JAC Advance Access originally published online on September 24, 2009
Journal of Antimicrobial Chemotherapy 2009 64(6):1299-1306; doi:10.1093/jac/dkp345
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Original research |
Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes in Belgium
1 Laboratoire de Référence MRSA-Staphylocoques, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium 2 Unité d'Epidémiologie des Maladies Infectieuses, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium 3 Epidemiology Unit, Scientific Institute of Public Health, Brussels, Belgium
Received 16 April 2009; returned 23 June 2009; revised 25 August 2009; accepted 25 August 2009
* Corresponding author. Service de Microbiologie, Hôpital Erasme, 808, route de Lennik, 1070 Brussels, Belgium. Tel: +32-2-555-69-71; Fax: +32-2-555-31-10; E-mail: odenis{at}ulb.ac.be
Objectives: A national survey was conducted to determine the prevalence, risk factors and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage among nursing home (NH) residents in Belgium.
Methods: A random stratified, cross-sectional prevalence survey was conducted in NH residents who were screened for MRSA carriage by multisite enriched culture. Characteristics of NHs and residents were collected by a questionnaire survey and analysed by two-stage logistic regression modelling. MRSA isolates were genotyped by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing, multilocus sequence typing (MLST) and resistance genes.
Results: Of 2953 residents screened in 60 NHs, 587 (19.9%) were MRSA carriers. Risk factors included hospital contact, antibiotic exposure, impaired mobility and skin lesions at the resident level, and lack of MRSA surveillance, lack of antibiotic therapeutic formulary and the combination of less-developed infection control activities and a high ratio of physicians to residents at the institution level. MRSA isolates showed eight major types, three of which were predominant: B2-ST45-SCCmec IV (49%; where ST stands for sequence type); A21-ST8-SCCmec IV (13%); and A20-ST8-SCCmec IV (10%). Each was recovered in 55, 21 and 25 NHs, respectively. The geographical distribution of NH genotypes paralleled that of acute-care hospitals.
Conclusions: A high prevalence of MRSA carriage in NH residents was associated with hospital care, co-morbidities and less-developed coordination of institutional care. The predominant MRSA strains from NH residents and hospitalized patients of the same area were identical. Strengthening and coordination of MRSA surveillance and control activities are warranted within and between NHs and hospitals.
Keywords: prevalence , risk factors , molecular epidemiology
These authors contributed equally to this work.
Present address: European Centre for Disease Prevention and Control, Stockholm, Sweden.