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JAC Advance Access published online on October 2, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm365
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in invasive isolates from southern and eastern Mediterranean countries

Michael A. Borg1,*, Marlieke de Kraker2, Elizabeth Scicluna1, Nienke van de Sande-Bruinsma2, Edine Tiemersma2, Jos Monen2, Hajo Grundmann on behalf of the ARMed Project members and collaborators2,{dagger}

1 Infection Control Unit, Mater Dei Hospital, Msida MSD05, Malta 2 National Institute of Public Health and the Environment, Center for Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, The Netherlands

Received 3 June 2007; returned 28 July 2007; revised 23 August 2007; accepted 26 August 2007

* Correspondence address. ARMed Project, Infection Control Unit, St Luke's Hospital, G'Mangia MSD08, Malta. Tel: +356-2545-4528; Fax: +356-2545-4529; E-mail: michael.a.borg{at}gov.mt

Objectives: Efforts aimed at curtailing the ever increasing spread of methicillin-resistant Staphylococcus aureus (MRSA) require effective information of its epidemiology. However, knowledge about the situation in southern and eastern countries of the Mediterranean is incomplete since reports have been sporadic and difficult to compare.

Methods: Over a 36 month period from 2003 to 2005, the ARMed project collected more than 5000 susceptibility test results of invasive isolates of S. aureus from blood cultures routinely processed within participating laboratories servicing 62 hospitals situated in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey.

Results: Overall, the median MRSA proportion was 39% (interquartile range: 27.1% to 51.1%). The highest proportions of MRSA were reported by Jordan, Egypt and Cyprus, where more than 50% of the invasive isolates were methicillin-resistant. Considerable variation was identified in the proportion of MRSA in hospitals within the same country.

Conclusions: It appears that most of the countries in the Mediterranean region are experiencing a surge in MRSA infections. This requires a greater focus to identify relevant drivers of resistance and implement effective practices in order to address them, especially improved infection control and antibiotic consumption practices.

Key Words: surveillance , epidemiology , resistance , ARMed

{dagger} ARMed Project members and collaborators are listed in the Acknowledgements section.


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M. A. Borg, P. Zarb, M. Ferech, H. Goossens, and on behalf of the ARMed Project Group
Antibiotic consumption in southern and eastern Mediterranean hospitals: results from the ARMed project
J. Antimicrob. Chemother., October 1, 2008; 62(4): 830 - 836.
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