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Journal of Clinical Microbiology, January 2009, p. 73-78, Vol. 47, No. 1
0095-1137/09/$08.00+0     doi:10.1128/JCM.01557-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Emergence and Characterization of Community-Associated Methicillin-Resistant Staphyloccocus aureus Infections in Denmark, 1999 to 2006{triangledown}

A. R. Larsen, M. Stegger, S. Böcher, M. Sørum, D. L. Monnet,{dagger} and R. L. Skov*

National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark

Received 12 August 2008/ Returned for modification 7 October 2008/ Accepted 17 October 2008

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) infections has changed worldwide. From being strictly nosocomial, MRSA is now frequently found as a community-associated (CA) pathogen. Denmark has been a low-prevalence country for MRSA since the mid-1970s but has in recent years experienced an increasing number of CA-MRSA cases. The aim of this study was to describe the emergence of CA-MRSA infections in Denmark. All Danish MRSA specimens and corresponding clinical data from 1999 to 2006 were investigated. Isolates were analyzed by antibiotic resistance and molecular typing and were assigned to clonal complexes (CC). Clinical data were extracted from discharge summaries and general practitioners' notes, from which assessments of community association were made for all infected cases. CA-MRSA cases constituted 29.4% of all MRSA infections (n = 1,790) and an increasing proportion of the annual numbers of MRSA infections during the study period. CA-MRSA was associated with a young age, skin and soft tissue infections, and non-Danish origin. Transmission between household members was frequently reported. Molecular typing showed >60 circulating clones, where 89.4% of the isolates belonged to five CC (CC80, CC8, CC30, CC5, and CC22), 81.2% carried staphylococcal cassette chromosome mec IV, and 163/244 (69.4%) were positive for Panton-Valentine leukocidin. Clinical and microbiological characteristics indicated that import of MRSA occurs frequently. Resistance to ≥3 antibiotic classes was observed for 48.8% of the isolates. The emergence of CA-MRSA in Denmark was caused by diverse strains, both well-known and new CA-MRSA strains. The results suggest multiple introductions of MRSA as an important source for CA-MRSA infections in Denmark.

* Corresponding author. Mailing address: Statens Serum Institut, National Center for Antimicrobials and Infection Control, Artillerivej 5 (B.47/204), 2300 Copenhagen S, Denmark. Phone: 45 32688348. Fax: 45 32683231. E-mail: rsk{at}ssi.dk

{triangledown} Published ahead of print on 29 October 2008.

{dagger} Present address: Scientific Advice Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden.

Journal of Clinical Microbiology, January 2009, p. 73-78, Vol. 47, No. 1
0095-1137/09/$08.00+0     doi:10.1128/JCM.01557-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Larsen, A. R., Goering, R., Stegger, M., Lindsay, J. A., Gould, K. A., Hinds, J., Sorum, M., Westh, H., Boye, K., Skov, R. (2009). Two Distinct Clones of Methicillin-Resistant Staphylococcus aureus (MRSA) with the Same USA300 Pulsed-Field Gel Electrophoresis Profile: a Potential Pitfall for Identification of USA300 Community-Associated MRSA. J. Clin. Microbiol. 47: 3765-3768 [Abstract] [Full Text]  


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