MRSA Transmission Dynamics Among Interconnected Acute, Intermediate-Term, and Long-Term Healthcare Facilities in Singapore

Chow, Angela; Lim, Vanessa; Khan, Ateeb; Pettigrew, Kerry A.; Lye, David C.; Kanagasabai, Kala; Phua, Kelvin; Krishnan, Prabha; Ang, Brenda; Marimuthu, Kalisvar; Hon, Pei-Yun; Koh, Jocelyn; Leong, Ian Yi Onn; Parkhill, Julian; Hsu, Li Yang; Holden, Matthew T. G.

doi:10.1093/cid/cix072

Cited by 34 publications

(29 citation statements)

References 19 publications

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“…Fourthly, blinded microbiologic assessment of samples reduced any potential detection bias. Finally, our MRSA clones were consistent with the epidemiology of MRSA in Singapore, rendering any potential selection bias unlikely [11,30].…”

Section: Discussionsupporting

confidence: 72%

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Chlorhexidine and octenidine use, carriage of qac genes, and reduced antiseptic susceptibility in methicillin-resistant Staphylococcus aureus isolates from a healthcare network

Htun

Hon

Holden

et al. 2019

Clinical Microbiology and Infection

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Objectives. With the widespread use of antiseptics in healthcare facilities for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) transmission, there are concerns for antiseptic tolerance and resistance. We sought to understand the use of chlorhexidine and octenidine, qac genes carriage and reduced antiseptic susceptibilities. Methods. A serial cross-sectional study was conducted in an acute care hospital and three extended-care facilities of a healthcare network in June-July, 2014-2016. Two of the extended-care facilities were exposed to intranasal octenidine and universal daily chlorhexidine/octenidine bathing. The minimum inhibitory concentration (MIC) levels and qac genes were determined by broth microdilution tests and whole genome sequencing respectively. Multivariable logistic regression was used to assess for the independent associations between antiseptic exposures, qac genes and reduced antiseptic susceptibilities. Results. A total of 878 MRSA isolates were obtained. There were associations between qacA/B carriage and chlorhexidine (adjusted odds ratio [aOR]: 7.80; 95% confidence interval [

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Section: Discussionsupporting

confidence: 72%

“…Qiagen, Hilden, Germany) for whole genome sequencing. The detailed method was described elsewhere [11]. Briefly, DNA libraries were created using a method adapted from the Illumina Indexing standard protocol.…”

Section: Whole Genome Sequencingmentioning

confidence: 99%

Chlorhexidine and octenidine use, carriage of qac genes, and reduced antiseptic susceptibility in methicillin-resistant Staphylococcus aureus isolates from a healthcare network

Htun

Hon

Holden

et al. 2019

Clinical Microbiology and Infection

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“…In 2014, the prevalence of MRSA was found to be significantly higher in intermediate (29.9%) and long-term (20.4%) care facilities than in acute care hospitals (11.8%), as reported in a recent study. (34) The organism has also been sporadically reported in the community as well as in local food and animals. (35)(36)(37) The MOH, working with public sector hospitals, has stepped up measures to track and control the rates of MRSA, which have since fallen considerably from over a decade ago.…”

Section: Pharmaceutical Industrymentioning

confidence: 98%

Ten-year narrative review on antimicrobial resistance in Singapore

Chua¹,

Kwa²,

Tan³

et al. 2019

smedj

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Antimicrobial resistance (AMR) results in drug-resistant infections that are harder to treat, subsequently leading to increased morbidity and mortality. In 2008, we reviewed the problem of AMR in Singapore, limiting our discussion to the human healthcare sector. Ten years later, we revisit this issue again, reviewing current efforts to contain it in order to understand the progress made as well as current and emerging challenges. Although a significant amount of work has been done to control AMR and improve antibiotic prescribing in Singapore, most of it has focused on the hospital setting, with mixed impact. The role of antibiotic use and AMR in food animals and the environment-and the link to human health-is better understood today. This issue of AMR encompasses both human health as well as animal/food safety, and efforts to control it will need to continually evolve to maintain or improve on current gains.

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“…MRSA has been categorised into three main types, namely healthcare-acquired (HA), community-associated (CA) and livestock-associated (LA) MRSA based on its involvement in nosocomial-, community-and livestock-associated infections, respectively. Although MRSA was assumed to have restricted human or animal hosts, recent reports indicate a blurring epidemiology of emerging MRSA clones between different hosts attributable to progressive clonal expansion, adaptability, and transmission between the various host types, thus making the traditional definitions indistinct [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Genome Mining and Comparative Pathogenomic Analysis of An Endemic Methicillin-Resistant Staphylococcus Aureus (MRSA) Clone, ST612-CC8-t1257-SCCmec_IVd(2B), Isolated in South Africa

et al. 2019

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This study undertook genome mining and comparative genomics to gain genetic insights into the dominance of the methicillin-resistant Staphylococcus aureus (MRSA) endemic clone ST612-CC8-t1257-SCCmec_IVd(2B), obtained from the poultry food chain in South Africa. Functional annotation of the genome revealed a vast array of similar central metabolic, cellular and biochemical networks within the endemic clone crucial for its survival in the microbial community. In-silico analysis of the clone revealed the possession of uniform defense systems, restriction-modification system (type I and IV), accessory gene regulator (type I), arginine catabolic mobile element (type II), and type 1 clustered, regularly interspaced, short palindromic repeat (CRISPR)Cas array (N = 7 ± 1), which offer protection against exogenous attacks. The estimated pathogenic potential predicted a higher probability (average Pscore ≈ 0.927) of the clone being pathogenic to its host. The clone carried a battery of putative virulence determinants whose expression are critical for establishing infection. However, there was a slight difference in their possession of adherence factors (biofilm operon system) and toxins (hemolysins and enterotoxins). Further analysis revealed a conserved environmental tolerance and persistence mechanisms related to stress (oxidative and osmotic), heat shock, sporulation, bacteriocins, and detoxification, which enable it to withstand lethal threats and contribute to its success in diverse ecological niches. Phylogenomic analysis with close sister lineages revealed that the clone was closely related to the MRSA isolate SHV713 from Australia. The results of this bioinformatic analysis provide valuable insights into the biology of this endemic clone.

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MRSA Transmission Dynamics Among Interconnected Acute, Intermediate-Term, and Long-Term Healthcare Facilities in Singapore

Cited by 34 publications

References 19 publications

Chlorhexidine and octenidine use, carriage of qac genes, and reduced antiseptic susceptibility in methicillin-resistant Staphylococcus aureus isolates from a healthcare network

Chlorhexidine and octenidine use, carriage of qac genes, and reduced antiseptic susceptibility in methicillin-resistant Staphylococcus aureus isolates from a healthcare network

Ten-year narrative review on antimicrobial resistance in Singapore

Genome Mining and Comparative Pathogenomic Analysis of An Endemic Methicillin-Resistant Staphylococcus Aureus (MRSA) Clone, ST612-CC8-t1257-SCCmec_IVd(2B), Isolated in South Africa

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