Increasing incidence and widespread dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in central Europe, with special reference to German hospitals  Wolfgang Witte, Michael Kresken, Christine Braulke, Christa Cuny  Clinical Microbiology and Infection  Volume 3, Issue 4, Pages 414-422 (August 1997) DOI: 10.1111/j.1469-0691.1997.tb00277.x Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 1 Prevalence of MRSA among Staphylococcus aureus isolates in central Europe (and Germany) from 1976 to 1995. The studies performed between 1975 and 1984, and between 1990 and 1995, were conducted in cooperation with laboratories in Austria, Germany and Switzerland by the Bacterial Resistance Study Group of the Paul Ehrlich Society for Chemotherapy, and those performed in 1989 and 1992 were conducted with German hospitals by the study group of Knothe et al [12]. Clinical Microbiology and Infection 1997 3, 414-422DOI: (10.1111/j.1469-0691.1997.tb00277.x) Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 2 SmaI-macrorestriction patterns and PCR pattern of epidemic MRSA: ▴ Berlin epidemic MRSA; * southern German epidemic MRSA; • northern German epidemic MRSA; ○ Hannover area epidemic MRSA; Ø southeastern German/western Austrian epidemic MRSA; ⊡ Vienna epidemic MRSA; S = S. aureus 8325 as reference. Clinical Microbiology and Infection 1997 3, 414-422DOI: (10.1111/j.1469-0691.1997.tb00277.x) Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 3 Interregional dissemination of multiply resistant and oxacillin-resistant S. aureus (MRSA) in Germany in 1992 and 1993: • northern German epidemic strain; * southern German epidemic strain; A Berlin epidemic strain; ○ Hannover area epidemic strain; Ø southeastern German/western Austrian epidemic strain; ⊡ Vienna epidemic strain. Clinical Microbiology and Infection 1997 3, 414-422DOI: (10.1111/j.1469-0691.1997.tb00277.x) Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 4 Interregional dissemination of multiply resistant and oxacillin-resistant S. aureus (MRSA) in Germany in 1995 and 1996. ▴Berlin epidemic MRSA; *southern German epidemic MRSA; • northern German epidemic MRSA; ○ Hannover area epidemic MRSA; Ø southeastern German/western Austrian epidemic MRSA; ⊡ Vienna epidemic MRSA. Clinical Microbiology and Infection 1997 3, 414-422DOI: (10.1111/j.1469-0691.1997.tb00277.x) Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 5 SmaI macrorestriction and rRNA gene spacer patterns of MRSA which are different from epidemic MRSA. Clinical Microbiology and Infection 1997 3, 414-422DOI: (10.1111/j.1469-0691.1997.tb00277.x) Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 6 Relatedness of SmaI macrorestriction patterns of MRSA which are different from those of epidemic strains: ×, MRSA different from epidemic strains; +, reference strains for clonal groups within the species S. aureus, (for symbols of epidemic MRSA, see Figure 2); I, group of S. aureus exhibiting phage pattern 29, 52, +; II, group of S. aureus exhibiting phage group II patterns; III, group of S. aureus exhibiting phage group III patterns; IV, group of S. aureus exhibiting phage pattern 94, 96; V, group of S. aureus exhibiting phage pattern 95. Clinical Microbiology and Infection 1997 3, 414-422DOI: (10.1111/j.1469-0691.1997.tb00277.x) Copyright © 1997 European Society of Clinical Infectious Diseases Terms and Conditions