Capturing the cloud of diversity reveals complexity and heterogeneity of MRSA carriage, infection and transmission

Paterson, Gavin K.; Harrison, Ewan M.; Murray, Gemma G. R.; Welch, John J.; Warland, James; Holden, Matthew T. G.; Morgan, Fiona J. E.; Ba, Xiaoliang; Koop, Gerrit; Harris, Simon R.; Maskell, Duncan J.; Peacock, Sharon J.; Herrtage, M. E.; Parkhill, Julian; Holmes, Mark A.

doi:10.1038/ncomms7560

Cited by 110 publications

(153 citation statements)

References 60 publications

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“…However, it obviously belonged to the outbreak, suggesting that an LA-MRSA strain colonizing or infecting different sites within the same person may evolve independently over time. Recent reports that applied whole-genome sequencing on multiple colonies from the same person also identified a cloud of diversity among the isolates (21,34,35). These studies were carried out on ST22 and ST239 MRSA isolates, but similar findings might be expected from LA-MRSA.…”

Section: Discussionmentioning

confidence: 68%

Next-Generation Sequencing Confirms Presumed Nosocomial Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in the Netherlands

Bosch

Witteveen

Haenen

et al. 2016

Appl Environ Microbiol

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Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) was detected in 2003 and rapidly became the predominant MRSA clade in the Netherlands. Studies have shown that transmissions are difficult to identify, since this MRSA variant represents a genetically homogenous clade when current typing techniques are used. Here, next-generation sequencing was performed on 206 LA-MRSA isolates to assess the capability of LA-MRSA to be transmitted between humans. The usefulness of single nucleotide variants (SNVs), the composition of the SCCmec region, and the presence of plasmids to identify transmission of LA-MRSA were assessed. In total, 30 presumed putative nosocomial transmission events and 2 LA-MRSA outbreaks were studied; in most cases, SNV analysis revealed that the isolates of the index patient and the contact(s) clustered closely together. In three presumed events, the isolates did not cluster together, indicating that transmission was unlikely. The composition of the SCCmec region corroborated these findings. However, plasmid identification did not support our SNV analysis, since different plasmids were present in several cases where SNV and SCCmec analysis suggested that transmission was likely. Next-generation sequencing shows that transmission of LA-MRSA does occur in Dutch health care settings. Transmission was identified based on SNV analysis combined with epidemiological data and in the context of epidemiologically related and unrelated isolates. Analysis of the SCCmec region provided limited, albeit useful, information to corroborate conclusions on transmissions, but plasmid identification did not. IMPORTANCE In 2003, a variant of methicillin-resistant Staphylococcus aureus (MRSA) isolated from pigs was also found in pig farmers inFrance and the Netherlands. Soon thereafter, this livestock-associated MRSA (LA-MRSA) was identified in many other countries. Transmission of LA-MRSA between humans, particularly in the health care setting, is regarded to occur sporadically. Moreover, studies that describe LA-MRSA transmission used molecular characterization of isolates with limited discriminatory power, making the validity of the conclusion that transmission occurred questionable. In our study, we sequenced the complete genomes of 206 LA-MRSA isolates, obtained from more than 30 presumed LA-MRSA transmission events. Analysis of the data showed that transmission of LA-MRSA between humans had indeed occurred in more than 90% of these events. We conclude that transmission of LA-MRSA between humans does occur in Dutch health care settings; therefore, a decision to discontinue the search and destroy policy for LA-MRSA should be taken with caution. M ethicillin-resistant Staphylococcus aureus (MRSA) is an important cause of hospital-acquired and community-acquired infections (1). In 2003, an MRSA variant cultured from pigs and pig farmers emerged in the Netherlands and France (2, 3). This clonal lineage was designated MLST clonal complex 398 (CC398), and a large number of countries reported ...

