Multinational surveillance programmes for methicillin-resistant Staphylococcus aureus (MRSA) are dependent on national structures for data collection. This study aimed to capture the diversity of national MRSA surveillance programmes and to propose a framework for harmonisation of MRSA surveillance. The International Society of Antimicrobial Chemotherapy (ISAC) MRSA Working Group conducted a structured survey on MRSA surveillance programmes and organised a webinar to discuss the programmes' strengths and challenges as well as guidelines for harmonisation. Completed surveys represented 24 MRSA surveillance programmes in 16 countries. Several countries reported separate epidemiological and microbiological surveillance. Informing clinicians and national policy-makers were the most common purposes of surveillance. Surveillance of bloodstream infections (BSIs) was present in all programmes. Other invasive infections were often included. Three countries reported active surveillance of MRSA carriage. Methodology and reporting of antimicrobial susceptibility, virulence factors, molecular genotyping and epidemiological metadata varied greatly. Current MRSA surveillance programmes rely upon heterogeneous data collection systems, which hampers international epidemiological monitoring and research. To harmonise MRSA surveillance, we suggest improving the integration of microbiological and epidemiological data, implementation of central biobanks for MRSA isolate collection, and inclusion of a representative sample of skin and soft-tissue infection cases in addition to all BSI cases.

Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven the Netherlands

Centre International de Recherche en Infectiologie Université de Lyon INSERM U1111 Université Claude Bernard Lyon 1 CNRS UMR5308 ENS de Lyon Lyon France; Centre National de Référence des Staphylocoques Institut des Agents Infectieux Hospices Civils de Lyon Lyon France

Department of Clinical Microbiology Faculty of Medicine Brawijaya University Dr Saiful Anwar Hospital Malang Indonesia

Department of Clinical Microbiology University Hospital for Infectious Diseases University of Zagreb School of Dental Medicine Zagreb Croatia

Department of Epidemiology and Clinical Microbiology National Medicines Institute Warsaw Poland

Department of Infection Control Mater Dei Hospital Msida Malta

Department of Medical Microbiology and Infectious Diseases Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands

Department of Medical Microbiology Faculty of Medicine Universitas Airlangga Surabaya Indonesia; Dr Soetomo General Academic Hospital Surabaya Indonesia

Department of Medicine University of Pennsylvania Philadelphia Pennsylvania USA

Department of Microbiology LHUB ULB Université Libre de Bruxelles Brussels Belgium

East Tallinn Central Hospital Laboratory Tallinn Estonia

Healthcare associated infections and antimicrobial resistance Sciensano Brussels Belgium

Healthcare associated infections and antimicrobial resistance Sciensano Brussels Belgium; Faculty of Medicine Université libre de Bruxelles Brussels Belgium

Hospital Preventive Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland; Swiss National Reference Center for Emerging Antibiotic Resistance Lausanne site Lausanne Switzerland

Institute for Infection and Immunity St George's University of London London UK

Institute for Medical Microbiology Immunology and Hygiene University of Cologne Köln Germany

Mission nationale SPARES Limoges University Hospital Limoges France

National Infection Service Public Health England London UK

National MRSA Reference Laboratory St James's Hospital Dublin 8 Ireland

National Reference Laboratory for Antibiotics Centre for Epidemiology and Microbiology National Institute of Public Health 10000 Prague Czech Republic; Department of Microbiology 3rd Faculty of Medicine Charles University University Hospital Kralovske Vinohrady and National Institute of Public Health 10000 Prague Czech Republic

National Reference Laboratory for Antimicrobial Resistance Department of Bacteria Fungi and Parasites Statens Serum Institut Copenhagen Denmark

Robert Koch Institute Department of Infectious Diseases National Reference Centre for Staphylococci and Enterococci Wernigerode Branch Germany

Swiss Centre for Antibiotic Resistance Institute for Infectious Diseases University of Bern Bern Switzerland

The Norwegian MRSA Reference Laboratory St Olavs Hospital Trondheim Norway

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