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Staphylococcus epidermidis joint isolates: Whole-genome sequencing demonstrates evidence of hospital transmission and common antimicrobial resistance

Published online by Cambridge University Press:  15 December 2023

Samantha J. Simon
Affiliation:
Research Department, New England Baptist Hospital, Boston, Massachusetts
Mohamad Sater
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Ian Herriott
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Miriam Huntley
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Emma Briars
Affiliation:
Day Zero Diagnostics, Boston, Massachusetts
Brian L. Hollenbeck*
Affiliation:
Research Department, New England Baptist Hospital, Boston, Massachusetts Infectious Diseases, New England Baptist Hospital, Boston, Massachusetts
*
Corresponding author: Brian L. Hollenbeck; Email: bhollenb@nebh.org

Abstract

Objective:

We investigated genetic, epidemiologic, and environmental factors contributing to positive Staphylococcus epidermidis joint cultures.

Design:

Retrospective cohort study with whole-genome sequencing (WGS).

Patients:

We identified S. epidermidis isolates from hip or knee cultures in patients with 1 or more prior corresponding intra-articular procedure at our hospital.

Methods:

WGS and single-nucleotide polymorphism–based clonality analyses were performed, including species identification, in silico multilocus sequence typing (MLST), phylogenomic analysis, and genotypic assessment of the prevalence of specific antibiotic resistance and virulence genes. Epidemiologic review was performed to compare cluster and noncluster cases.

Results:

In total, 60 phenotypically distinct S. epidermidis isolates were identified. After removal of duplicates and impure samples, 48 isolates were used for the phylogenomic analysis, and 45 (93.7%) isolates were included in the clonality analysis. Notably, 5 S. epidermidis strains (10.4%) showed phenotypic susceptibility to oxacillin yet harbored mecA, and 3 (6.2%) strains showed phenotypic resistance despite not having mecA. Smr was found in all isolates, and mupA positivity was not observed. We also identified 6 clonal clusters from the clonality analysis, which accounted for 14 (31.1%) of the 45 S. epidermidis isolates. Our epidemiologic investigation revealed ties to common aspirations or operative procedures, although no specific common source was identified.

Conclusions:

Most S. epidermidis isolates from clinical joint samples are diverse in origin, but we identified an important subset of 31.1% that belonged to subclinical healthcare–associated clusters. Clusters appeared to resolve spontaneously over time, suggesting the benefit of routine hospital infection control and disinfection practices.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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