Epidemiologie von MRSA-Patientenisolate anhand der spa-Typisierung am Uniklinikum Marburg (2016-2023) unter Berücksichtigung der COVID-19-Pandemie
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Abstract
1. Background and Objectives
The COVID-19 pandemic led to profound changes in healthcare systems, social behavior, and population mobility. These changes may also have influenced the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA). A better understanding of regional MRSA prevalence and the distribution of common clonal complexes is essential for the targeted development of local prevention and control strategies.
2. Materials and Methods
In this retrospective, single-center study, 561 valid MRSA first isolates collected between 2016 and 2023 were analyzed. Molecular characterization was performed using multiplex PCR for the detection of spa and PVL genes. Molecular results were linked with demographic, geographic, and basic clinical data. All data were fully anonymized, ensuring that no conclusions could be drawn about individual patients. Statistical analysis was performed descriptively and using appropriate significance tests to assess temporal trends and distribution patterns of MRSA isolates.
3. Results
During the study period, a marked decline in MRSA burden was observed at the Marburg site. The median age of affected patients was in the older age group, and men were more frequently affected than women. Molecular analysis identified more than one hundred different spa types, with a small number of dominant types accounting for the majority of isolates. The most frequent spa type was t003, which was predominantly associated with hospital-associated lineages. The Panton–Valentine leukocidin gene was detected in only a small proportion of isolates.
Antibiotic resistance analyses showed high resistance rates to several antibiotic classes, while reserve antibiotics largely remained effective. Hospital-associated isolates tended to show higher levels of multidrug resistance compared with community- and livestock-associated isolates.
Over time, a pronounced decline in MRSA detections and a shift in type distribution became apparent, particularly from the onset of the COVID-19 pandemic. While the proportion of hospital-associated isolates decreased, the relative proportion of community-associated lineages increased. Geographic analysis revealed a heterogeneous distribution of MRSA cases within the Marburg-Biedenkopf district, with distinct regional clusters.
4. Discussion
The declining MRSA prevalence at University Hospital Marburg is consistent with national and European trends and is likely attributable to improved hygiene measures and structured screening programs.
The COVID-19 pandemic represents a major turning point within the observation period. While the proportion of hospital-associated MRSA isolates decreased continuously, a relative increase in community-associated isolates was observed. This development may plausibly be explained by altered transmission dynamics due to contact restrictions, reduced elective hospital admissions, and intensified hygiene measures. At the same time, limitations in routine diagnostics and changes in clinical priorities during the pandemic may have influenced MRSA detection.
Molecular typing demonstrated the dominance of a limited number of spa types, particularly the hospital-associated type t003. Despite declining MRSA case numbers, the overall clonal structure remained largely stable throughout the study period, indicating persistent circulation of established lineages. The observed regional clusters suggest the influence of local factors, complex transmission networks, and heterogeneous MRSA transmission dynamics.
5. Conclusion
The results show that MRSA epidemiology is influenced by both long-term hygiene measures and pandemic-related changes. This study highlights the importance of continuous surveillance in order to further develop hygiene, screening, and prevention strategies based on local epidemiological data and existing transmission networks.
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