Outbreak of Methicillin-Resistant <i>Staphylococcus aureus</i> ST398 in a Dutch Nursing Home

Verkade, Erwin; Bosch, Thijs; Hendriks, Yvonne; Kluytmans, Jan

doi:10.1086/665726

Cited by 23 publications

(16 citation statements)

References 7 publications

(12 reference statements)

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“…None of the isolates reported here were attributed to community-associated MRSA (CA-MRSA) or livestockassociated MRSA (LA-MRSA). That CA-MRSA can represent a substantial proportion of MRSA in nursing home residents has been reported from the US [49], and LA-MRSA has been identified among isolates from Dutch nursing homes [50]. In Germany, CA-MRSA is not common so far, nor is LA-MRSA as nasal coloniser and infectious agent in regions of Germany with low density of livestock farming such as the Rhine-Main region [51].…”

Section: Discussionmentioning

confidence: 99%

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Hogardt

Proba

Mischler³

et al. 2015

Eurosurveillance

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Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/ MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge.

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Section: Discussionmentioning

confidence: 99%

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Hogardt

Proba

Mischler³

et al. 2015

Eurosurveillance

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“…However, these strains present very different characteristics, MSSA-t571-CC398 being the more representative one (David et al, 2013;McCarthy et al, 2012;Price et al, 2012). In any case, in spite of that the human-to-human transferability of MRSA CC398 appears to be low, some hospital outbreaks of MRSA CC398 strains have also been detected (Verkade et al, 2012). According to our results, it seems to be an association between livestock-contact and MRSA-CC398 infection/colonization, due to the significant high percentage observed in this group; nevertheless, the parallel considerable detection of CC398 in group-B could indicate the potential human-to-human transmissibility.…”

Section: Discussionmentioning

confidence: 99%

“…So, the professional relationship with livestock-animals was considered as a risk factor of colonization and infection by MRSA-CC398 (Garcia-Graells et al, 2012). However, this CC has been progressively detected in hospital settings (Verkade et al, 2012;Williamson et al, 2014), and in the community (VanCleef et al, 2011). A previous study carried out by our research group established that tetracycline resistance (Tet R ) could be a good marker for the rapid determination of CC398 strains and other animal-related CCs among MRSA clinical isolates.…”

Section: Introductionmentioning

confidence: 99%

Characterization of tetracycline and methicillin resistant Staphylococcus aureus strains in a Spanish hospital: Is livestock-contact a risk factor in infections caused by MRSA CC398?

Benito

Lozano

Rezusta

et al. 2014

International Journal of Medical Microbiology

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“…To assess the capability of LA-MRSA to cause nosocomial transmission, we included 12 LA-MRSA isolates from a presumed outbreak in a Dutch health care facility and 12 isolates from an outbreak in a Dutch nursing home (23). Furthermore, inspection of the 9,698 questionnaires obtained from 2008 to 2012 showed that in 1,291 cases, MRSA was isolated because nosocomial transmission was suspected.…”

Section: Methodsmentioning

confidence: 99%

“…Isolates originating from 2 different outbreaks were subjected to NGS analysis. The first set of 12 isolates belonged to a previously reported outbreak in a Dutch nursing home (23). SNV analysis of the isolates showed a maximum of 23 SNVs between the isolate from the index patient and other outbreak isolates (Fig.…”

Section: Snv Analysismentioning

confidence: 99%

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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Outbreak of Methicillin-Resistant Staphylococcus aureus ST398 in a Dutch Nursing Home

Cited by 23 publications

References 7 publications

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Characterization of tetracycline and methicillin resistant Staphylococcus aureus strains in a Spanish hospital: Is livestock-contact a risk factor in infections caused by MRSA CC398?

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

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