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

2. 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)

3. 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)

4. MRSA in Poland - surveys
Increase of MRSA isolates in hospitals from 13.3% in 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

5. MRSA susceptibility trends

6. Main MRSA clones in Polish hospitals over two decades
EARS-Net
13.3% MRSA ,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

7. 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)

8. 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

9. 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

10. Staphylococcus aureus resistance trends

11. 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%

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

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