Long Persistence of Methicillin-Susceptible Strains of
            <i>Staphylococcus aureus</i>
            Causing Sepsis in a Neonatal Intensive Care Unit

Gómez-González, Carmen; Alba, C. de; Otero, Joaquín R.; Sanz, Francisca; Cháves, Fernando

doi:10.1128/jcm.00019-07

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…Colonized HCWs have been responsible for S. aureus outbreaks in neonates 2 29 , 30 We found hands of 3 HCWs to be positive for MSSA, providing proof for at least transient MSSA hand carriage. Without systematic HCW screening, we cannot formally exclude the possibility that a colonized HCW acted as a point source.…”

Section: Discussionmentioning

confidence: 60%

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Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Achermann

Seidl

Kuster

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVE In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward. DESIGN Multimodal outbreak investigation SETTING A public 800-bed tertiary care university hospital in Switzerland METHODS Investigations in 2012-2013, triggered by a MSSA infection cluster, included prospective MSSA infection surveillance, microbiologic screening of neonates and environment, onsite observations, and a prospective cohort study. MSSA isolates were characterized by pulsed-field gel electrophoresis (PFGE) and selected isolates were examined for multilocus sequence type (MLST) and virulence factors. RESULTS Among 726 in 2012, 30 (4.1%) patients suffered from MSSA infections including 8 (1.1%) with bacteremia. Among 655 admissions in 2013, 13 (2.0%) suffered from MSSA infections including 2 (0.3%) with bacteremia. Among 177 neonates screened for S. aureus carriage, overall 77 (44%) tested positive. A predominant PFGE-1-ST30 strain was identified in 6 of 30 infected neonates (20%) and 30 of 77 colonized neonates (39%). This persistent clone was pvl-negative, tst-positive and belonged to agr group III. We found no environmental point source. MSSA carriage was associated with central vascular catheter use but not with a particular midwife, nurse, physician, or isolette. Observed healthcare worker behavior may have propagated transmission via hands and fomites. Despite multimodal interventions, clonal transmission and colonization continued and another clone, PFGE-6-ST5, became predominant. CONCLUSIONS Hospital-acquired MSSA clones represent a high proportion of MSSA colonization but not MSSA infections in neonate inpatients. In contrast to persisting MSSA, transmission infection rates decreased concurrently with interventions. It remains to be established whether eradication of hospital-acquired MSSA strains would reduce infection rates further.

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Section: Discussionmentioning

confidence: 60%

“…HCWs and the environment are likely sources for neonatal S. aureus colonization 2 29 , 30 Hence, it is difficult to fully appraise the present findings. In very young infants, colonization with S. aureus of up to 40%, a level equal to our findings, seems to be physiological in the community 39 .…”

Section: Discussionmentioning

confidence: 94%

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Achermann

Seidl

Kuster

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…No ICU patient was colonized by tst -positive S. aureus strain upon admission, whereas 14 acquired it during their stay. Observed differences regarding ICU and non-ICU strains are probably due to the dissemination of ST30 clone among patients and ICU staff, since colonized healthcare workers have been responsible for S. aureus outbreaks—especially in neonatal ICUs, as reported [ 19 ]. This successful spread is reinforced by PFGE/ agr analysis, which revealed that type A/3 stratified to ST30 and carriage of tst gene is consistently present among MRSA since 2001, as well as in MSSA as found in the present study [ 20 ].…”

Section: Discussionmentioning

confidence: 97%

Spread of Tst–Positive Staphylococcus aureus Strains Belonging to ST30 Clone among Patients and Healthcare Workers in Two Intensive Care Units

