title: Nationwide surveillance of resistance rates of Staphylococcus aureus clinical isolates from Greek hospitals, 2012-2013.
abstract: Purpose To evaluate the in vitro efficacy of several anti-staphylococcal agents against a nationwide collection of contemporary Staphylococcus aureus clinical isolates from several healthcare centres in Greece. Methods Thirty hospitals throughout Greece (18 in Attica) provided all clinical isolates of S.aureus from April 2012 to May 2013 to a central lab to be re-submitted to susceptibility testing. The MICs were evaluated by Vitek® 2 with the exception of ceftaroline (OXOID M.I.C. Evaluator™). Vancomycin and daptomycin MICs were also evaluated by Etest®. Heterogeneously vancomycin-intermediate strains (hVISA) were detected by the Etest® GRD. VISA phenotype was confirmed by PAP-AUC. Results A total of 1005 isolates (39% MRSA) were studied. Susceptibility rates were: erythromycin 66.5%, clindamycin 79.2%, SXT 98.9%, rifampicin 97.3%, fusidic acid 67%, moxifloxacin 78.8%, vancomycin 99.9%, ceftaroline 92.9% and linezolid, tigecycline and daptomycin 100%. For mupirocin, high level resistance could be excluded for 98.9% of isolates. Vancomycin Etest® MIC50/90were 1.5/1.5 mg/L, 58.5% of isolates exhibited a MIC > 1 and 8.7% a MIC of 2 mg/L, while Vitek® MIC50/90were 1/1 and 3.1% showed MIC > 1 mg/L. One VISA strain was detected. Among the selected 175 isolates that were screened for hVISA phenotype, six (3.4%) were positive. In 315 bloodstream isolates, 64.1% had a vancomycin Etest® MIC > 1 mg/L. Conclusions This multi-centre surveillance study revealed that a significant percentage of contemporary S.aureus isolates from Greek patients have a vancomycin MIC (> 1 mg/L) that may compromise the clinical efficacy of the drug for the treatment of serious infections. The in vitro activity of SXT, rifampicin, mupirocin, linezolid, tigecycline, daptomycin and ceftaroline remains excellent.
authors.affiliation: a 4th Department of Internal Medicine , Athens University School of Medicine, University General Hospital 'Attikon' , Chaidari, Athens , Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Souli
authors.affiliation: b 6th Department of Internal Medicine , Hygeia Hospital , Marousi, Athens , Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Karaiskos
authors.affiliation: b 6th Department of Internal Medicine , Hygeia Hospital , Marousi, Athens , Greece.
authors.forename: Lambrini
authors.initials: L
authors.lastname: Galani
authors.affiliation: c Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine , University Hospital of Heraklion , Heraklion , Crete.
authors.forename: Sofia
authors.initials: S
authors.lastname: Maraki
authors.affiliation: d Department of Clinical Microbiology , Evaggelismos Hospital , Athens , Greece.
authors.forename: Efstathia
authors.initials: E
authors.lastname: Perivolioti
authors.affiliation: d Department of Clinical Microbiology , Evaggelismos Hospital , Athens , Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Argyropoulou
authors.affiliation: e Microbiology Department , 'Aghia Sophia' Children's Hospital , Athens , Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Charissiadou
authors.affiliation: e Microbiology Department , 'Aghia Sophia' Children's Hospital , Athens , Greece.
