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Abstract

In this retrospective observational study, we analysed a community outbreak of impetigo with meticillin-resistant (MRSA), with additional resistance to fusidic acid (first-line treatment). The outbreak occurred between June 2018 and January 2020 in the eastern part of the Netherlands with an epidemiological link to three cases from the north-western part. Forty nine impetigo cases and eight carrier cases were identified, including 47 children. All but one impetigo case had community-onset of symptoms. Pharmacy prescription data for topical mupirocin and fusidic acid and GP questionnaires suggested an underestimated outbreak size. The 57 outbreak isolates were identified by the Dutch MRSA surveillance as MLVA-type MT4627 and sequence type 121, previously reported only once in 2014. Next-generation sequencing revealed they contained a fusidic acid resistance gene, exfoliative toxin genes and an epidermal cell differentiation inhibitor gene. Whole-genome multilocus sequence typing revealed genetic clustering of all 19 sequenced isolates from the outbreak region and isolates from the three north-western cases. The allelic distances between these Dutch isolates and international isolates were high. This outbreak shows the appearance of community-onset MRSA strains with additional drug resistance and virulence factors in a country with a low prevalence of antimicrobial resistance.

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/content/10.2807/1560-7917.ES.2022.27.49.2200245
2022-12-08
2024-12-21
/content/10.2807/1560-7917.ES.2022.27.49.2200245
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An unusual outbreak in the Netherlands: community-onset impetigo caused by a meticillin-resistant Staphylococcus aureus with additional resistance to fusidic acid, June 2018 to January 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Karuna+E.W.+Vendrik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vendrik Karuna E.W.</a>, <a href="/search?value1=Ed+J.+Kuijper&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuijper Ed J.</a>, <a href="/search?value1=Marieke+Dimmendaal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dimmendaal Marieke</a>, <a href="/search?value1=Welmoed+Silvis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Silvis Welmoed</a>, <a href="/search?value1=Els+Denie-Verhaegh&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Denie-Verhaegh Els</a>, <a href="/search?value1=Annemarie+de+Boer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Boer Annemarie</a>, <a href="/search?value1=Bent+Postma&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Postma Bent</a>, <a href="/search?value1=Annelot+F.+Schoffelen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schoffelen Annelot F.</a>, <a href="/search?value1=Wilhelmina+L.M.+Ruijs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ruijs Wilhelmina L.M.</a>, <a href="/search?value1=Fleur+M.H.P.A.+Koene&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koene Fleur M.H.P.A.</a>, <a href="/search?value1=Mariska+Petrignani&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Petrignani Mariska</a>, <a href="/search?value1=Mari%C3%ABtte+Hooiveld&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hooiveld Mariëtte</a>, <a href="/search?value1=Sandra+Witteveen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Witteveen Sandra</a>, <a href="/search?value1=Leo+M.+Schouls&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schouls Leo M.</a>, <a href="/search?value1=Daan+W.+Notermans&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Notermans Daan W.</a>, <a href="/search?value1=MRSA+consortium&option1=author&noRedirect=true" class="nonDisambigAuthorLink">MRSA consortium</a></span>. An unusual outbreak in the Netherlands: community-onset impetigo caused by a meticillin-resistant Staphylococcus aureus with additional resistance to fusidic acid, June 2018 to January 2020. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(49):pii=2200245. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.49.2200245" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.49.2200245</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 09 Mar 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 15 Aug 2022 </span> </p>
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