Methicillin-resistant Staphylococcus aureus in Europe.

In order to obtain pan-European data on methicillin-resistant Staphylococcus aureus (MRSA), 43 laboratories from ten European countries each screened 200 consecutive Staphylococcus aureus isolates for methicillin resistance. Only one isolate per patient was permitted. All participants used a uniform oxacillin-supplemented screening plate. MRSA isolates were sent to Munich for reconfirmation and further susceptibility testing. Phage typing of the MRSA strains was performed in Denmark. Of the 7,333 Staphylococcus aureus strains screened, 936 (12.8%) were methicillin resistant. The proportion of MRSA in the various European countries ranged from < 1% in Scandinavia to > 30% in Spain, France and Italy. Rates of resistance to the non-glycopeptide antibiotics were lowest for rifampin and highest for ciprofloxacin. Sixty percent of the methicillin-resistant strains originated from patients in surgical and medical departments, with wounds being the most common isolation source. MRSA was found more frequently in intensive care patients. Only 13% of the strains were non-typable, and 76% of the isolates belonged to phage group III. For each area phage typing detected one or a few dominating (epidemic) types, but 46% of the strains did not belong to these types; the MRSA population is thus a mixture of epidemic and non-epidemic strains. MRSA seems to be a growing problem, especially in southern Europe, where incidence and rates of antibiotic resistance are alarmingly high.