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Clonality among multidrug-resistant hospital-associated Staphylococcus epidermidis in northern Europe
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology. (Sjöstedt)
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology. (Sjöstedt)
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2009 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 41, no 9, 642-649 p.Article in journal (Refereed) Published
Abstract [en]

Using pulsed-field gel electrophoresis (PFGE) we have previously described the occurrence and possible dissemination of a clone of multidrug-resistant Staphylococcus epidermidis (MDRSE) in 2 hospitals in northern Sweden during 2001-2003. The aims of the present study were to investigate if this clone still persisted, 7 y later, in these 2 hospitals and whether this specific clone was detectable among clinical isolates from 9 other hospitals, 6 Swedish as well as a Norwegian, Danish and a German hospital. In total, 173 clinical isolates of MDRSE isolated during 2003 to 2008 were analysed using PFGE, of which 22 isolates were also characterized by multilocus sequence typing (MLST). Two dominating PFGE types (types A and B) were identified, consisting of 56 (32%) and 38 (22%) isolates, respectively. Type A, which was detected in the Norwegian and all Swedish hospitals, proved indistinguishable to the clone previously identified in 2001-2003 and corresponded with a novel sequence type (ST215). Type B was discovered in the German, Danish and in 7 Swedish hospitals and corresponded with ST2. In conclusion, we have demonstrated the occurrence, persistence and potential dissemination of 2 MDRSE genotypes, including a novel sequence type (ST215), within hospitals in northern Europe.

Place, publisher, year, edition, pages
2009. Vol. 41, no 9, 642-649 p.
Keyword [en]
clonal spread of multidrug-resistant staphylococci
National Category
Microbiology in the medical area Infectious Medicine
Research subject
Clinical Bacteriology; Infectious Diseases
Identifiers
URN: urn:nbn:se:umu:diva-34175DOI: 10.1080/00365540903146987PubMedID: 19634070OAI: oai:DiVA.org:umu-34175DiVA: diva2:319619
Available from: 2010-05-20 Created: 2010-05-18 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Molecular epidemiology of coagulase-negative staphylococci in hospitals and in the community
Open this publication in new window or tab >>Molecular epidemiology of coagulase-negative staphylococci in hospitals and in the community
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Coagulase-negative staphylococci (CoNS) and in particular Staphylococcus epidermidis have emerged as major pathogens primarily causing nosocomial infections in patients with indwelling medical devices. These infections are often caused by multidrug-resistant strains of S. epidermidis (MDRSE). Other clinical entities due to CoNS are lower urinary tract infections (UTI) in women and native valve endocarditis. The purpose of this work was to investigate the frequency of antibiotic resistance and the molecular epidemiology of both hospital and community-associated isolates of S. epidermidis in order to examine if certain clones are related to MDRSE infections. Furthermore, we aimed to explore if specific clones of S. saprophyticus are associated with UTI in women.

Methods

A total of 359 hospital-associated methicillin-resistant isolates of CoNS obtained from 11 hospitals in northern Europe and 223 community-associated staphylococcal isolates were examined. Furthermore, 126 isolates of S. saprophyticus isolated from women with uncomplicated UTI from five different locations in northern Europe were analyzed. Pulsed-field gel electrophoresis (PFGE) was used for genotyping. Additionally, some of the S. epidermidis isolates were analyzed with multilocus sequence typing (MLST). Antibiotic susceptibility was determined for all isolates by the disc diffusion test.

Results

293 of the 359 (82%) hospital-associated and 124 of the 223 (56%) community-associated isolates belonged to the species S. epidermidis. Among the hospital-associated S. epidermidis isolates, two dominating PFGE types (type A and B) were distinguished, comprising 78 (27%) and 51 (17%) isolates, respectively. Type A, which was detected in a Norwegian and eight Swedish hospitals, corresponded with a novel sequence type (ST215). Type B was discovered in a German, a Danish and seven Swedish hospitals and corresponded with ST2. In contrast, community-associated isolates of S. epidermidis were genetically extremely diverse with no predominating genotype, and showed a low rate of antibiotic resistance; only two (1.6%) methicillin-resistant strains were detected.

Among 126 analyzed isolates of S. saprophyticus, 47 different PFGE profiles were identified. Several clusters of genetically highly related isolates were detected among isolates obtained from different locations and periods of time.

Conclusion

We have demonstrated the occurrence, persistence and potential dissemination of two multidrug-resistant S. epidermidis (MDRSE) genotypes, including a novel sequence type (ST215), within hospitals in northern Europe. Community-associated isolates of S. epidermidis showed a low rate of methicillin-resistance and were genetically heterogeneous. These results indicate that MDRSE by large are confined to the hospital setting in our region. Moreover, although the S. saprophyticus population was quite heterogeneous, indistinguishable isolates of S. saprophyticus causing lower UTI in women were identified in different countries 11 years apart, indicating the persistence and geographical spread of some clones of S. saprophyticus.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2010. 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1354
Keyword
staphylococcus epidermidis, staphylococcus saprophyticus, electrophoresis, gel, pulsed-field, genetic diversity, methicillin-resistance, UTI, drug resistance, multiple, bacterial, epidemiology, molecular, cross infection, molecular sequence data
National Category
Microbiology in the medical area Microbiology in the medical area Infectious Medicine
Research subject
Clinical Bacteriology; Microbiology; Infectious Diseases
Identifiers
urn:nbn:se:umu:diva-34289 (URN)978-91-7459-020-3 (ISBN)
Public defence
2010-09-03, Byggnad 6L, Major Groove,, Mikrobiologi, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
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Available from: 2010-05-28 Created: 2010-05-25 Last updated: 2012-07-09Bibliographically approved

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