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Antibiotic Dereplication Using the Antibiotic Resistance Platform
Published on: October 17, 2019
Increasing trend in fusidic acid resistance among MRSA isolates in the Netherlands, 2016-23
F Velthuis1, I M Nauta1, W Altorf-van der Kuil1
1Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, Bilthoven 3720 BA, The Netherlands.
Objectives:
Recently, several MRSA community outbreaks occurred in the Netherlands, including one caused by an impetigo-causing MRSA strain resistant to fusidic acid. Since fusidic acid and flucloxacillin are the main treatment options for impetigo, increasing resistance limits treatment possibilities. We examined trends in fusidic acid resistance percentages among MRSA isolates in the Netherlands.
Materials And Methods:
Data on routine bacteriological cultures between 2016 and 2023 from 30 laboratories were extracted from the national surveillance system on antimicrobial resistance (ISIS-AR). Fusidic acid resistance percentages per year were calculated both overall and per age group for all MRSA isolates, and more specific, for the subset of MRSA isolates from wound/pus/skin samples collected by general practitioners (WPS-GP). Trends were determined using logistic regression and compared with trends among MSSA isolates.
Results:
We found an increase in fusidic acid resistance among MRSA isolates from 15% (2016) to 29% (2023) (P < 0.001), which differed significantly (P < 0.001) from the trend among MSSA isolates (10%-12%). An increase was also found in MRSA WPS-GP isolates, both among young children and the population of 13-64 years old, but not among elderly. The trends remained significant after exclusion of isolates associated with known fusidic acid-resistant MRSA outbreaks, both among MRSA isolates overall (OR = 1.10, 95% CI: 1.07-1.14, P < 0.001) and among MRSA WPS-GP isolates (OR = 1.14, 1.07-1.21, P < 0.001).
Conclusions:
In conclusion, an increasing trend in fusidic acid resistance was found among MRSA isolates. Since impaired treatment for impetigo might ease the spread of (fusidic acid-resistant) MRSA, extra vigilance is warranted.
Insights
Fusidic acid resistance in Methicillin-resistant Staphylococcus aureus (MRSA) has significantly increased in the Netherlands from 2016 to 2023. This rise in antimicrobial resistance poses challenges for treating common skin infections like impetigo.
Area of Science:
- Microbiology
- Epidemiology
- Antimicrobial Resistance
Background:
- Community outbreaks of Methicillin-resistant Staphylococcus aureus (MRSA) have been reported in the Netherlands.
- A notable outbreak involved an MRSA strain causing impetigo and exhibiting resistance to fusidic acid.
- Fusidic acid and flucloxacillin are primary treatments for impetigo, making resistance a significant clinical concern.
Purpose of the Study:
- To investigate the trends in fusidic acid resistance among MRSA isolates in the Netherlands between 2016 and 2023.
- To compare these trends with those observed in Methicillin-susceptible Staphylococcus aureus (MSSA) isolates.
Main Methods:
- Data from routine bacteriological cultures (2016-2023) were collected from 30 Dutch laboratories via the ISIS-AR surveillance system.
- Fusidic acid resistance percentages were calculated annually for all MRSA isolates and specifically for wound/pus/skin samples from general practitioners (WPS-GP).
- Trend analysis was performed using logistic regression, with comparisons made against MSSA isolate trends.
Main Results:
- Fusidic acid resistance in MRSA isolates increased from 15% in 2016 to 29% in 2023 (P < 0.001).
- This trend significantly differed from MSSA isolates, which showed stable resistance (10%-12%).
- Increased resistance was observed in MRSA WPS-GP isolates across young children and adults (13-64 years), but not in the elderly. Trends remained significant even after excluding known outbreak-associated isolates.
Conclusions:
- There is a clear increasing trend in fusidic acid resistance among MRSA isolates in the Netherlands.
- The rise in resistance, particularly in strains causing impetigo, may facilitate the spread of resistant MRSA.
- Increased vigilance and monitoring are necessary to manage this growing public health concern.
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