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

Theresa Madigan, Scott A. Cunningham, Robin Patel, Kerryl E. Greenwood-Quaintance, Jean E. Barth, Priya Sampathkumar, Nicolynn C. Cole, Peggy C. Kohner, Christopher E. Colby, Garth F. Asay, Jennifer L. Fang, Christine A. Baker, Angela L. Heinrich, Kelly A. Fjerstad, Maria J. Lujero, Nicholas D Chia, Patricio R. Jeraldo, Heidi Nelson, W Charles Huskins

Research output: Contribution to journalArticle

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Abstract

ObjectiveTo evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.DesignInvestigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014-2017).SettingSingle-center level IV NICU.PatientsNICU infants and healthcare workers (HCWs).MethodsInfants 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.ResultsWe 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.ConclusionWe 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.

Original languageEnglish (US)
JournalInfection Control and Hospital Epidemiology
DOIs
StateAccepted/In press - Jan 1 2018

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Neonatal Intensive Care Units
Methicillin-Resistant Staphylococcus aureus
Disease Outbreaks
Genome
Pulsed Field Gel Electrophoresis
Delivery of Health Care
Multilocus Sequence Typing
Hand Hygiene
Molecular Typing
Axilla
Groin

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit. / Madigan, Theresa; Cunningham, Scott A.; Patel, Robin; Greenwood-Quaintance, Kerryl E.; Barth, Jean E.; Sampathkumar, Priya; Cole, Nicolynn C.; Kohner, Peggy C.; Colby, Christopher E.; Asay, Garth F.; Fang, Jennifer L.; Baker, Christine A.; Heinrich, Angela L.; Fjerstad, Kelly A.; Lujero, Maria J.; Chia, Nicholas D; Jeraldo, Patricio R.; Nelson, Heidi; Huskins, W Charles.

In: Infection Control and Hospital Epidemiology, 01.01.2018.

Research output: Contribution to journalArticle

Madigan, T, Cunningham, SA, Patel, R, Greenwood-Quaintance, KE, Barth, JE, Sampathkumar, P, Cole, NC, Kohner, PC, Colby, CE, Asay, GF, Fang, JL, Baker, CA, Heinrich, AL, Fjerstad, KA, Lujero, MJ, Chia, ND, Jeraldo, PR, Nelson, H & Huskins, WC 2018, 'Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit', Infection Control and Hospital Epidemiology. https://doi.org/10.1017/ice.2018.239
Madigan, Theresa ; Cunningham, Scott A. ; Patel, Robin ; Greenwood-Quaintance, Kerryl E. ; Barth, Jean E. ; Sampathkumar, Priya ; Cole, Nicolynn C. ; Kohner, Peggy C. ; Colby, Christopher E. ; Asay, Garth F. ; Fang, Jennifer L. ; Baker, Christine A. ; Heinrich, Angela L. ; Fjerstad, Kelly A. ; Lujero, Maria J. ; Chia, Nicholas D ; Jeraldo, Patricio R. ; Nelson, Heidi ; Huskins, W Charles. / Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit. In: Infection Control and Hospital Epidemiology. 2018.
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abstract = "ObjectiveTo evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.DesignInvestigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014-2017).SettingSingle-center level IV NICU.PatientsNICU infants and healthcare workers (HCWs).MethodsInfants 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.ResultsWe 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.ConclusionWe 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.",
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AU - Madigan, Theresa

AU - Cunningham, Scott A.

AU - Patel, Robin

AU - Greenwood-Quaintance, Kerryl E.

AU - Barth, Jean E.

AU - Sampathkumar, Priya

AU - Cole, Nicolynn C.

AU - Kohner, Peggy C.

AU - Colby, Christopher E.

AU - Asay, Garth F.

AU - Fang, Jennifer L.

AU - Baker, Christine A.

AU - Heinrich, Angela L.

AU - Fjerstad, Kelly A.

AU - Lujero, Maria J.

AU - Chia, Nicholas D

AU - Jeraldo, Patricio R.

AU - Nelson, Heidi

AU - Huskins, W Charles

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N2 - ObjectiveTo evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.DesignInvestigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014-2017).SettingSingle-center level IV NICU.PatientsNICU infants and healthcare workers (HCWs).MethodsInfants 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.ResultsWe 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.ConclusionWe 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.

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