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Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit

Published online by Cambridge University Press:  04 October 2018

Theresa Madigan
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Scott A. Cunningham
Affiliation:
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota
Robin Patel*
Affiliation:
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
Kerryl E. Greenwood-Quaintance
Affiliation:
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota
Jean E. Barth
Affiliation:
Infection Prevention and Control, Mayo Clinic, Rochester, Minnesota
Priya Sampathkumar
Affiliation:
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota Infection Prevention and Control, Mayo Clinic, Rochester, Minnesota
Nicolynn C. Cole
Affiliation:
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota
Peggy C. Kohner
Affiliation:
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota
Christopher E. Colby
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Garth F. Asay
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Jennifer L. Fang
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Christine A. Baker
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Department of Nursing, Mayo Clinic, Rochester, Minnesota
Angela L. Heinrich
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Department of Nursing, Mayo Clinic, Rochester, Minnesota
Kelly A. Fjerstad
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Department of Nursing, Mayo Clinic, Rochester, Minnesota
Maria J. Lujero
Affiliation:
Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Department of Nursing, Mayo Clinic, Rochester, Minnesota
Nicholas Chia
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, Minnesota Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota
Patricio R. Jeraldo
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, Minnesota Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota
Heidi Nelson
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, Minnesota Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota
W. Charles Huskins
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Infection Prevention and Control, Mayo Clinic, Rochester, Minnesota
*
Author for correspondence: Robin Patel MD, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905. E-mail: patel.robin@mayo.edu

Abstract

Objective

To evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.

Design

Investigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014–2017).

Setting

Single-center level IV NICU.

Patients

NICU infants and healthcare workers (HCWs).

Methods

Infants were screened for MRSA using a swab of the anterior nares, axilla, and groin, initially by targeted (ring) screening, and later by universal weekly screening. Clinical cultures were collected as indicated. HCWs were screened once using swabs of the anterior nares. MRSA isolates were typed using WGS with core-genome multilocus sequence typing (cgMLST) analysis and by pulsed-field gel electrophoresis (PFGE). Colonized and infected infants and HCWs were decolonized. Control strategies included reinforcement of hand hygiene, use of contact precautions, cohorting, enhanced environmental cleaning, and remodeling of the NICU.

Results

We identified 64 MRSA-positive infants: 53 (83%) by screening and 11 (17%) by clinical cultures. Of 85 screened HCWs, 5 (6%) were MRSA positive. WGS of MRSA isolates identified 2 large clusters (WGS groups 1 and 2), 1 small cluster (WGS group 3), and 8 unrelated isolates. PFGE failed to distinguish WGS group 2 and 3 isolates. WGS groups 1 and 2 were codistributed over time. HCW MRSA isolates were primarily in WGS group 1. New infant MRSA cases declined after implementation of the control interventions.

Conclusion

We identified 2 contemporaneous MRSA outbreaks alongside sporadic cases in a NICU. WGS was used to determine strain relatedness at a higher resolution than PFGE and was useful in guiding efforts to control MRSA transmission.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: The results of this project were presented in part at the ASM Microbe 2017 meeting on June 5, 2017, in New Orleans, Louisiana, and at the Pediatric Academic Societies meeting on May 6, 2018, in Toronto, Canada.

Cite this article: Madigan T, et al. (2018). Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit. Infection Control & Hospital Epidemiology 2018, 39, 1412–1418 doi: 10.1017/ice.2018.239

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