authors.forename: Levantia
authors.initials: L
authors.lastname: Zachariadou
authors.affiliation: f Microbiology Department , 'KAT' Hospital , Kifissia, Athens , Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Tsiplakou
authors.affiliation: f Microbiology Department , 'KAT' Hospital , Kifissia, Athens , Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Papaioannou
authors.affiliation: g Microbiological Laboratory, Bacteriology Department , 'G.Papanikolaou' General Hospital of Thessaloniki , Thessaloniki , Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Tsorlini
authors.affiliation: g Microbiological Laboratory, Bacteriology Department , 'G.Papanikolaou' General Hospital of Thessaloniki , Thessaloniki , Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Katsifa
authors.affiliation: h Microbiology Department , 'Korgialenio-Benakio' Hellenic Red Cross Hospital , Athens , Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Baka
authors.affiliation: h Microbiology Department , 'Korgialenio-Benakio' Hellenic Red Cross Hospital , Athens , Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Pantazi
authors.affiliation: i Microbiology Department , General Hospital of Corfu , Corfu , Greece.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Paschali
authors.affiliation: i Microbiology Department , General Hospital of Corfu , Corfu , Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Kyratsa
authors.affiliation: j Department of Clinical Microbiology , 'Thriassio' General Hospital , Elefsina , Greece.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Trikka-Graphakos
authors.affiliation: j Department of Clinical Microbiology , 'Thriassio' General Hospital , Elefsina , Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Giannopoulou
authors.affiliation: k Microbiology-Biochemistry Laboratory and National Reference Laboratory for Mycobacteria , 'Sotiria' Chest Diseases Hospital of Athens , Athens , Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Vogiatzakis
authors.affiliation: k Microbiology-Biochemistry Laboratory and National Reference Laboratory for Mycobacteria , 'Sotiria' Chest Diseases Hospital of Athens , Athens , Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Moraitou
authors.affiliation: l Microbiology Department , 'A.Syggros' University Hospital for Skin and Venereal Diseases , Athens , Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Papadogeorgaki
authors.affiliation: l Microbiology Department , 'A.Syggros' University Hospital for Skin and Venereal Diseases , Athens , Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Avgerinou
authors.affiliation: m Microbiology Department , Sismanogleio-A. Fleming General Hospital , Vrilissia, Athens , Greece.
authors.forename: Theofano
authors.initials: T
authors.lastname: Panagea
authors.affiliation: n Department of Microbiology , 'Laikon' General Hospital , Athens , Greece.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Pantazatou
authors.affiliation: o Department of Microbiology , University Hospital of Larissa , Larissa, Thessalia , Greece.
authors.forename: Efthymia
authors.initials: E
authors.lastname: Petinaki
authors.affiliation: p Microbiology Laboratory , General Hospital of Xanthi , Xanthi, Thrace , Greece.
authors.forename: Giannoula
authors.initials: G
authors.lastname: Stamatopoulou
authors.affiliation: q Department of Microbiology , 'Hippokration' General Hospital of Athens , Athens , Greece.
authors.forename: Marina
authors.initials: M
authors.lastname: Toutouza
authors.affiliation: r Department of Microbiology , General Hospital of Kavala , Kavala , Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Karatzoglou
authors.affiliation: s Department of Microbiology , 'G. Gennimatas' General Hospital of Thessaloniki , Thessaloniki , Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Kontopoulou
authors.affiliation: t Microbiology Laboratory , 'G. Gennimatas' General Hospital of Athens , Athens , Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Orfanidou
authors.affiliation: u Microbiology Laboratory , Hygeia Hospital , Marousi, Athens , Greece.
authors.forename: Irene
authors.initials: I
authors.lastname: Karantani
authors.affiliation: v Microbiology Laboratory , 'Agios Pavlos' General Hospital of Thessaloniki , Thessaloniki , Greece.
authors.forename: Panteleimon
authors.initials: P
authors.lastname: Fytas
authors.affiliation: w Microbiology Department , 'Alexandra' General Hospital of Athens , Athens , Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Tzanetou
authors.affiliation: x Department of Microbiology , General Hospital of Nea Ionia-Konstantopouleio - Patision , Athens , Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Platsouka
authors.affiliation: y Microbiology Department , 'Theageneio' Cancer Hospital of Thessaloniki , Thessaloniki , Greece.
authors.forename: Polyzo
authors.initials: P
authors.lastname: Kazila
authors.affiliation: z Laboratory of Microbiology , General Hospital of Drama , Drama , Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Chli
authors.affiliation: aa Department of Microbiology , General Hospital of Rhodes , Rhodes , Greece.
authors.forename: Ntina
authors.initials: N
authors.lastname: Statiri
authors.affiliation: b 6th Department of Internal Medicine , Hygeia Hospital , Marousi, Athens , Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016521:Electrophoresis, Gel, Pulsed-Field; D062665:Epidemiological Monitoring; D006115:Greece / Q000453:epidemiology; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Meticillin-resistant Staphylococcus aureus; ceftaroline; daptomycin; heterogeneously vancomycin- intermediate Staphylococcus aureus; linezolid; trimethoprim/sulfamethoxazole