Severe infections in the Netherlands caused by community-acquired methicillin-susceptible Staphylococcus aureus clonal complex 152 carrying PVL, edinB and etE2

ObjectivesTo describe severe community-acquired methicillin-susceptible Staphylococcus aureus (MSSA) clonal complex (CC) 152 infections identified in the Netherlands. MethodsWe conducted a retrospective case series of S. aureus CC152 identified between December 2021 and early 2025 in the northeastern Netherlands.Cases were detected through clinicianinitiated molecular characterisation of severe infections and routine screening for methicillinresistant S. aureus (MRSA) carriage.Clinical and microbiological data were analysed, and whole-genome sequencing was performed on all included isolates. ResultsThirteen individuals with CC152 were identified, including seven MSSA cases with severe infection and six MRSA carriers.Severe MSSA infections predominantly presented as necrotising pneumonia, often following respiratory viral infection, and were characterised by rapid clinical deterioration requiring intensive care support, with one fatal outcome.Isolates carried multiple virulence genes, including Panton-Valentine leukocidin (PVL), epidermal cell differentiation inhibitor B (edinB), and exfoliative toxin E variant (etE2), with all isolates carrying PVL and 10/13 isolates harbouring the edinB/etE2 combination. ConclusionsThese findings support previous reports suggesting MSSA CC152 may represent an underrecognised virulent lineage in Europe.Increased clinical awareness and targeted molecular characterisation of severe MSSA infections may improve detection and surveillance.In suspected toxin-mediated disease, early adjunctive therapy aimed at toxin suppression may be considered.