The dissemination of methicillin-resistant Staphylococcus aureus in the Euregion Meuse-Rhine

  • Ruud Deurenberg, University Hospital Maastricht, The Netherlands
  • Eric Nulens, General Hospital Sint-Jan, Brugge, Belgium
  • Silvie Sebatian, University Hospital Maastricht, The Netherlands
  • Christel Driessen, University Hospital Maastricht, The Netherlands
  • Dr Alexander Friedrich, University of Münster, Germany
  • Dr Frank van Tiel, University Hospital Maastricht, The Netherlands
  • Dr Patrick Beizzer, University Hospital Maastricht, The Netherlands
  • Dr Ellen Stobberingh, University Hospital Maastricht, The Netherlands

    • Objective:
    The Euregion Meuse-Rhine (EMR) consists of the border regions of Belgium, Germany and The Netherlands. Cross-border patient mobility is an important issue in the EMR, but concern is rising about the possible dissemination of MRSA with the patients, since the prevalence of MRSA differs in the countries (23.6%, 13.8%, and 1% in Belgium, Germany, and The Netherlands, respectively). The objective of this study was to investigate the dissemination of MRSA in the EMR and the possible spread of PVL-positive MRSA in the EMR.

    Methods:
    MRSA strains (n=257) from Belgian (n=44), German (n=93) and Dutch (n=121) hospitals, isolated between July 2005 and April 2006, were characterized by spa and SCCmec typing. The presence of CNA, PVL and TSST-1 was investigated.

    Results:
    The Dutch isolates were associated with ST5-MRSA-II, ST5-MRSA-IV, ST8-MRSA-IV, ST30-MRSA-IV, ST36-MRSA-II and ST45-MSRA-IV, while the Belgian and German isolates were mainly associated with ST45-MTSA-IV and ST5-MRSA-II, respectively. CNA was present among 36% of the isolates and all isolates associated with CC30 and CC45 harbored CNA. TSST-1 was present among 3% of the isolates. Furthermore, 5% of the MRSA isolates were PVL-positive and had a diverse genetic background, associated with ST1, 8 and 80.

    Conclusions:
    The Dutch isolates had a more diverse genetic background compared to the Belgian and German isolates. ST5-MRSA-II, ST5-MRSA-IV, ST30-MRSA-IV and ST36-MRSA-II have not been described previously in The Netherlands, and could have been imported through cross-border healthcare. PVL-positive MRSA has entered the hospital environment in the EMR.