title: MRSA infections among patients in the emergency department: a European multicentre study.
abstract: MRSA is a therapeutic concern worldwide, and a major agent of community-acquired skin and soft tissue infections (CA-SSTIs). While the US epidemiology of MRSA in CA-SSTIs is well described and reports the high prevalence of the USA300 clone, data on the European situation are lacking.
  
  
  
  To determine the prevalence and clonal characteristics of MRSA in CA-SSTIs in seven European emergency departments.
  
  
  
  From April to June 2015, patients presenting to the tertiary hospital emergency department with a Staphylococcus aureus CA-SSTI were prospectively enrolled. S. aureus isolates were characterized by antimicrobial susceptibility testing, detection of Panton-Valentine leucocidin encoding genes and spa-typing, MLST and/or DNA microarray.
  
  
  
  Two-hundred and five cases of S. aureus-associated CA-SSTIs were included, comprising folliculitis, furuncles, abscesses, paronychia, impetigo, carbuncles and cellulitis. Of the 205 cases, we report an MRSA prevalence rate of 15.1%, with a north (0%) to south (29%) increasing gradient. Fifty-one isolates were Panton-Valentine leucocidin-positive (24.9%), whether MSSA or MRSA, with a heterogeneous distribution between countries. Clonal distribution of MSSA and MRSA showed high diversity, with no predominant circulating clone and no archetypical USA300 CA-MRSA clone.
  
  
  
  This original prospective multicentre study highlights stark differences in European MRSA epidemiology compared with the USA, and that the USA300 CA-MRSA clone is not predominant among community-infected patients in Europe.
authors: National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France coralie.bouchiat@chu-lyon.fr.
authors: C
authors: C
authors: Bouchiat
authors: Staphylococcus Reference Service, Public Health England, 61 Colindale Avenue London NW9 5EQ, UK.
authors: S
authors: S
authors: Curtis
authors: National Reference Laboratory for Staphylococci, University of Patras, University Campus, Rion 26504, Patras, Greece.
authors: I
authors: I
authors: Spiliopoulou
authors: National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France.
authors: M
authors: M
authors: Bes
authors: Laboratory of Clinical Microbiology and Virology, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
authors: C
authors: C
authors: Cocuzza
authors: Cantacuzino National Institute of Research, Splaiul Independentei 103, RO-050096 Bucharest, Romania.
authors: I
authors: I
authors: Codita
authors: National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France.
authors: C
authors: C
authors: Dupieux
authors: National Reference Laboratory for Staphylococci, University of Patras, University Campus, Rion 26504, Patras, Greece.
authors: N
authors: N
authors: Giormezis
authors: Staphylococcus Reference Service, Public Health England, 61 Colindale Avenue London NW9 5EQ, UK.
authors: A
authors: A
authors: Kearns
authors: National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France.
authors: F
authors: F
authors: Laurent
authors: Servei de Microbiologia Hospital Universitari Germans Trias i Pujol, Badalona, Spain.|CIBER Enfermedades Respiratorias. Carretera del Canyet s/n. 08916 Badalona, Spain.
authors: S
authors: S
authors: Molinos
authors: Laboratory of Clinical Microbiology and Virology, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
authors: R
authors: R
authors: Musumeci
authors: Servei de Microbiologia Hospital Universitari Germans Trias i Pujol, Badalona, Spain.|CIBER Enfermedades Respiratorias. Carretera del Canyet s/n. 08916 Badalona, Spain.
authors: C
authors: C
authors: Prat
authors: Epidemiology unit, Hospices Civils de Lyon, Place d'Arsonval, 69008 Lyon, France.
authors: M
authors: M
authors: Saadatian-Elahi
authors: Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tuebingen, Geissweg 3, 72076 Tuebingen, Germany.
authors: E
authors: E
authors: Tacconelli
authors: National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France.
authors: A
authors: A
authors: Tristan
authors: Institut für Mikrobiologie und Infektionsmedizin, University Hospital Tuebingen, Auf der Morgenstelle 28, 72076 Tuebingen, Germany.
authors: B
authors: B
authors: Schulte
authors: National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France.
authors: F
authors: F
authors: Vandenesch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004636:Emergency Service, Hospital; D005060:Europe / Q000453:epidemiology; D005098:Exotoxins / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D046228:Microarray Analysis; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D020411:Oligonucleotide Array Sequence Analysis; D015995:Prevalence; D011446:Prospective Studies; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013205:Staphylococcal Protein A / Q000235:genetics; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D013205:Staphylococcal Protein A