Predominance of dfrG as determinant of trimethoprim resistance in imported Staphylococcus aureus.
To investigate the global occurrence of trimethoprim-sulfamethoxazole resistance and the genetic mechanisms of trimethoprim resistance, we analysed Staphylococcus aureus from travel-associated skin and soft-tissue infections treated at 13 travel clinics in Europe. Thirty-eight per cent (75/196) were trimethoprim-resistant and 21% (41/196) were resistant to trimethoprim-sulfamethoxazole. Among methicillin-resistant S. aureus, these proportions were 30% (7/23) and 17% (4/23), respectively. DfrG explained 92% (69/75) of all trimethoprim resistance in S. aureus. Travel to South Asia was associated with the highest risk of acquiring trimethoprim-sulfamethoxazole-resistant S. aureus. We conclude that globally dfrG is the predominant determinant of trimethoprim resistance in human S. aureus infection.
Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: dennis.nurjadi@uni-heidelberg.de.
D
D
Nurjadi
Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany.
J
J
Schäfer
Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
B
B
Friedrich-Jänicke
Missionsärztliche Klinik, Würzburg, Germany.
A
A
Mueller
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
A
A
Neumayr
ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
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A
Calvo-Cano
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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A
Goorhuis
Instituut voor Tropische Ziekten, Havenziekenhuis, Rotterdam, The Netherlands.
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N
Molhoek
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
H
H
Lagler
Department of Medicine, University of Helsinki, Finland; Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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A
Kantele
Instituut voor Tropische Ziekten, Havenziekenhuis, Rotterdam, The Netherlands.
P J J
PJ
Van Genderen
ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
J
J
Gascon
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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MP
Grobusch
Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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E
Caumes
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
C
C
Hatz
Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany.
R
R
Fleck
Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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FP
Mockenhaupt
Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany; Institute of Public Health, Unit of Epidemiology and Biostatistics, Heidelberg University Hospital, Heidelberg, Germany.
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P
Zanger
D001426:Bacterial Proteins / Q000235:genetics; D005060:Europe; D006801:Humans; D018461:Soft Tissue Infections / Q000382:microbiology; D013203:Staphylococcal Infections / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000382:microbiology; D013211:Staphylococcus aureus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics*; D014195:Travel; D014296:Trimethoprim Resistance
D001426:Bacterial Proteins; D013762:Tetrahydrofolate Dehydrogenase
Communicable diseases; Panton–Valentine leukocidin; emerging drug resistance; methicillin-resistant Staphylococcus aureus; molecular epidemiology; sentinel surveillance; staphylococcal skin infections; travel; trimethoprim–sulfamethoxazole combination