TY - JOUR
T1 - An unusual outbreak in the Netherlands
T2 - community-onset impetigo caused by a meticillin-resistant Staphylococcus aureus with additional resistance to fusidic acid, June 2018 to January 2020
AU - Vendrik, Karuna E. W.
AU - Kuijper, Ed J.
AU - Dimmendaal, Marieke
AU - Silvis, Welmoed
AU - Denie-Verhaegh, Els
AU - de Boer, Annemarie
AU - Postma, Bent
AU - Schoffelen, Annelot F.
AU - Ruijs, Wilhelmina L. M.
AU - Koene, Fleur M. H. P. A.
AU - Petrignani, Mariska
AU - Hooiveld, Mariette
AU - Witteveen, Sandra
AU - Schouls, Leo M.
AU - Notermans, Daan W.
AU - MRSA consortium
AU - Schuurman, Robert F. W.
AU - Schipper, Bart
AU - Oijevaar, Margreeth J. C.
AU - Hiltermann, Lennard F. M.
AU - van Loenen, Geert-Jan M.
AU - Jurgens, Renate
AU - Noordenbos, Wieke I.
AU - Leeflang, Gert-Jan
AU - Janssen, Gertrude
AU - Wintermans, Bas B.
AU - Leversteijn-van Hall, Maurine A.
AU - van den Bijllaardt, Wouter
AU - van Mansfeld, Rosa
AU - van Dijk, Karin
AU - Zwart, Bas
AU - Diederen, Bram M. W.
AU - Voss, Andreas
AU - Dorigo-Zetsma, Julia W.
AU - Ott, Alewijn
AU - Oudbier, Joke H.
AU - van der Vusse, Marleen
AU - Vlek, Anneloes L. M.
AU - Buiting, Anton G. M.
AU - Bode, Lonneke
AU - Paltansing, Sunita
AU - van Griethuysen, Arjanne J.
AU - den Reijer, Martijn
AU - van Trijp, Marijke J. C. A.
AU - van Burgel, Nathalie D.
AU - Muller, Anouk E.
AU - van der Linden, Michael P. M.
AU - van Rijn, Michiel
AU - Wolfhagen, Maurice J. H. M.
AU - Waar, Karola
AU - van Dam, Alje P.
AU - Overdevest, Ilse T. M. A.
AU - Stam, Arjen
AU - Vainio, Saara J.
AU - van Dam, Dick W.
N1 - Funding Information: This study was funded by the Dutch Ministry of Health. Publisher Copyright: © 2022 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
PY - 2022/12/8
Y1 - 2022/12/8
N2 - In this retrospective observational study, we analysed a community outbreak of impetigo with meticillin-resistant Staphylococcus aureus (MRSA), with additional resistance to fusidic acid (first-line treatment). The outbreak occurred between June 2018 and January 2020 in the eastern part of the Netherlands with an epidemiological link to three cases from the northwestern part. Forty nine impetigo cases and eight carrier cases were identified, including 47 children. All but one impetigo case had community-onset of symptoms. Pharmacy prescription data for topical mupirocin and fusidic acid and GP questionnaires suggested an underestimated outbreak size. The 57 outbreak isolates were identified by the Dutch MRSA surveillance as MLVA-type MT4627 and sequence type 121, previously reported only once in 2014. Nextgeneration sequencing revealed they contained a fusidic acid resistance gene, exfoliative toxin genes and an epidermal cell differentiation inhibitor gene. Whole-genome multilocus sequence typing revealed genetic clustering of all 19 sequenced isolates from the outbreak region and isolates from the three northwestern cases. The allelic distances between these Dutch isolates and international isolates were high. This outbreak shows the appearance of communityonset MRSA strains with additional drug resistance and virulence factors in a country with a low prevalence of antimicrobial resistance.
AB - In this retrospective observational study, we analysed a community outbreak of impetigo with meticillin-resistant Staphylococcus aureus (MRSA), with additional resistance to fusidic acid (first-line treatment). The outbreak occurred between June 2018 and January 2020 in the eastern part of the Netherlands with an epidemiological link to three cases from the northwestern part. Forty nine impetigo cases and eight carrier cases were identified, including 47 children. All but one impetigo case had community-onset of symptoms. Pharmacy prescription data for topical mupirocin and fusidic acid and GP questionnaires suggested an underestimated outbreak size. The 57 outbreak isolates were identified by the Dutch MRSA surveillance as MLVA-type MT4627 and sequence type 121, previously reported only once in 2014. Nextgeneration sequencing revealed they contained a fusidic acid resistance gene, exfoliative toxin genes and an epidermal cell differentiation inhibitor gene. Whole-genome multilocus sequence typing revealed genetic clustering of all 19 sequenced isolates from the outbreak region and isolates from the three northwestern cases. The allelic distances between these Dutch isolates and international isolates were high. This outbreak shows the appearance of communityonset MRSA strains with additional drug resistance and virulence factors in a country with a low prevalence of antimicrobial resistance.
UR - http://www.scopus.com/inward/record.url?scp=85144440231&partnerID=8YFLogxK
U2 - https://doi.org/10.2807/1560-7917.ES.2022.27.49.2200245
DO - https://doi.org/10.2807/1560-7917.ES.2022.27.49.2200245
M3 - Article
C2 - 36695440
SN - 1025-496X
VL - 27
JO - Euro surveillance
JF - Euro surveillance
IS - 49
M1 - 2200245
ER -