Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
Clin Microbiol Infect. 2012 Jul;18(7):656-61. doi: 10.1111/j.1469-0691.2011.03662.x. Epub 2011 Oct 3.
The Netherlands is known for its low methicillin-resistant Staphylococcus aureus (MRSA) prevalence. Yet MRSA with no link to established Dutch risk factors for acquisition, MRSA of unknown origin (MUO), has now emerged and hampers early detection and control by active screening upon hospital admittance. We assessed the magnitude of the problem and determined the differences between MUO and MRSA of known origin (MKO) for CC398 and non-CC398. National MRSA Surveillance data (2008-2009) were analysed for epidemiological determinants and genotypic characteristics (Panton-Valentine leukocidin, spa). A quarter (24%) of the 5545 MRSA isolates registered were MUO, i.e. not from defined risk groups. There are two genotypic MUO groups: CC398 MUO (352; 26%) and non-CC398 MUO (998; 74%). CC398 MUO needs further investigation because it could suggest spread, not by direct contact with livestock (pigs, veal calves), but through the community. Non-CC398 MUO is less likely to be from a nursing home than non-CC398 MKO (relative risk 0.55; 95% CI 0.42-0.72) and Panton-Valentine leukocidin positivity was more frequent in non-CC398 MUO than MKO (relative risk 1.19; 95% CI 1.11-1.29). Exact transmission routes and risk factors for non-CC398 as CC398 MUO remain undefined.
荷兰以其较低的耐甲氧西林金黄色葡萄球菌（MRSA）患病率而闻名。然而，现在已经出现了与荷兰获得性 MRSA 已知危险因素无关的 MRSA（MUO），这阻碍了通过入院时主动筛查进行早期检测和控制。我们评估了问题的严重程度，并确定了 CC398 和非 CC398 的 MUO 和已知来源的 MRSA（MKO）之间的差异。对国家 MRSA 监测数据（2008-2009 年）进行了流行病学决定因素和基因特征（杀白细胞素 Panton-Valentine，spa）分析。在登记的 5545 株 MRSA 分离株中，有四分之一（24%）为 MUO，即不属于明确的危险群体。有两个基因型 MUO 组：CC398 MUO（352；26%）和非 CC398 MUO（998；74%）。CC398 MUO 需要进一步调查，因为它可能表明传播不是通过直接接触牲畜（猪、小牛肉牛），而是通过社区传播。非 CC398 MUO 不太可能来自养老院，而非 CC398 MKO（相对风险 0.55；95%CI 0.42-0.72），并且非 CC398 MUO 中 Panton-Valentine 白细胞素阳性率高于 MKO（相对风险 1.19；95%CI 1.11-1.29）。非 CC398 作为 CC398 MUO 的确切传播途径和危险因素仍未确定。