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Section: Discussionmentioning

confidence: 68%

Next-Generation Sequencing Confirms Presumed Nosocomial Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in the Netherlands

Bosch

Witteveen

Haenen

et al. 2016

Appl Environ Microbiol

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“…Finally, we assessed transmission events based on shared spa types between household members. However, recent whole genome sequencing studies have demonstrated that shared spa types may not indicate true transmission events; both false positives and false negatives are possible [46,47]. …”

Section: Discussionmentioning

confidence: 99%

Livestock-Associated, Antibiotic-Resistant Staphylococcus aureus Nasal Carriage and Recent Skin and Soft Tissue Infection among Industrial Hog Operation Workers

et al. 2016

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Swine production work is a risk factor for nasal carriage of livestock-associated (LA-) Staphylococcus aureus and also for skin and soft tissue infection (SSTI). However, whether LA-S. aureus nasal carriage is associated with increased risk of SSTI remains unclear. We aimed to examine S. aureus nasal carriage and recent (≤3 months prior to enrollment) SSTI symptoms among industrial hog operation (IHO) workers and their household contacts. IHO workers and their household contacts provided a nasal swab and responded to a questionnaire assessing self-reported personal and occupational exposures and recent SSTI symptoms. Nasal swabs were analyzed for S. aureus, including methicillin-resistant S. aureus (MRSA), multidrug-resistant-S. aureus (MDRSA), absence of scn (livestock association), and spa type. S. aureus with at least one indicator of LA was observed among 19% of 103 IHO workers and 6% of 80 household members. Prevalence of recent SSTI was 6% among IHO workers and 11% among 54 minor household members (0/26 adult household members reported SSTI). Among IHO workers, nasal carriers of MDRSA and scn-negative S. aureus were 8.8 (95% CI: 1.8, 43.9) and 5.1 (95% CI: 1.2, 22.2) times as likely to report recent SSTI as non-carriers, respectively. In one household, both an IHO worker and child reported recent SSTI and carried the same S. aureus spa type (t4976) intranasally. Prevalence of scn-negative S. aureus (PR: 5.0, 95% CI: 1.2, 21.4) was elevated among IHO workers who reported never versus always wearing a face mask at work. Although few SSTI were reported, this study of IHO workers and their household contacts is the first to characterize a relation between nasal carriage of antibiotic-resistant LA-S. aureus and SSTI. The direction and temporality of this relation and IHO workers’ use of face masks to prevent nasal carriage of these bacteria warrant further investigation.

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“…In contrast, in the UK where the use of clindamycin is limited, all EMRSA-15 ermC leader peptides were intact, therefore making these isolates susceptible to clindamycin [21]. The human EMRSA-15 epidemic has also spread into the companion animal population [22,23], with veterinary hospitals also being healthcare settings that may experience high levels of transmission [24]. A c c e p t e d M a n u s c r i p t 12 documented in Portugal, Singapore and Australia [25][26][27].…”

Section: Hospital-associated Meticillin-resistantmentioning

confidence: 99%

Genomic insights into the emergence and spread of international clones of healthcare-, community- and livestock-associated meticillin-resistant Staphylococcus aureus : Blurring of the traditional definitions

Bal

Coombs

Holden

et al. 2016

Journal of Global Antimicrobial Resistance

120

105

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Please cite this article as: Bal AM, Coombs GW, Holden MTG, Lindsay JA, Nimmo GR, Tattevin P, Skov RL, Genomic insights into the emergence and spread of international clones of healthcare-, community-and livestock-associated meticillinresistant Staphylococcus aureus: blurring of the traditional definitions, Journal of Global Antimicrobial Resistance (2010), http://dx.doi.org/10.1016/j.jgar. 2016.04.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.  Genomics-based diagnostic tools such as whole-genome sequencing are useful in providing rapid information in relation to epidemiology and outbreaks.

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Capturing the cloud of diversity reveals complexity and heterogeneity of MRSA carriage, infection and transmission

Cited by 110 publications

References 60 publications

Next-Generation Sequencing Confirms Presumed Nosocomial Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in the Netherlands

Next-Generation Sequencing Confirms Presumed Nosocomial Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in the Netherlands

Livestock-Associated, Antibiotic-Resistant Staphylococcus aureus Nasal Carriage and Recent Skin and Soft Tissue Infection among Industrial Hog Operation Workers

Genomic insights into the emergence and spread of international clones of healthcare-, community- and livestock-associated meticillin-resistant Staphylococcus aureus : Blurring of the traditional definitions

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