Major article| Volume 42, ISSUE 11, P1197-1202, November 2014

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Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus strains isolated in a multicenter study of nursing home residents in Croatia

Published:September 18, 2014DOI:


      • This cross-sectional study investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in 877 residents and staff of 7 nursing homes in Croatia.
      • The overall prevalence of MRSA colonization was 7.1%, and the dominant SCCmec types were II and IV.
      • All MRSA isolates were negative for Panton-Valentine leukocidin–encoding genes. The predominant S aureus protein A type was t008.
      • Our study demonstrates the spread of 2 clones within and among Croatian nursing homes.


      Residents of nursing homes (NHs) are often hospitalized and could present a potential reservoir for methicillin-resistant Staphylococcus aureus (MRSA). The aim of the study was to determine the prevalence for MRSA carriage in residents and staff in Croatian NHs and to characterize MRSA strains using genotyping techniques.


      A cross-sectional study was performed among 877 residents and staff of 7 NHs representing 3 major Croatian regions. Nasal swabs from residents and staff and other samples from residents with invasive devices were obtained. Identified isolates were submitted to susceptibility testing and genotyping with SCCmec typing, S aureus protein A (spa) locus typing, and pulsed-field gel electrophoresis (PFGE).


      The overall prevalence of MRSA colonization was 7.1% (95 confidence interval, 5.4%-8.8%), ranging from 0% to 28.8%. Four MRSA isolates were found in NH staff. All MRSA isolates were negative for Panton-Valentine leukocidin–encoding genes. SCCmec type II was found in 32 MRSA strains; SCCmec IV, in 27 strains; SCCmec I, in 3 strains. The predominant spa type was t008, found in 49 strains; PFGE analysis revealed 2 major clonal groups.


      MRSA strains were found to be colonizing residents and staff of 7 NHs in Croatia. Our study demonstrates the spread of 2 clones within and among Croatian NHs. The data presented here provide an important baseline for future surveillance of MRSA in NH.

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        • McClean P.
        • Hughes C.
        • Tunney M.
        • Goossens H.
        • Jans B.
        • European Surveillance of Antimicrobial Consumption (ESAC) Nursing Home Project Group
        Antimicrobial prescribing in European nursing homes.
        J Antimicrob Chemother. 2011; 66: 1609-1616
        • Christensen K.
        • Doblhammer G.
        • Rau R.
        • Vaupel J.W.
        Aging populations: the challenges ahead.
        Lancet. 2009; 374: 1196-1208
      1. Afric I. Expert seminar on risk management in nursing homes. Available from: Accessed June 1, 2014.

