Antibiotic Exposure and Other Risk Factors for Antimicrobial Resistance in Nasal Commensal Staphylococcus aureus: An Ecological Study in 8 European Countries

Abstract

ObjectivesAntimicrobial resistance (AMR) has become a global public health concern which threatens the effective treatment of bacterial infections. Resistant Staphylococcus aureus (including MRSA) increasingly appears in individuals with no healthcare associated risks. Our study assessed risk factors for nasal carriage of resistant S. aureus in a multinational, healthy, community-based population, including ecological exposure to antibiotics.MethodsData were collected in eight European countries (Austria, Belgium, Croatia, France, Hungary, the Netherlands, Spain and Sweden). Commensal AMR patterns were assessed by collecting 28,929 nasal swabs from healthy persons (aged 4+). Ecological exposure to antibiotics was operationalized as systemic antibiotic treatment patterns, extracted from electronic medical records of primary care practices in which the participants were listed (10–27 per country). A multilevel analysis related AMR in nasal commensal S. aureus to antibiotic exposure and other risk factors (e.g. age and profession).ResultsOf the 6,093 S. aureus isolates, 77% showed resistance to at least one antibiotic. 7.1% exhibited multidrug resistance (defined as resistance to 3 or more antibiotic classes), and we found 78 cases MRSA (1.3%). A large variation in antibiotic exposure was found between and within countries. Younger age and a higher proportion of penicillin prescriptions in a practice were associated with higher odds for carriage of a resistant S. aureus. Also, we found higher multidrug resistance rates in participants working in healthcare or nurseries.ConclusionsThis study indicates that in a population with no recent antibiotic use, the prescription behavior of the general practitioner affects the odds for carriage of a resistant S. aureus, highlighting the need for cautious prescribing in primary care. Finally, since variation in AMR could partly be explained on a national level, policy initiatives to decrease AMR should be encouraged at the national level within Europe.

High prevalence of Staphylococcus aureus nasal carriage among children in Szolnok, Hungary

“…Compared with our results, they measured higher resistance to ciprofloxacin (27.1%) and erythromycin (20%) [21]. In the study of van Bijnen et al [15], penicillin resistance among the 539 Hungarian isolates was 76.1% and considering all the eight countries, it varied between 64.8% and 87.1%; erythromycin R was 12.1% (range: 1.5%-16.5%); clindamycin R was 12.1% (range: 1.4%-14.6%); tetracycline R was 6.7% (range: 1.8%-7.2%); gentamicin R was 0.0% (range: 0.0%-2.0%); and ciprofloxacin R was 2.0% (range: 0.6%-2.5%). We can conclude that among children, tetracycline resistance is lower, whereas to erythromycin, clindamycin, gentamicin, and ciprofloxacin are similar to those in the aforementioned paper.…”

“…Van Bijnen et al published an ecological study in 2015, involving eight European countries (including Hungary), in which nearly 29,000 healthy persons aged >4 years were screened for nasal commensal S. aureus. Unfortunately no country-specific results were published, but the average carriage rate was 21.2% [15]. Similarly, in our previous study involving 878 healthy children from different cities of Hungary, we calculated a nearly identical carriage rate as 21.3% [5].…”

“…We can establish that CA-MRSA carriage rate is very low in Hungary in small children. Van Bijnen et al [15] found a similarly low prevalence of MRSA (1.3%) among 6,093 S. aureus isolates in Europe in the aforementioned study. Regev-Yochay et al [19] demonstrated a 68 LAUB ET AL.…”

Multidrug and Mupirocin Resistance in Environmental Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates from Homes of People Diagnosed with Community-Onset MRSA Infection

“…Small household size was associated with older index patients, who may have more comorbidities that increase their frequency of contact with the health care system and increase their antimicrobial use; however, the rate of prior antimicrobial use was high among both large and small households. The prior use of antimicrobial drugs has been associated with an increased risk for MRSA and drug resistance in previous studies of people (22,23). After households were randomized to the use of twice-daily nasal mupirocin and two chlorhexidine body washes for all people in the home, two consistent protective effects emerged.…”

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

“…Consistent with our results, Staphylococcus spp. worldwide currently show high resistance (≥80%) to penicillin G. After analyzing nearly 29,000 nasal swabs from healthy individuals from eight European countries, van Bijnen et al 15 described an association between frequent penicillin prescription and high odds of nasal carriage of resistant S. aureus. We also observed a high frequency of penicillin use during our analysis of patient records.…”