Incidence of invasive meticillin-resistant Staphylococcus aureus infections in Germany, 2010 to 2014

Abstract

Voluntary surveillance systems in Germany suggest a recent decline in the incidence of infections (subsequent to at least 2010) with meticillin-resistant Staphylococcus aureus (MRSA) from various types of specimens and settings. We asked whether this decline is reflected by data from the mandatory national surveillance system for invasive MRSA infections. Our analysis is based on the population in Germany in 2010 to 2014. Cases were identified from passive reporting by microbiological laboratories of the diagnosis of MRSA from blood culture or cerebrospinal fluid. Respective clinical data were subsequently added to the notification. We calculated risk ratios (RR) between consecutive years, stratifying cases by sex, age and federal state of residence. The national incidence increased from 4.6 episodes per 100,000 persons in 2010 to 5.6 in 2012 (2011 vs 2010: RR: 1.13, 95% confidence interval (CI): 1.08–1.18; 2012 vs 2011: RR: 1.08, 95% CI: 1.04–1.13). It stagnated at 5.4 per 100,000 in 2013 (RR: 0.97, 95% CI: 0.93–1.01) before declining to 4.8 in 2014 (RR: 0.88, 95% CI: 0.84–0.91). This trend was observed in most, but not all federal states and strata of sex and age groups. Only 204 of 20,679 (1%) episodes of infection were notified as belonging to an outbreak. Our analysis corroborates previous findings that the incidence of invasive MRSA infections in Germany may be declining.

Decline in the proportion of methicillin resistance among Staphylococcus aureus isolates from non-invasive samples and in outpatient settings, and changes in the co-resistance profiles: an analysis of data collected within the Antimicrobial Resistance Surveillance Network, Germany 2010 to 2015

“…Our data are also consistent with previous analyses that have indicated declines in MRSA in the hospital setting and for invasive infections [ 1 – 3 ], with the previous analysis of ARS data from outpatient setting [ 5 ] and indirectly also with data from the national reference laboratory that suggest low levels of LA- and CA-MRSA in Germany [ 6 , 9 ]. Therefore, they indicate a general decline in MRSA-infection in Germany in all settings and for all sample types.…”

“…The incidence of infections with methicillin resistant Staphylococcus aureus (MRSA) is thought to be on the decline in Germany. This is corroborated by data from the national mandatory reporting system [ 1 ], from a hospital surveillance system [ 2 ], from surveys [ 3 ] and from analysis of data submitted to the European Antimicrobial Resistance Surveillance Network [ 4 ]. However, these analyses rely on invasive samples or on samples from hospitals only.…”

“…The MRSA epidemic in Germany and Europe is thought to be mainly health-care associated based on the age distribution of cases [ 1 ] and molecular analysis of the isolates [ 7 ]. However, there are regions with a high density of swine farming, where livestock-associated (LA) MRSA makes up a considerable proportion of MRSA infections seen in hospitals.…”

“…It also includes data on co-resistance to other antibiotics for a large number of MRSA isolates. To complement recent analysis of declining MRSA infections in invasive samples and in hospitals [ 1 – 4 ] and to extend previous analysis from ARS [ 5 , 11 ], we investigated whether declining trends of MRSA may be seen for all clinical settings, including outpatient settings, and for all sample types, including non-invasive samples. We further investigated whether or not there are changes in MRSA’s co-resistance profiles.…”

Application of a MALDI-TOF analysis platform (ClinProTools) for rapid and preliminary report of MRSA sequence types in Taiwan

“…Since their emergence in the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) infections have been a major health care concern worldwide ( Chen & Huang, 2014 ; Walter et al, 2015 ; Wang et al, 2010 ). Many epidemiological studies have revealed that different multilocus sequence types (MLST) present specific characteristics such as virulence gene profiles ( Recker et al, 2017 ; Schuenck et al, 2012 ; Wang et al, 2009 , 2010 , 2012 ).…”