Papadimitriou-Olivgeris

Δρούγκα

Fligou

et al. 2017

Toxins

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Staphylococcus aureus is a major cause of infections. Toxic shock syndrome toxin (TSST-1) and Panton–Valentine leukocidin (PVL) are associated with severe clinical syndromes. S. aureus colonizing isolates recovered from healthcare workers and patients in the intensive care unit (ICU) of a university hospital comprising Group A were compared with those from adult non-ICU carriers (Group B). mecA, lukS/lukF-PV (Panton–Valentine leukocidin, PVL), and tst (toxic shock syndrome toxin) gene carriage was detected by PCR. Clones were identified in all methicillin-resistant S. aureus (MRSA) and toxin-positive methicillin-susceptible strains (MSSA) by pulsed-field gel electrophoresis (PFGE), agr groups, and multi locus sequencing typing (MLST). Group A included 90 S. aureus isolates, whereas Group B 53. PVL was more frequently found among MRSA vs. MSSA (p < 0.001) and in strains of Group B as compared to Group A (p < 0.001), consistent with the spread of ST80-IV. Higher incidence of tst gene carriage was identified among MSSA vs. MRSA (P 0.005) belonging mainly to ST30, and Group A vs. Group B (P 0.002). The wide dissemination of ST80-IV mainly in the community is responsible for a high percentage of PVL-positive MRSA, while silent spread of tst-positive S. aureus clones among ICU patients and personnel poses a threat of hospital transmission and possible severe infections.

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“…Outbreaks of methicillin-resistant S. aureus (MRSA) at the NICU are described and relatively easy to detect [15][16][17][18]. Meanwhile, the detection of methicillin-sensitive S. aureus (MSSA) outbreaks seems to be more difficult, excluding outbreaks in patients who suffer from a skin infection [19][20][21][22]. In this study, whole-genome sequencing (WGS), the typing method with the highest discriminatory power, was used to determine whether MSSA transmission and genetic makeup, contribute to the occurrence of neonatal S. aureus bacteremia.…”

Section: Introductionmentioning

confidence: 99%

Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia

Slingerland

Vos

Bras

et al. 2020

Antimicrob Resist Infect Control

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Background: Neonatal Staphylococcus aureus (S. aureus) bacteremia is an important cause of morbidity and mortality. In this study, we examined whether methicillin-susceptible S. aureus (MSSA) transmission and genetic makeup contribute to the occurrence of neonatal S. aureus bacteremia. Methods: A retrospective, single-centre study was performed. All patients were included who suffered from S. aureus bacteremia in the neonatal intensive care unit (NICU), Erasmus MC-Sophia, Rotterdam, the Netherlands, between January 2011 and November 2017. Whole-genome sequencing (WGS) was used to characterize the S. aureus isolates, as was also done in comparison to reference genomes. Transmission was considered likely in case of genetically indistinguishable S. aureus isolates. Results: Excluding coagulase-negative staphylococci (CoNS), S. aureus was the most common cause of neonatal bacteremia. Twelve percent (n = 112) of all 926 positive blood cultures from neonates grew S. aureus. Based on core genome multilocus sequence typing (cgMLST), 12 clusters of genetically indistinguishable MSSA isolates were found, containing 33 isolates in total (2-4 isolates per cluster). In seven of these clusters, at least two of the identified MSSA isolates were collected within a time period of one month. Six virulence genes were present in 98-100% of all MSSA isolates. In comparison to S. aureus reference genomes, toxin genes encoding staphylococcal enterotoxin A (sea) and toxic shock syndrome toxin 1 (tsst-1) were present more often in the genomes of bacteremia isolates. Conclusion: Transmission of MSSA is a contributing factor to the occurrence of S. aureus bacteremia in neonates. Sea and tsst-1 might play a role in neonatal S. aureus bacteremia.

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Long Persistence of Methicillin-Susceptible Strains of Staphylococcus aureus Causing Sepsis in a Neonatal Intensive Care Unit

Cited by 11 publications

References 17 publications

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Spread of Tst–Positive Staphylococcus aureus Strains Belonging to ST30 Clone among Patients and Healthcare Workers in Two Intensive Care Units

Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia

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