Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark

Jesper Larsen, Andreas Petersen, Anders R. Larsen, Raphael N. Sieber, Marc Stegger, Anders Koch, Frank Møller Aarestrup, Lance B. Price, Robert L. Skov, Danish MRSA Study Grp

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Abstract

Background: Livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) is causing an increasing number of skin and soft tissue infections (SSTIs) in Denmark and other European countries with industrial pig production. Yet, its impact on MRSA bloodstream infections (BSIs) has not been well studied. Methods: We investigated the clinical epidemiology of all human cases of LA-MRSA CC398 BSI during 2010-2015. Cases of LA-MRSA CC398 BSI were compared to cases of BSI caused by other types of MRSA and cases of SSTI caused by LA-MRSA CC398. Whole-genome sequence analysis was used to assess the phylogenetic relationship among LA-MRSA CC398 isolates from Danish pigs and cases of BSI and SSTI. Results: The number of LA-MRSA CC398 BSIs and SSTIs increased over the years, peaking in 2014, when LA-MRSA CC398 accounted for 16% (7/44) and 21% (211/985) of all MRSA BSIs and SSTIs, corresponding to 1.2 and 37.4 cases of BSI and SSTI per 1 000 000 person-years, respectively. Most patients with LA-MRSA CC398 BSI had no contact to livestock, although they tended to live in rural areas. LA-MRSA CC398 caused 24.3 BSIs per 1000 SSTIs among people with no livestock contact, which is similar to the ratio observed for other types of MRSA. Whole-genome sequence analysis showed that most of the BSI and SSTI isolates were closely related to Danish pig isolates. Conclusions: This study demonstrates that the increasing number of LA-MRSA CC398 BSIs occurred in parallel with a much larger wave of LA-MRSA CC398 SSTIs and an expanding pig reservoir.
Original languageEnglish
JournalClinical Infectious Diseases
Volume65
Issue number7
Pages (from-to)1072-1076
Number of pages5
ISSN1058-4838
DOIs
Publication statusPublished - 2017

Keywords

  • Bacteremia
  • Humans
  • Livestock
  • MRSA
  • Zoonosis

Cite this

Larsen, J., Petersen, A., Larsen, A. R., Sieber, R. N., Stegger, M., Koch, A., ... Grp, D. MRSA. S. (2017). Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark. Clinical Infectious Diseases, 65(7), 1072-1076. https://doi.org/10.1093/cid/cix504
Larsen, Jesper ; Petersen, Andreas ; Larsen, Anders R. ; Sieber, Raphael N. ; Stegger, Marc ; Koch, Anders ; Aarestrup, Frank Møller ; Price, Lance B. ; Skov, Robert L. ; Grp, Danish MRSA Study. / Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 7. pp. 1072-1076.
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title = "Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark",
abstract = "Background: Livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) is causing an increasing number of skin and soft tissue infections (SSTIs) in Denmark and other European countries with industrial pig production. Yet, its impact on MRSA bloodstream infections (BSIs) has not been well studied. Methods: We investigated the clinical epidemiology of all human cases of LA-MRSA CC398 BSI during 2010-2015. Cases of LA-MRSA CC398 BSI were compared to cases of BSI caused by other types of MRSA and cases of SSTI caused by LA-MRSA CC398. Whole-genome sequence analysis was used to assess the phylogenetic relationship among LA-MRSA CC398 isolates from Danish pigs and cases of BSI and SSTI. Results: The number of LA-MRSA CC398 BSIs and SSTIs increased over the years, peaking in 2014, when LA-MRSA CC398 accounted for 16{\%} (7/44) and 21{\%} (211/985) of all MRSA BSIs and SSTIs, corresponding to 1.2 and 37.4 cases of BSI and SSTI per 1 000 000 person-years, respectively. Most patients with LA-MRSA CC398 BSI had no contact to livestock, although they tended to live in rural areas. LA-MRSA CC398 caused 24.3 BSIs per 1000 SSTIs among people with no livestock contact, which is similar to the ratio observed for other types of MRSA. Whole-genome sequence analysis showed that most of the BSI and SSTI isolates were closely related to Danish pig isolates. Conclusions: This study demonstrates that the increasing number of LA-MRSA CC398 BSIs occurred in parallel with a much larger wave of LA-MRSA CC398 SSTIs and an expanding pig reservoir.",
keywords = "Bacteremia, Humans, Livestock, MRSA, Zoonosis",
author = "Jesper Larsen and Andreas Petersen and Larsen, {Anders R.} and Sieber, {Raphael N.} and Marc Stegger and Anders Koch and Aarestrup, {Frank M{\o}ller} and Price, {Lance B.} and Skov, {Robert L.} and Grp, {Danish MRSA Study}",
year = "2017",
doi = "10.1093/cid/cix504",
language = "English",
volume = "65",
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journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "7",

