). Abstract, edited.]
The Lancet Infectious Diseases, Early Online Publication, 14 November 2012
doi:10.1016/S1473-3099(12)70268-2
This article can be found in the following collections:
Genetics & Genomics;
Infectious Diseases (
Anti-infective therapy,
Healthcare-associated infections,
Paediatric infections,
Infectious diseases-other);
Paediatrics (
Paediatric infections)
Whole-genome sequencing for analysis of an outbreak of meticillin-resistant Staphylococcus aureus: a descriptive study
Original Text
Simon R Harris PhD a *, Edward JP Cartwright MBBS b d *, M Est?e T?r?k FRCP b d e, Matthew TG Holden PhD a, Nicholas M Brown MD d e, Amanda L Ogilvy-Stuart FRCP e, Matthew J Ellington DPhil d, Michael A Quail PhD a, Stephen D Bentley PhD a, Prof Julian Parkhill PhD a ?, Prof Sharon J Peacock FRCP a b c d e ?
Summary
Background
The emergence of meticillin-resistant
Staphylococcus aureus (MRSA) that can persist in the community and replace existing hospital-adapted lineages of MRSA means that it is necessary to understand transmission dynamics in terms of hospitals and the community as one entity. We assessed the use of whole-genome sequencing to enhance detection of MRSA transmission between these settings.
Methods
We studied a putative MRSA outbreak on a special care baby unit (SCBU) at a National Health Service Foundation Trust in Cambridge, UK. We used whole-genome sequencing to validate and expand findings from an infection-control team who assessed the outbreak through conventional analysis of epidemiological data and antibiogram profiles. We sequenced isolates from all colonised patients in the SCBU, and sequenced MRSA isolates from patients in the hospital or community with the same antibiotic susceptibility profile as the outbreak strain.
Findings
The hospital infection-control team identified 12 infants colonised with MRSA in a 6 month period in 2011, who were suspected of being linked, but a persistent outbreak could not be confirmed with conventional methods. With whole-genome sequencing, we identified 26 related cases of MRSA carriage, and showed transmission occurred within the SCBU, between mothers on a postnatal ward, and in the community. The outbreak MRSA type was a new sequence type (ST) 2371, which is closely related to ST22, but contains genes encoding Panton-Valentine leucocidin. Whole-genome sequencing data were used to propose and confirm that MRSA carriage by a staff member had allowed the outbreak to persist during periods without known infection on the SCBU and after a deep clean.
Interpretation
Whole-genome sequencing holds great promise for rapid, accurate, and comprehensive identification of bacterial transmission pathways in hospital and community settings, with concomitant reductions in infections, morbidity, and costs.
Funding
UK Clinical Research Collaboration Translational Infection Research Initiative, Wellcome Trust, Health Protection Agency, and the National Institute for Health Research Cambridge Biomedical Research Centre.
a Wellcome Trust Sanger Institute, Cambridge, UK; b Department of Medicine, University of Cambridge, Cambridge, UK; c Department of Pathology, University of Cambridge, Cambridge, UK; d Cambridge Microbiology and Public Health Laboratory, Cambridge, UK; e Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
Correspondence to: Prof Sharon J Peacock, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
* Joint first authors
? Contributed equally
