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Clin Microbiol Infect. 2019 Jun;25(6):739-746. doi: 10.1016/j.cmi.2018.09.023. Epub 2018 Oct 11.

Import of community-associated, methicillin-resistant Staphylococcus aureus to Europe through skin and soft-tissue infection in intercontinental travellers, 2011-2016.

Author information

1
Department of Infectious Diseases, Medical Microbiology and Hygiene, University Clinics, Heidelberg, Germany.
2
Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany.
3
Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
4
Klinikum Würzburg Mitte gGmbH, Missioklinik, Tropenmedizin, Würzburg, Germany.
5
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria; Department of Tropical Medicine, University Medical Centre Hamburg Eppendorf & Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
6
Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands.
7
Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
8
Swiss Tropical and Public Health Institute, Department Medicine, Basel, Switzerland; University of Basel, Basel, Switzerland.
9
ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
10
Inflammation Centre, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland.
11
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
12
Department of Infectious Diseases, Medical Microbiology and Hygiene, University Clinics, Heidelberg, Germany; Heidelberg Institute of Global Health, Unit of Epidemiology and Biostatistics, University Clinics, Heidelberg, Germany. Electronic address: philipp.zanger@uni-heidelberg.de.
13
Center of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands.
14
Barcelona Centre for International Health Research (ISGlobal), Barcelona, Spain.
15
University of Basel and Swiss Tropical and Public Health Institute, Basel, Switzerland.
16
Charité, Berlin, Germany.
17
Department of Tropical Medicine, University Medical Centre Eppendorf and Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
18
Heidelberg Institute of Global Health, Heidelberg, Germany.
19
Abteilung für Infektions- und Tropenmedizin der Ludwig-Maximilians-Universität, München, Germany.
20
Paul-Lechler Krankenhaus, Tübingen, Germany.
21
Missionsärztliche Klinik, Würzburg, Germany.

Abstract

OBJECTIVES:

Recently, following import by travel and migration, epidemic community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused nosocomial outbreaks in Europe, sometimes with a fatal outcome. We describe clinico-epidemiological characteristics of CA-MRSA detected by the European Network for the Surveillance of imported S. aureus (www.staphtrav.eu) from May 2011 to November 2016.

METHODS:

Sentinel surveillance at 13 travel clinics enrolling patients with travel-associated skin and soft-tissue infection (SSTI) and analysing lesion and nose swabs at one central laboratory.

RESULTS:

A total of 564 independent case-patients with SSTI were enrolled and had 374 (67%) S. aureus-positive lesions, of which 14% (51/374) were MRSA. The majority of CA-MRSA isolates from SSTI were Panton-Valentine leucocidin (PVL) -positive (43/51, 84%). The risk of methicillin-resistance in imported S. aureus varied by travel region (p <0.001) and was highest in Latin America (16/57, 28%, 95% CI 17.0-41.5) and lowest in Sub-Saharan Africa (4/121, 3%, 95% CI 0.9-8.3). Major epidemic clones (USA300 / USA300 Latin-American Variant, Bengal Bay, South Pacific) accounted for more than one-third (19/51, 37%) of CA-MRSA imports. CA-MRSA SSTI in returnees was complicated (31/51 multiple lesions, 61%; 22/50 recurrences, 44%), led to health-care contact (22/51 surgical drainage, 43%; 7/50 hospitalization, 14%), was transmissible (13/47 reported similar SSTI in non-travelling contacts, 28%), and associated with S. aureus nasal colonization (28 of 51 CA-MRSA cases, 55%; 24 of 28 colonized with identical spa-type in nose and lesion, 85%).

CONCLUSIONS:

Travel-associated CA-MRSA SSTI is a transmissible condition that leads to medical consultations and colonization of the infected host.

KEYWORDS:

Communicable disease control; Communicable diseases (emerging); Cross-sectional studies; Emerging; Methicillin-resistant Staphylococcus aureus; Panton–Valentine leucocidin; Staphylococcal skin infections; Travel medicine; sentinel surveillance

PMID:
30315958
DOI:
10.1016/j.cmi.2018.09.023
[Indexed for MEDLINE]

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