Geographic distribution of Staphylococcus aureus causing invasive infections in Europe: A molecular-epidemiological analysis

Hajo Grundmann*, David M. Aanensen, Cees C. Van Den Wijngaard, Brian G. Spratt, Dag Harmsen, Alexander W. Friedrich, Artur J. Sabat, Jan Muilwijk, Jos Monen, Adriana Tami, Tjibbe Donker, Helmut Mittermayer, Karina Krziwanek, Sabine Stumvoll, Walter Koller, Olivier Denis, Marc Struelens, Dimitr Nashev, Ana Budimir, Smilja KalenicDespo Pieridou-Bagatzouni, Vladislav Jakubu, Helena Zemlickova, Henrik Westh, Marit Sørum, Robert Skov, Frederic Laurent, Jerome Ettienne, Birgit Strommenger, Wolfgang Witte, Sofia Vourli, Alkis Vatopoulos, Anni Vainio, Jaana Vuopio-Varkila, Miklos Fuzi, Erika Ungvári, Stephan Murchan, Angela Rossney, Edvins Miklasevics, Arta Balode, Gunnsteinn Haraldsson, Karl G. Kristinsson, Monica Monaco, Analisa Pantosti, Michael Borg, Marga Van Santen-Verheuvel, Xander Huijsdens, Lillian Marstein, Trond Jacobsen, Gunnar Skov Simonsen, Marta Aires-de-Sousa, Herminia De Lencastre, Agnieszka Luczak-Kadlubowska, Waleria Hryniewicz, Monica Straut, Irina Codita, Maria Perez-Vazquez, Oscar Cuevas, Vesna Cvitkovic Spik, Manica Mueller-Premru, Sara Haegman, Barbro Olsen-Liljequist, Matthew Ellington, Angela Kearns, Robin Köck, Alexander Mellmann, Karsten Becker, Ulrich Vogel

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    443 Citations (Scopus)

    Abstract

    Background: Staphylococcus aureus is one of the most important human pathogens and methicillin-resistant variants (MRSAs) are a major cause of hospital and community-acquired infection. We aimed to map the geographic distribution of the dominant clones that cause invasive infections in Europe. Methods and Findings: In each country, staphylococcal reference laboratories secured the participation of a sufficient number of hospital laboratories to achieve national geo-demographic representation. Participating laboratories collected successive methicillin-susceptible (MSSA) and MRSA isolates from patients with invasive S. aureus infection using an agreed protocol. All isolates were sent to the respective national reference laboratories and characterised by quality-controlled sequence typing of the variable region of the staphylococcal spa gene (spa typing), and data were uploaded to a central database. Relevant genetic and phenotypic information was assembled for interactive interrogation by a purpose-built Web-based mapping application. Between September 2006 and February 2007, 357 laboratories serving 450 hospitals in 26 countries collected 2,890 MSSA and MRSA isolates from patients with invasive S. aureus infection. A wide geographical distribution of spa types was found with some prevalent in all European countries. MSSA were more diverse than MRSA. Genetic diversity of MRSA differed considerably between countries with dominant MRSA spa types forming distinctive geographical clusters. We provide evidence that a network approach consisting of decentralised typing and visualisation of aggregated data using an interactive mapping tool can provide important information on the dynamics of MRSA populations such as early signalling of emerging strains, cross border spread, and importation by travel. Conclusions: In contrast to MSSA, MRSA spa types have a predominantly regional distribution in Europe. This finding is indicative of the selection and spread of a limited number of clones within health care networks, suggesting that control efforts aimed at interrupting the spread within and between health care institutions may not only be feasible but ultimately successful and should therefore be strongly encouraged.

    Original languageEnglish
    Article numbere1000215
    JournalPLoS Medicine
    Volume7
    Issue number1
    DOIs
    Publication statusPublished - Jan 2010

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