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DANMAP 2015 3D
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121 danmap 2015 8. resistance in human clinical bacteria 8.6 staphylococcus
aureus
staphylococcus
aureus
is part of the normal flora of the skin and mucosa in approximately 50% of humans. some people only carry s.
aureus
intermittently whereas others carry s. au- reus for longer time. however, in addition s.
aureus
also causes infections ranging from superficial skin infections i.e. impetigo and boils to invasive infections such as post-operative wound infections, infections related to intravenous catheters and prosthetic devices, bacteremia, osteomyelitis, endocarditis and septic arthritis. in denmark, a voluntary surveillance programme of all s. aure- us bacteremia
cases
was established in 1957. laboratory and clinical notification of methicillin-resistant s.
aureus
(
mrsa
) has existed since november 2006. at ssi, all isolates are typed by spa typing, susceptibility testing is performed for 17 antimicrobials and the presence of the gene lukf-pv is deter- mined. lukf-pv codes for a cytotoxin (panton-valentine leu- cocidin, pvl), which has been closely linked to skin abscesses and the very rare condition of severe necrotizing pneumonia. pvl is found both in mssa and
mrsa
, for
mrsa
pvl has been closely associated with community acquired
mrsa
strains. in addition demographic and epidemiological information is reg- istered. based on the epidemiological information each case is classified with respect to possible place of acquisition: hospital (ha), community (ca), healthcare-associated with a community onset (haco), import (imp) and livestock-associated
mrsa
(cc398). for ca and haco classification is separated into known and not known exposure. surveillance of bacteraemia in 2015, 1,973 s.
aureus
bacteremia
cases
corresponding to 36.71
cases
per 100,000 inhabitants were reported from the departments of clinical microbiology (dcm) in denmark. for the third year in a row, the number of
cases
was higher than in the previous year (ca. 1,500 annual
cases
). by compari- son with the numbers of bacteremia
cases
registered in the danish microbiology database (miba) since 2010, the number of
cases
reported to ssi has been almost complete (94-97%). the increasing number of
cases
the last 3 years may therefore reflect a change in practice in the hospitals, with either more samples taken, improved diagnostics or both as well as a real increase in occurence. twenty-nine (1.5%) of the bacteremia
cases
were caused by
mrsa
. this is a decline compared to 2014 but at the same level as in previous years, and still very low compared to most other countries participating in ears- net [ears-net 2014]. three of the 29
mrsa
cases
were caused by cc398 (8
mrsa
cc398 in 2014). four hundred and fifty two (23%) patients died within thirty days of the onset of bacteremia. the mortality for the
mrsa
bacteremia
cases
was 24% (n=7). antimicrobial resistance in s.
aureus
bactere- mia isolates from 2005?2015 is presented in table 8.4. the highest frequency of resistance to other antimicrobials than penicillin was observed for fusidic acid (16%), erythromycin (7%), clindamycin (7%) and norfloxacin (6%). susceptibility to all tested antimicrobial agents was at the same level as in 2014, but resistance to erythromycin, clindamycin, fusidic acid and norfloxacin has increased steadily since 2005 (table 8.4). typing identified 567 different spa types distributed in 25 different cc groups (the ten most prevalent spa types repre- senting 33% of the total are presented in table 8.5). the pvl toxin was demonstrated in 25 (1.3%)
cases
of which five were
mrsa
. the 25 pvl containing isolates were distributed over 22 different spa types and 10 different cc groups. antimicrobial agent 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 % % % % % % % % % % methicillin 1.4 0.6 1.3 1.6 1.4 1.4 1.2 1.7 2.9 1.5 penicillin 80 78 77 77 75 77 74 76 77 71 erythromycin 5 4 5 7 5 7 6 7 8 7 clindamycin 4 3 4 6 4 6 6 6 8 7 tetracycline 3 2 3 2 3 2 2 3 5 4 fusidic acid 10 9 9 9 13 13 14 15 15 16 rifampicin <1 <1 <1 <1 <1 <1 <1 0 <1 <1 norfloxacin 2 1 2 2 3 4 4 5 6 6 kanamycin 1 <1 1 1 1 <1 1 2 2 3 linezolid nt nt 0 0 0 0 0 0 0 0 mupirocin 0 <1 <1 <1 <1 <1 <1 <1 <1 <1 trimethoprim-sulfamethoxazole nt nt nt nt nt <1 1 1 1 <1 notes: nt = not tested. in web annex table a8.1 the distribution of mics and resistance for all tested antimicrobial agents are shown. table 8.4. resistance (%) in isolates from s.
aureus
bacteraemia
cases
, denmark danmap 2015
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