioners (WPS-GP). Trends were determined using logistic regression and compared with trends among MSSA isolates.

Results: We found an increase in fusidic acid resistance among MRSA isolates from 15% (2016) to 29% (2023) (P < 0.001), which differed significantly (P < 0.001) from the trend among MSSA isolates (10%-12%). An increase was also found in MRSA WPS-GP isolates, both among young children and the population of 13-64 years old, but not among elderly. The trends remained significant after exclusion of isolates associated with known fusidic acid-resistant MRSA outbreaks, both among MRSA isolates overall (OR = 1.10, 95% CI: 1.07-1.14, P < 0.001) and among MRSA WPS-GP isolates (OR = 1.14, 1.07-1.21, P < 0.001).

Conclusions: In conclusion, an increasing trend in fusidic acid resistance was found among MRSA isolates. Since impaired treatment for impetigo might ease the spread of (fusidic acid-resistant) MRSA, extra vigilance is warranted.

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Figures

Figure 1.
Figure 1.
Yearly fusidic acid resistance percentages in MSSA and MRSA isolates between 2016 and 2023 in the Netherlands. The left two panels (a) show resistance percentages in isolates from all materials and healthcare settings. The right two panels (b) show resistance percentages in isolates from WPS-GP. The error bars show the 95% CI. N indicates the total number of isolates tested for fusidic acid between 2016 and 2023. aLinear regression analysis significant with a P value of <0.001.
Figure 2.
Figure 2.
Yearly fusidic acid resistance percentages in MRSA from WPS-GP between 2016 and 2023 per age group in the Netherlands. Age groups are defined as follows: 0–12 years old, 13–64 years old and ≥65 years old. Numbers above bars show the total number of MRSA isolates tested for fusidic acid susceptibility per year. There were no trend analyses performed for the separate age groups as the number of resistant isolates was <10 for multiple years.
Figure 3.
Figure 3.
Yearly fusidic acid resistance percentages in MRSA linked to genotyping information from the national MRSA surveillance (Type-Ned) between 2016 and 2023 in the Netherlands. The left two panels (a) show isolates from all materials and healthcare settings including and excluding MC0005 (mostly ST5) and MT4627 (ST121). The right two panels (b) show isolates from WPS-GP including and excluding MC0005 and MT4627. The error bars show the 95% CI. N indicates the total number of isolates tested for fusidic acid between 2016 and 2023. aLinear regression analysis significant with a P value of <0.001.
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