        • Lasseter G.
        • Charlett A.
        • Lewis D.
        • Donald I.
        • Howell-Jones R.
        • McNulty C.A.
        Staphylococcus aureus carriage in care homes: identification of risk factors, including the role of dementia.
        Epidemiol Infect. 2010; 138: 686-696
        • Budimir A.
        • Kalenić S.
        Community-associated methicillin-resistant Staphylococcus aureus: molecular evolution, characteristics, and significance.
        Liječ Vjesn. 2007; 129: 355-363
        • Budimir A.
        • Bošnjak Z.
        • Kalenić S
        Methicillin-resistant Staphylococcus aureus (MRSA) in Croatia.
        Croatian J Infect. 2012; 32: 59-66
        • Habrun B.
        • Račić I.
        • Beck R.
        • Budimir A.
        • Benić M.
        • Kompes G.
        • et al.
        The presence of methicillin-resistant Staphylococcus aureus on large pig breeding farms in Croatia.
        Acta Vet Hung. 2011; 59: 419-425
        • Hughes C.
        • Tunney M.
        • Bradley M.C.
        Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people.
        Cochrane Database Syst Rev. 2013; : CD006354
        • Oliveira D.C.
        • de Lencastre H.
        Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus.
        Antimicrob Agents Chemother. 2002; 46: 2155-2161
        • Budimir A.
        • Deurenberg R.H.
        • Bošnjak Z.
        • Stobberingh E.E.
        • Cetkovic H.
        • Kalenic S.
        A variant of the southern German clone of methicillin-resistant Staphylococcus aureus is predominant in Croatia.
        Clin Microbiol Infect. 2010; 16: 1077-1083
        • Budimir A.
        • Deurenberg R.H.
        • Plecko V.
        • Vink C.
        • Kalenic S.
        • Stobberingh E.E.
        Molecular characterization of methicillin-resistant Staphylococcus aureus bloodstream isolates from Croatia.
        J Antimicrob Chemother. 2006; 57: 331-334
        • Tenover F.C.
        • Arbeit R.D.
        • Goering R.V.
        • Mickelsen P.A.
        • Murray B.E.
        • Persing D.H.
        • et al.
        Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing.
        J Clin Microbiol. 1995; 33: 2233-2239
        • O'Sullivan N.R.
        • Keane C.T.
        The prevalence of methicillin-resistant Staphylococcus aureus among the residents of six nursing homes for the elderly.
        J Hosp Infect. 2000; 45: 322-329
        • den Heijer C.D.
        • van Bijnen E.M.
        • Paget W.J.
        • Pringle M.
        • Goossens H.
        • Bruggeman C.A.
        • et al.
        Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant S aureus, in nine European countries: a cross-sectional study.
        Lancet Infect Dis. 2013; 13: 409-415
        • Denis O.
        • Jans B.
        • Deplano A.
        • Nonhoff C.
        • De Ryck R.
        • Suetens C.
        • et al.
        Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes in Belgium.
        J Antimicrob Chemother. 2009; 64: 1299-1306
        • Horner C.
        • Parnell P.
        • Hall D.
        • Kearns A.
        • Heritage J.
        • Wilcox M.
        Meticillin-resistant Staphylococcus aureus in elderly residents of care homes: colonization rates and molecular epidemiology.
        J Hosp Infect. 2013; 83: 212-218
        • Murphy C.R.
        • Hudson L.O.
        • Spratt B.G.
        • Quan V.
        • Kim D.
        • Peterson E.
        • et al.
        Predicting high prevalence of community methicillin-resistant Staphylococcus aureus strains in nursing homes.
        Infect Control Hosp Epidemiol. 2013; 34: 325-326
        • Sabat A.J.
        • Budimir A.
        • Nashev D.
        • Sá-Leão R.
        • van Dijl J.M.
        • Laurent F.
        • et al.
        Overview of molecular typing methods for outbreak detection and epidemiological surveillance.
        Euro Surveill. 2013; 18: 20380
        • Hoefnagels-Schuermans A.
        • Niclaes L.
        • Buntinx F.
        • Suetens C.
        • Jans B.
        • Verhaegen J.
        • et al.
        Molecular epidemiology of methicillin-resistant Staphylococcus aureus in nursing homes: a cross-sectional study.
        Infect Control Hosp Epidemiol. 2002; 23: 546-549
        • Smith C.S.
        • Parnell P.
        • Hodgson G.
        • Darby B.
        • Barr B.
        • Tompkins D.
        • et al.
        Are methicillin-resistant Staphylococcus aureus that produce Panton-Valentine leucocidin (PVL) found among residents of care homes?.
        J Antimicrob Chemother. 2008; 62: 968-972
        • Jans B.
        • Schoevaerdts D.
        • Huang T.D.
        • Berhin C.
        • Latour K.
        • Bogaerts P.
        • et al.
        Epidemiology of multidrug-resistant microorganisms among nursing home residents in Belgium.
        PLoS One. 2013; 8: e64908
        • Latour K.
        • Catry B.
        • Broex E.
        • Vankerckhoven V.
        • Muller A.
        • Stroobants R.
        • et al.
        Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey.
        Pharmacoepidemiol Drug Saf. 2012; 21: 937-944
        • Kalenić S.
        • Budimir A.
        • Bosnjak Z.
        • Acketa L.
        • Belina D.
        • Benko I.
        • et al.
        Guidelines on hand hygiene in health care institutions.
        Lijec Vjesn. 2011; 133: 155-170
        • Kalenić S.
        • Pal M.P.
        • Palcevski V.V.
        • Horvatić J.
        • Mestrović T.
        • Barsić B.
        • et al.
        Guidelines for prevention, control and treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA).
        Lijec Vjesn. 2008; 130: 7-32