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Transmission Clusters of Methicillin-Resistant Staphylococcus Aureus in Long-Term Care Facilities Based on Whole-Genome Sequencing

Published online by Cambridge University Press:  04 March 2016

O. Colin Stine ,
Shana Burrowes ,
Sophia David ,
J. Kristie Johnson  and
Mary-Claire Roghmann
O. Colin Stine
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States
Shana Burrowes
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States
Sophia David
Affiliation:
Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, United States
Mary-Claire Roghmann*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States Geriatrics Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, United States
*
Address correspondence to Mary-Claire Roghmann, MD, MS, University of Maryland School of Medicine, 10 South Pine Street, MTSF Room 336, Baltimore, MD 21201 (mroghman@epi.umaryland.edu).
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Abstract

OBJECTIVE

To define how often methicillin-resistant Staphylococcus aureus (MRSA) is spread from resident to resident in long-term care facilities using whole-genome sequencing

DESIGN

Prospective cohort study

SETTING

A long-term care facility

PARTICIPANTS

Elderly residents in a long-term care facility

METHODS

Cultures for MRSA were obtained weekly from multiple body sites from residents with known MRSA colonization over 12-week study periods. Simultaneously, cultures to detect MRSA acquisition were obtained weekly from 2 body sites in residents without known MRSA colonization. During the first 12-week cycle on a single unit, we sequenced 8 MRSA isolates per swab for 2 body sites from each of 6 residents. During the second 12-week cycle, we sequenced 30 MRSA isolates from 13 residents with known MRSA colonization and 3 residents who had acquired MRSA colonization.

RESULTS

MRSA isolates from the same swab showed little genetic variation between isolates with the exception of isolates from wounds. The genetic variation of isolates between body sites on an individual was greater than that within a single body site with the exception of 1 sample, which had 2 unrelated strains among the 8 isolates. In the second cycle, 10 of 16 residents colonized with MRSA (63%) shared 1 of 3 closely related strains. Of the 3 residents with newly acquired MRSA, 2 residents harbored isolates that were members of these clusters.

CONCLUSIONS

Point prevalence surveys with whole-genome sequencing of MRSA isolates may detect resident-to-resident transmission more accurately than routine surveillance cultures for MRSA in long-term care facilities.

Infect Control Hosp Epidemiol 2016;37:685–691

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 6 , June 2016 , pp. 685 - 691
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Koser, CU, Holden, MT, Ellington, MJ, et al. Rapid whole-genome sequencing for investigation of a neonatal MRSA outbreak. N Engl J Med 2012;366:2267–2275.CrossRefGoogle ScholarPubMed
2. Harris, SR, Cartwright, EJ, Torok, ME, et al. Whole-genome sequencing for analysis of an outbreak of meticillin-resistant Staphylococcus aureus: a descriptive study. Lancet Infect Dis 2013;13:130–136.CrossRefGoogle ScholarPubMed
3. Eyre, DW, Golubchik, T, Gordon, NC, et al. A pilot study of rapid benchtop sequencing of Staphylococcus aureus and Clostridium difficile for outbreak detection and surveillance. BMJ Open 2012;2. 10.1136/bmjopen-2012-001124.CrossRefGoogle ScholarPubMed
4. Miller, RM, Price, JR, Batty, EM, et al. Healthcare-associated outbreak of methicillin-resistant Staphylococcus aureus bacteraemia: role of a cryptic variant of an epidemic clone. J Hosp Infect 2014;86:83–89.CrossRefGoogle ScholarPubMed
5. Uhlemann, AC, Dordel, J, Knox, JR, et al. Molecular tracing of the emergence, diversification, and transmission of S. aureus sequence type 8 in a New York community. Proc Natl Acad Sci U S A 2014;111:6738–6743.CrossRefGoogle Scholar
6. Alam, MT, Read, TD, Petit, RA 3rd, et al. Transmission and microevolution of USA300 MRSA in U.S. households: evidence from whole-genome sequencing. MBio 2015;6:e00054–15.CrossRefGoogle ScholarPubMed
7. Nursing Home Care. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/fastats/nursing-home-care.htm. Published 2015. Accessed February 11, 2016.Google Scholar
8. Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008;29:785–814.CrossRefGoogle ScholarPubMed
9. Roghmann, MC, Johnson, JK, Sorkin, JD, et al. Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infect Control Hosp Epidemiol 2015;36:1–8.CrossRefGoogle ScholarPubMed
10. Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.CrossRefGoogle ScholarPubMed
11. Hudson, LO, Reynolds, C, Spratt, BG, et al. Diversity of methicillin-resistant Staphylococcus aureus strains isolated from residents of 26 nursing homes in Orange County, California. J Clin Microbiol 2013;51:3788–3795.CrossRefGoogle ScholarPubMed
12. Evans, ME, Kralovic, SM, Simbartl, LA, et al. Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities. Am J Infect Control 2014;42:60–62.CrossRefGoogle ScholarPubMed
13. Crnich, CJ, Duster, M, Hess, T, Zimmerman, DR, Drinka, P. Antibiotic resistance in non-major metropolitan skilled nursing facilities: prevalence and interfacility variation. Infect Control Hosp Epidemiol 2012;33:1172–1174.CrossRefGoogle ScholarPubMed
14. Furuno, JP, Shurland, SM, Zhan, M, et al. Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents. Infect Control Hosp Epidemiol 2011;32:244–249.CrossRefGoogle ScholarPubMed
15. Miller, LG, Diep, BA. Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46:752–760.CrossRefGoogle ScholarPubMed
16. Harmsen, D, Claus, H, Witte, W, Rothganger, J, Turnwald, D, Vogel, U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442–5448.CrossRefGoogle Scholar
17. Harris, SR, Feil, EJ, Holden, MT, et al. Evolution of MRSA during hospital transmission and intercontinental spread. Science 2010;327:469–474.CrossRefGoogle ScholarPubMed
18. Stamatakis, A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics 2014;30:1312–1313.CrossRefGoogle ScholarPubMed
19. Didelot, X, Gardy, J, Colijn, C. Bayesian inference of infectious disease transmission from whole-genome sequence data. Mol Biol Evol 2014;31:1869–1879.CrossRefGoogle ScholarPubMed
20. Worby, CJ, Lipsitch, M, Hanage, WP. Within-host bacterial diversity hinders accurate reconstruction of transmission networks from genomic distance data. PLoS Comput Biol 2014;10:e1003549.CrossRefGoogle ScholarPubMed
21. Price, JR, Golubchik, T, Cole, K, et al. Whole-genome sequencing shows that patient-to-patient transmission rarely accounts for acquisition of Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2014;58:609–618.CrossRefGoogle Scholar
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