Faria Nuno A, Oliveira Duarte C, Westh Henrik, Monnet Dominique L, Larsen Anders R, Skov Robert, de Lencastre Hermínia
Laboratório de Genética Molecular, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal.
J Clin Microbiol. 2005 Apr;43(4):1836-42. doi: 10.1128/JCM.43.4.1836-1842.2005.
Strict infection control measures introduced during the 1970s have kept the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections extremely low in Denmark. Nevertheless, similarly to other countries, MRSA infections began to appear in the community in the late 1990s. A nationwide surveillance program has collected and stored all MRSA isolates since 1988 and, since 1999, clinical information has been also recorded. We used this information and isolates in a detailed epidemiological and molecular analysis of the 81 MRSA infections identified in Denmark in 2001. MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing, and SCCmec typing. Comparison of the 45 community-onset MRSA (CO-MRSA) infections with the 36 hospital-acquired MRSA (HA-MRSA) infections showed several striking contrasts. Most CO-MRSA were recovered from skin and soft tissue infections caused by isolates carrying the Panton-Valentine leucocidin toxin genes, and the majority (84%) of isolates belonged to a single clonal type, ST80-IV, which has been found in the community in other European countries. Clone ST80-IV could be traced in Denmark back to 1993. ST80-IV was rarely found in HA-MRSA infections, which belonged to a large number of clonal types, including some pandemic MRSA clones. The low number of HA-MRSA infections and the diversity of MRSA clones in Danish hospitals may be the result of successful infection control measures that prevent spread of clones in hospitals. The mechanism of spread of the ST80-IV clone in the Danish community is not known, and new control measures are needed to control further spread of this and other CA-MRSA clones.
20世纪70年代引入的严格感染控制措施使丹麦耐甲氧西林金黄色葡萄球菌（MRSA）感染的发生率一直极低。然而，与其他国家类似，MRSA感染在20世纪90年代末开始在社区中出现。自1988年以来，一项全国性监测计划收集并保存了所有MRSA分离株，自1999年起还记录了临床信息。我们利用这些信息和分离株对2001年丹麦确诊的81例MRSA感染进行了详细的流行病学和分子分析。MRSA分离株通过脉冲场凝胶电泳（PFGE）、spa分型、多位点序列分型和SCCmec分型进行鉴定。对45例社区获得性MRSA（CO-MRSA）感染与36例医院获得性MRSA（HA-MRSA）感染的比较显示出一些显著差异。大多数CO-MRSA分离自携带杀白细胞素毒素基因的分离株引起的皮肤和软组织感染，并且大多数（84%）分离株属于单一克隆类型ST80-IV，该类型已在其他欧洲国家的社区中发现。丹麦的ST80-IV克隆可追溯到1993年。ST80-IV在HA-MRSA感染中很少见，HA-MRSA感染属于大量克隆类型，包括一些大流行的MRSA克隆。丹麦医院中HA-MRSA感染数量较少以及MRSA克隆的多样性可能是成功的感染控制措施防止克隆在医院传播的结果。ST80-IV克隆在丹麦社区中的传播机制尚不清楚，需要采取新的控制措施来控制该克隆及其他社区获得性MRSA克隆的进一步传播。
