title: Decline in the proportion of methicillin resistance among Staphylococcus aureus isolates from non-invasive samples and in outpatient settings, and changes in the co-resistance profiles: an analysis of data collected within the Antimicrobial Resistance Surveillance Network, Germany 2010 to 2015.
abstract: Recent analysis of trends of non-invasive infections with methicillin resistant Staphylococcus aureus (MRSA), of trends of MRSA infections in outpatient settings and of co-resistance profiles of MRSA isolates are scarce or lacking in Germany.
  
  
  
  We analysed data from the Antimicrobial Resistance Surveillance Network (ARS). We included in the analysis the first isolate of S. aureus per patient and year, which had a valid test result for oxacillin resistance and which was not a screening sample. We limited the analysis to isolates from facilities, which contributed to ARS for all six years between 2010 and 2015. We compared the proportion of methicillin resistance among S. aureus isolates by calendar year using Chi-square and Fisher's exact test. We corrected for multiple testing using the Bonferroni correction. We stratified the analysis by sample type including various non-invasive sample types and by type of care (e.g. hospital versus outpatient clinic). We also analysed the non-susceptibility of MRSA to selected antibiotics.
  
  
  
  The analysis included 148,561 S. aureus isolates. The distribution of these isolates by sex, age, region, sample type, clinical speciality and type of care remained relatively stable over the six years analysed. The proportion of MRSA among S. aureus isolates decreased continuously from 16% in 2010 to 10% in 2015. This decrease was seen for all types of care and for the majority of sample types, including the outpatient clinic (12 to 8%), as well as blood culture (19 to 9%), urine samples (25 to 15%), swabs (14 to 9%), respiratory samples (22 to 11%) and lesions (15 to 10%). The non-susceptibility of MRSA isolates to tobramycin (47 to 32%), ciprofloxacin (95 to 89%), moxifloxacin (94 to 84%), clindamycin (80 to 71%) and erythromycin (81 to 72%) declined markedly, but it increased for tetracyclines (6 to 9%) and gentamicin (3 to 6%). Non-susceptibility of MRSA to linezolid, teicoplanin, tigecycline and vancomycin remained rare.
  
  
  
  This analysis indicates that the incidence of MRSA infections declined in a variety of settings in Germany between 2010 and 2015 and that the co-resistance profiles of MRSA isolates changed markedly.
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany. walterj@rki.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Walter
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Noll
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Feig
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Weiss
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Claus
authors.affiliation: National Reference Centre for Staphylococci and Enterococci; Unit 13 Nosocomial Pathogens and Antibiotic Resistances; Robert Koch Institute, Burgstr. 37, D-38855, Wernigerode, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Werner
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Eckmanns
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Hermes
authors.affiliation: Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
authors.forename: Muna
authors.initials: M
authors.lastname: Abu Sin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D062486:Public Health Surveillance; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
keywords: Antimicrobial resistance; Germany; Livestock-associated MRSA; Methicillin-resistant Staphylococcus aureus (MRSA); Surveillance