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

  • Theresa Madigan (a1), Scott A. Cunningham (a2), Robin Patel (a2) (a3), Kerryl E. Greenwood-Quaintance (a2), Jean E. Barth (a4), Priya Sampathkumar (a3) (a4), Nicolynn C. Cole (a2), Peggy C. Kohner (a2), Christopher E. Colby (a5), Garth F. Asay (a5), Jennifer L. Fang (a5), Christine A. Baker (a5) (a6), Angela L. Heinrich (a5) (a6), Kelly A. Fjerstad (a5) (a6), Maria J. Lujero (a5) (a6), Nicholas Chia (a7) (a8), Patricio R. Jeraldo (a7) (a8), Heidi Nelson (a7) (a8) and W. Charles Huskins (a1) (a4)...

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.

Copyright

Corresponding author

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

Footnotes

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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

Footnotes

References

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

  • Theresa Madigan (a1), Scott A. Cunningham (a2), Robin Patel (a2) (a3), Kerryl E. Greenwood-Quaintance (a2), Jean E. Barth (a4), Priya Sampathkumar (a3) (a4), Nicolynn C. Cole (a2), Peggy C. Kohner (a2), Christopher E. Colby (a5), Garth F. Asay (a5), Jennifer L. Fang (a5), Christine A. Baker (a5) (a6), Angela L. Heinrich (a5) (a6), Kelly A. Fjerstad (a5) (a6), Maria J. Lujero (a5) (a6), Nicholas Chia (a7) (a8), Patricio R. Jeraldo (a7) (a8), Heidi Nelson (a7) (a8) and W. Charles Huskins (a1) (a4)...

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