title: Differences in MRSA prevalence and resistance patterns in a tertiary center before and after joining an international program for surveillance of antimicrobial resistance.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) emerged as one of the most important causes of hospital-acquired bloodstream infections (BSIs), especially the multidrug resistant clones. The aim of the present study was to compare prevalence and resistance patterns of MRSA bacteremia in the major tertiary-care academic and referral center in Serbia before and after implementing an active antimicrobial resistance (AMR) surveillance. Laboratory-based before-after study was conducted during a two-year period (January 2012 to December 2013) in Clinical Centre of Serbia. Isolation and identification of bacterial strains were done following standard microbiological procedures. During the AMR surveillance, nearly twice more bloodstream samples were collected compared to the year without surveillance (1,528 vs. 855). In total, 43 isolates of MRSA were identified. MRSA was significantly more prevalent during the AMR surveillance compared to the previous year [14 (66.7%) to 29 (76.3%); P = 0.046]. During the AMR surveillance, MRSA more frequently originated from medical departments compared to intensive care unit, surgical department, and internal medicine (P = 0.027) indicating increasing MRSA infections in patients with less severe clinical condition and no apparent risk factors. Higher prevalence of MRSA and its lower susceptibility to erythromycin were revealed by implementation of active AMR surveillance, which may reflect more thoughtful collection of bloodstream samples from patients with suspected BSI.
authors.affiliation: 1 Institute of Epidemiology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia.|4 Faculty of Medicine, University of Belgrade , Belgrade, Serbia.
authors.forename: Olivera
authors.initials: O
authors.lastname: Djuric
authors.affiliation: 2 Department of Microbiology, Clinical Centre of Serbia , Belgrade, Serbia.
authors.forename: Snezana
authors.initials: S
authors.lastname: Jovanovic
authors.affiliation: 2 Department of Microbiology, Clinical Centre of Serbia , Belgrade, Serbia.
authors.forename: Branka
authors.initials: B
authors.lastname: Stosovic
authors.affiliation: 2 Department of Microbiology, Clinical Centre of Serbia , Belgrade, Serbia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Tosic
authors.affiliation: 2 Department of Microbiology, Clinical Centre of Serbia , Belgrade, Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Jovanovic
authors.affiliation: 4 Faculty of Medicine, University of Belgrade , Belgrade, Serbia.
authors.forename: Naomi
authors.initials: N
authors.lastname: Nartey
authors.affiliation: 3 Institute of Social Medicine, Faculty of Medicine, University of Belgrade , Belgrade, Serbia.|4 Faculty of Medicine, University of Belgrade , Belgrade, Serbia.
authors.forename: Jovana
authors.initials: J
authors.lastname: Todorovic
authors.affiliation: 1 Institute of Epidemiology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia.|4 Faculty of Medicine, University of Belgrade , Belgrade, Serbia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Markovic-Denic
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008875:Middle Aged; D055771:Serbia / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D063128:Tertiary Health Care / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: HA-MRSA; antimicrobial resistance; bacteremia; surveillance