JAC Advance Access published online on March 6, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm037
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National survey of molecular epidemiology of Staphylococcus aureus colonization in Belgian cystic fibrosis patients
1 Department of Pediatric Infectious Diseases, Hospital Epidemiology and Infection Control Unit, Université Libre de Bruxelles, Hôpital des Enfants Reine Fabiola, Brussels, Belgium 2 Department of Microbiology, National Reference Laboratory for Staphylococci, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium 3 Department of Pediatrics, Pediatric Respiratory Medicine and Cystic Fibrosis Clinic Université Libre de Bruxelles, Hôpital des Enfants Reine Fabiola, Brussels, Belgium 4 Department of Microbiology, University of Ghent, Universitair Ziekenhuis van Ghent, Ghent, Belgium 5 Department of Pediatrics, Pediatric Respiratory Medicine and Cystic Fibrosis Clinic, University of Ghent, Universitair Ziekenhuis van Ghent, Ghent, Belgium 6 Department of Pediatrics, Pediatric Respiratory Medicine and Cystic Fibrosis Clinic, Katholieke Universiteit van Leuven, Gasthuisberg Hospital, Leuven, Belgium 7 Department of Microbiology, Université Libre de Bruxelles, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium 8 Zeepreventorium, De Haan, Belgium 9 Department of Microbiology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium 10 Department of Microbiology, University of Antwerpen, Universitair Ziekenhuis van Antwerpen, Antwerpen, Belgium 11 Department of Respiratory Medicine and Cystic Fibrosis Clinic, Université Libre de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium 12 Department of Pediatrics, Pediatric Respiratory Medicine and Cystic Fibrosis Clinic, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium 13 Department of Pediatrics, Pediatric Respiratory Medicine, Cliniques de St Joseph-l'Espérance, Montegnée, Belgium 14 Department of Pediatrics, Pediatric Respiratory Medicine, Infectious Diseases and Cystic Fibrosis Clinic, Academisch Ziekenhuis—Vrije Universiteit Brussel, Brussels, Belgium 15 Department of Microbiology, Cliniques de St Joseph-l'Espérance, Montegnée, Belgium 16 Department of Microbiology, Academisch Ziekenhuis—Vrije Universiteit Brussel, Brussels, Belgium 17 Department of Laboratory Medecine, Katholieke Universiteit van Leuven, Gasthuisberg Hospital, Leuven, Belgium
Received 19 September 2006; returned 12 November 2006; revised 2 January 2007; accepted 28 January 2007
* Corresponding author. Tel: +3224772232; Fax: +3224773356; E-mail: anne.vergison{at}ulb.ac.be
Objectives: Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is poorly defined in cystic fibrosis (CF) patients, and S. aureus detection may be hampered by the presence of small colony variants (SCVs). We conducted a multicentre survey to determine the prevalence of S. aureus and MRSA colonization in Belgian CF patients and characterize the phenotype and clonal distribution of their staphylococcal strains.
Methods: S. aureus isolated from CF patients attending nine CF centres were collected. Oxacillin resistance was detected by oxacillin agar screen and mecA PCR. Antibiotic susceptibility was tested by microdilution. MRSA strains were genotyped by PFGE and SCCmec typing and compared with hospital-associated MRSA strains.
Results: Laboratories used a diversity of sputum culture procedures, many of which appeared substandard. S. aureus was isolated from 275/627 (44%) CF patients (20% to 72% by centre). The prevalence of SCV colonization was 4%, but SCVs were almost exclusively recovered from patients in two centres performing an SCV search. Phenotypically, 14% of S. aureus isolates were oxacillin-resistant: 79% carried mecA and 19% were SCVs lacking mecA. The mean prevalence of ‘true’ MRSA colonization was 5% (0% to 17% by centre). By PFGE typing, 67% of CF-associated MRSA were related to five epidemic clones widespread in Belgian hospitals.
Conclusions: This first survey of S. aureus colonization in the Belgian CF population indicated a diversity in local prevalence rates and in proportion of oxacillin-resistant and SCV phenotypes, probably related to variation in bacteriological methods. These findings underscore the need for standard S. aureus detection methods and MRSA control policies in Belgian CF centres.
Key Words: oxacillin , MRSA , small colony variants
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