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Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant Staphylococcus aureus: a European cross-sectional study.

Heijer, C.D.J. den, Bijnen, E.M.E. van, Paget, W.J., Pringle, M., Goossen, H., Bruggeman, C.A., Schellevis, F.G., Stobberingh, E.E. Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant Staphylococcus aureus: a European cross-sectional study. European Journal of Public Health: 2014, 24(suppl. 2) Abstract: 7th European Public Health Conference 'Mind the Gap: Reducing Inequalities in health and health care'. 19-22 November 2014, Glasgow.
Background: Information on the prevalence of Staphylococcus aureus resistance has mainly been obtained from invasive strains, although the commensal flora is considered an important reservoir of resistance. Within ‘The Appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance’ (APRES) study, we compared the prevalence of nasal S. aureus carriage and antibiotic resistance, including meticillin-resistant S. aureus (MRSA), among healthy patients between nine European countries. The genotypic structure of the isolated MRSA strains was determined by means of spa-typing. Methods: Nasal swabs were obtained from patients recruited by general practitioners (GPs) participating in existing nationwide GP networks. Swabs were sent to national microbiological laboratories for identification and isolation of S. aureus. Antibiotic resistance testing was performed at one central microbiological laboratory. Results: S. aureus was isolated from 6,956 (21.6%) out of 32,206 patients swabbed. The adjusted S. aureus prevalence ranged from 12.1% (Hungary) to 29.4% (Sweden). Except for
penicillin, the highest resistance was observed to azithromycin: range 1.6% (Sweden) to 16.9% (France). In total, 91 MRSA strains were isolated, with the highest MRSA prevalence being found in Belgium (2.1%). 53 different spa types were detected, with t002 (9.9%) and t008 (7.7%) being most prevalent. Conclusion: The prevalence of S. aureus nasal carriage differed between nine European countries, even after correcting for age, sex and GP. In general, the prevalence of resistance, including MRSA, was low. MRSA strains found showed genotypic heterogeneity, both within and between countries.
Key messages
The prevalence of S. aureus resistance, including MRSA, was low in the community setting of the nine participating European countries.
The prevalence of S. aureus nasal carriage differed between nine European countries, even after correcting for age, sex and GP.