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Larsen, J, Petersen, A, Larsen, AR, Sieber, RN, Stegger, M, Koch, A, Aarestrup, FM, Price, LB, Skov, RL & Grp, DMRSAS 2017, 'Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark', Clinical Infectious Diseases, vol. 65, no. 7, pp. 1072-1076. https://doi.org/10.1093/cid/cix504

Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark. / Larsen, Jesper; Petersen, Andreas; Larsen, Anders R.; Sieber, Raphael N.; Stegger, Marc; Koch, Anders; Aarestrup, Frank Møller; Price, Lance B.; Skov, Robert L.; Grp, Danish MRSA Study.

In: Clinical Infectious Diseases, Vol. 65, No. 7, 2017, p. 1072-1076.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark

AU - Larsen, Jesper

AU - Petersen, Andreas

AU - Larsen, Anders R.

AU - Sieber, Raphael N.

AU - Stegger, Marc

AU - Koch, Anders

AU - Aarestrup, Frank Møller

AU - Price, Lance B.

AU - Skov, Robert L.

AU - Grp, Danish MRSA Study

PY - 2017

Y1 - 2017

N2 - Background: Livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) is causing an increasing number of skin and soft tissue infections (SSTIs) in Denmark and other European countries with industrial pig production. Yet, its impact on MRSA bloodstream infections (BSIs) has not been well studied. Methods: We investigated the clinical epidemiology of all human cases of LA-MRSA CC398 BSI during 2010-2015. Cases of LA-MRSA CC398 BSI were compared to cases of BSI caused by other types of MRSA and cases of SSTI caused by LA-MRSA CC398. Whole-genome sequence analysis was used to assess the phylogenetic relationship among LA-MRSA CC398 isolates from Danish pigs and cases of BSI and SSTI. Results: The number of LA-MRSA CC398 BSIs and SSTIs increased over the years, peaking in 2014, when LA-MRSA CC398 accounted for 16% (7/44) and 21% (211/985) of all MRSA BSIs and SSTIs, corresponding to 1.2 and 37.4 cases of BSI and SSTI per 1 000 000 person-years, respectively. Most patients with LA-MRSA CC398 BSI had no contact to livestock, although they tended to live in rural areas. LA-MRSA CC398 caused 24.3 BSIs per 1000 SSTIs among people with no livestock contact, which is similar to the ratio observed for other types of MRSA. Whole-genome sequence analysis showed that most of the BSI and SSTI isolates were closely related to Danish pig isolates. Conclusions: This study demonstrates that the increasing number of LA-MRSA CC398 BSIs occurred in parallel with a much larger wave of LA-MRSA CC398 SSTIs and an expanding pig reservoir.

AB - Background: Livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) is causing an increasing number of skin and soft tissue infections (SSTIs) in Denmark and other European countries with industrial pig production. Yet, its impact on MRSA bloodstream infections (BSIs) has not been well studied. Methods: We investigated the clinical epidemiology of all human cases of LA-MRSA CC398 BSI during 2010-2015. Cases of LA-MRSA CC398 BSI were compared to cases of BSI caused by other types of MRSA and cases of SSTI caused by LA-MRSA CC398. Whole-genome sequence analysis was used to assess the phylogenetic relationship among LA-MRSA CC398 isolates from Danish pigs and cases of BSI and SSTI. Results: The number of LA-MRSA CC398 BSIs and SSTIs increased over the years, peaking in 2014, when LA-MRSA CC398 accounted for 16% (7/44) and 21% (211/985) of all MRSA BSIs and SSTIs, corresponding to 1.2 and 37.4 cases of BSI and SSTI per 1 000 000 person-years, respectively. Most patients with LA-MRSA CC398 BSI had no contact to livestock, although they tended to live in rural areas. LA-MRSA CC398 caused 24.3 BSIs per 1000 SSTIs among people with no livestock contact, which is similar to the ratio observed for other types of MRSA. Whole-genome sequence analysis showed that most of the BSI and SSTI isolates were closely related to Danish pig isolates. Conclusions: This study demonstrates that the increasing number of LA-MRSA CC398 BSIs occurred in parallel with a much larger wave of LA-MRSA CC398 SSTIs and an expanding pig reservoir.

KW - Bacteremia

KW - Humans

KW - Livestock

KW - MRSA

KW - Zoonosis

U2 - 10.1093/cid/cix504

DO - 10.1093/cid/cix504

M3 - Journal article

VL - 65

SP - 1072

EP - 1076

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 7

ER -