USA300 was first recognized in Europe in Denmark in 2000 . Over 50 reports from 15 countries have followed, including cases causedby both USA300-0114 and USA300-LV (Table 1; Fig. 1). While imported cases have been reported frequently, autochthonous spread of USA300-0114 has also been recorded in Austria, Denmark, England, France, Ireland, The Netherlands, and Spain [39–46]. Autochthonous spread of USA300-LV is more limited, having been reported in only Italy and Spain [41,44,47,48]. Although USA300 MRSA isolates in Europe have been susceptible to most non-β-lactam antimicrobials, USA300-0114 isolates have generally been resistant to erythromycin, and frequently resistant to fluoroquinolones [44,49]. USA300-LV isolates have been resistant to tetracycline in less than half of cases, and to mupirocin or fusidic acid occasionally [44,48]. Although population-based prevalence data have been lacking, only three (0.3%) isolates from S. aureus bacteraemia cases in 26 European countries between September 2006 and February 2007 were consistent with USA300 MRSA . By comparison, only two isolates of ‘European’ ST80 CA-MRSA were detected in the same survey. Isolates consistent with USA300 are the most common PVL-positive MRSA strains in Spain, and, among these, USA300-LV is predominant [41,44,48,51]. Unlike the situation in Canada, USA300 generally makes up only a small proportion of all clinical MRSA isolates in Europe, ranging from 0.8% to 3.5% in various countries [39,44,45,47,51–55].
As elsewhere, furunculosis and other SSTIs have been the major clinical manifestations of infection with both USA300-0114 and USA300-LV in Europe [44,45,48,56]. Cases of severe invasive infection, including necrotizing pneumonia, meningitis, osteomyelitis, and deep vein thrombosis, have also been reported [56–61]. One community outbreak caused by USA300-0114 related to a beauty salon has been reported from The Netherlands . The great majority of cases have had their onset in the community, and CO-NR infections are common among these (Table 1). Although HO cases have been documented, no hospital outbreaks have been reported. Finally, one remarkable case of USA300-P infection in a dog has recently been reported from France . The isolate from a surgical wound infection was arginine catabolic mobile element-negative, and therefore may be related to USA300-LV. However, a family member of the treating veterinarian had recently undergone prolonged hospitalization in the USA. SCCmec subtyping was not reported.