MRSA reservoirs in Poland Dorota Żabicka, Joanna Empel National Medicines Institute, Warsaw, Poland

MRSA - epidemiology HA-MRSA – (hospital-associated MRSA) isolates typically additionally resistant to many other antibiotics CA-MRSA – (community-associated MRSA) isolates typically sensitive to other antibiotics FA-MRSA (farm-associated MRSA) or LA-MRSA (livestock-associated MRSA) isolates from patients in close contact with livestock (farmers, veterinary staff, slaughterhouses workers) CO-MRSA – (community-onset MRSA)

MRSA epidemiology in Poland EARS-Net data- invasive MRSA (isolates from blood) 2005 – 24% 2007 – 15% 2009 – 20% 2010 – 13% Big differences among locations Infections caused mainly by HA-MRSA (hospital-associated MRSA), increasing number of infections due to CA-MRSA (community-associated MRSA), sporadic isolations from colonization of FA-MRSA (farm-associated MRSA)

MRSA in Poland - surveys Increase of MRSA isolates in hospitals from 13.3% in 1999-2000 to 22.7 % in 2005 Strains isolated from different specimens (blood, skin and soft tissue infections, joint and bone infections and others) taken from patients age over 16 of the surgery, orthopaedics, haematology, ICU wards and dialysis centres all around Poland, second and tertiary care centres

MRSA susceptibility trends

Main MRSA clones in Polish hospitals over two decades EARS-Net 13.3% MRSA 1999-2000 22,7% MRSA (2005) 1990 1998 1994 2001 1999 2005 2008 2009 2011 ST239-III (Hungarian) (CC8) ST247-I (Iberian) (CC8) ST36-II (EMRSA-16) (CC5) ST225-II (Rhine-Hesse) (CC5) ST5-IV (Pediatric) (CC5) ST45-IV (Berlin) (CC45) (SeqNet survey 2011) hospital surveys hospital outbreaks

MRSA in Poland – survey 2005 High genetic variability of MRSA isolates, 18 clones identified belonging to four clonal complexes: CC8, CC5, CC45 and CC59 Most disseminated CC8 (74%) ST239- III (Hungarian clone) and ST247-I (Iberian clone) are the predominant clones ST45-IV (Berlin clone) has emerged as the third most predominant clone Most of the remaining clones were not previously encountered in Poland – may have been introduced from abroad as a result of increased international travel to and from Poland in recent years Five isolates were characterised as ST338-V clone, PVL positive (CA-MRSA)

Main MRSA clones in Polish hospitals over two decades 1990 1998 1994 2001 1999 2005 2008 2009 2011 ST239-III (Hungarian) (CC8) ST247-I (Iberian) (CC8) ST36-II (EMRSA-16) (CC5) ST225-II (Rhine-Hesse) (CC5) ST5-IV (Pediatric) (CC5) ST45-IV (Berlin) (CC45) (SeqNet survey 2011) hospital surveys hospital outbreaks

ST338-VT CC59 (Taiwan clone) in Poland (2005-2011) 58 MRSA isolates from 21 centres ST338-V(5C2&5; VT), PVL+, t437 (n=49) t3527 (n=7) t441 (n=1) Mostly seen in community settings, but increasingly in hospitals. Extremely homogenous background molecular typing analysis (MLVF and PFGE) Usually resistant to : clindamycin, erytromycin, tetracycline, kanamycin, chloramphenicol

Staphylococcus aureus resistance trends

Nasal carriage of S. aureus ST398 among veterinarians in 2008-2010 in Poland 2009 2010 Control Nasal carriage of S. aureus 29,4% 39,2% 29% 23% Nasal carriage of S. aureus ST398 12,2% 17,6% 11% 0,2% Nasal carriage of MRSA ST398 1,4% 3,9%

spa-CC 012 (56% of isolates studied) veterinarians group ST398 control group

Waleria Hryniewicz Katarzyna Bojarska Aleksandra Kozińska Natalia Marszałek Ewa Młodzińska Monika Orczykowska - Kotyna Aneta Wysmolińska