Browse > Article
http://dx.doi.org/10.14776/piv.2019.26.e23

Molecular Epidemiologic Study of a Methicillin-resistant Staphylococcus aureus Outbreak at a Newborn Nursery and Neonatal Intensive Care Unit  

Kang, Hyun Mi (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Park, Ki Cheol (Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Lee, Kyung-Yil (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Park, Joonhong (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea)
Park, Sun Hee (Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
Lee, Dong-Gun (Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
Kim, Jong-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
Publication Information
Pediatric Infection and Vaccine / v.26, no.3, 2019 , pp. 148-160 More about this Journal
Abstract
Purpose: This study aimed to investigate the molecular epidemiology of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak at a newborn nursery and neonatal intensive care unit (NICU). Methods: During the outbreak, from August to September 2017, MRSA isolates collected from neonates and medical staff underwent genotyping and screened for virulence factors. Antibiotic susceptibilities were tested. Results: During the study period, 41 neonates were admitted at the nursery (n=27) and NICU (n=14). Of these, 7 had MRSA infections (skin infection [n=6] and sepsis [n=1]) and 4 were colonized with MRSA. Associated medical staff (n=32) were screened; three were nasal MRSA carriers. Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375 was found to be the skin infection outbreak causing strain, with multi-drug resistance including low-level mupirocin resistance. SCCmec type IVa, ST 72, and a novel spa type designated t17879, was the cause of MRSA sepsis. Many different types of MRSA were colonized on the neonates; however, SCCmec type IVa, ST 72, spa type t664 was colonized in both neonates and a NICU nurse. All MRSA isolates from colonized infants were positive for the Panton-Valentine leukocidin (PVL) toxin gene. Conclusions: The strain causing an outbreak of skin infections had multi-drug resistance. Also, MRSA colonized in the neonates were found to carry the PVL toxin gene. Because different strains are present during an outbreak, molecular epidemiologic studies are important to identify the outbreak strain and colonized strains which aid in effective control and prevention of future MRSA outbreaks.
Keywords
Neonate; Methicillin-resistant Staphylococcus aureus; Transmission; Disease outbreaks;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Muttaiyah S, Coombs G, Pandey S, Reed P, Ritchie S, Lennon D, et al. Incidence, risk factors, and outcomes of Panton-Valentine leukocidin-positive methicillin-susceptible Staphylococcus aureus infections in Auckland, New Zealand. J Clin Microbiol 2010;48:3470-4.   DOI
2 Zhang C, Guo Y, Chu X. In vitro generation of Panton-Valentine leukocidin (PVL) in clinical methicillin-resistant Staphylococcus aureus (MRSA) and its correlation with PVL variant, clonal complex, infection type. Sci Rep 2018;8:7696.   DOI
3 Peacock JE Jr, Marsik FJ, Wenzel RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526-32.   DOI
4 McDougal LK, Steward CD, Killgore GE, Chaitram JM, McAllister SK, Tenover FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113-20.   DOI
5 Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000;38:1008-15.   DOI
6 Strommenger B, Kettlitz C, Weniger T, Harmsen D, Friedrich AW, Witte W. Assignment of Staphylococcus isolates to groups by spa typing, SmaI macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol 2006;44:2533-40.   DOI
7 Patel M, Waites KB, Hoesley CJ, Stamm AM, Canupp KC, Moser SA. Emergence of USA300 MRSA in a tertiary medical centre: implications for epidemiological studies. J Hosp Infect 2008;68:208-13.   DOI
8 Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666-74.   DOI
9 Nimmo GR. USA300 abroad: global spread of a virulent strain of community-associated methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2012;18:725-34.   DOI
10 Patel M, Thomas HC, Room J, Wilson Y, Kearns A, Gray J. Successful control of nosocomial transmission of the USA300 clone of community-acquired meticillin-resistant Staphylococcus aureus in a UK paediatric burns centre. J Hosp Infect 2013;84:319-22.   DOI
11 Kawaguchiya M, Urushibara N, Yamamoto D, Yamashita T, Shinagawa M, Watanabe N, et al. Characterization of PVL/ACME-positive methicillin-resistant Staphylococcus aureus (genotypes ST8-MRSA-IV and ST5-MRSA-II) isolated from a university hospital in Japan. Microb Drug Resist 2013;19:48-56.   DOI
12 Harris SR, Cartwright EJ, Torok ME, Holden MT, Brown NM, Ogilvy-Stuart AL, et al. Whole-genome sequencing for analysis of an outbreak of meticillin-resistant Staphylococcus aureus: a descriptive study. Lancet Infect Dis 2013;13:130-6.   DOI
13 Carey AJ, Della-Latta P, Huard R, Wu F, Graham PL 3rd, Carp D, et al. Changes in the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010;31:613-9.   DOI
14 McAdams RM, Ellis MW, Trevino S, Rajnik M. Spread of methicillin-resistant Staphylococcus aureus USA300 in a neonatal intensive care unit. Pediatr Int 2008;50:810-5.   DOI
15 Oliveira DC, de Lencastre H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2002;46:2155-61.   DOI
16 Sanchini A, Spitoni MG, Monaco M, Raglio A, Grigis A, Petro W, et al. Outbreak of skin and soft tissue infections in a hospital newborn nursery in Italy due to community-acquired meticillin-resistant Staphylococcus aureus USA300 clone. J Hosp Infect 2013;83:36-40.   DOI
17 Lee H, Kim ES, Choi C, Seo H, Shin M, Bok JH, et al. Outbreak among healthy newborns due to a new variant of USA300-related meticillin-resistant Staphylococcus aureus. J Hosp Infect 2014;87:145-51.   DOI
18 Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59:e10-52.   DOI
19 Milheirico C, Oliveira DC, de Lencastre H. Multiplex PCR strategy for subtyping the staphylococcal cassette chromosome mec type IV in methicillin-resistant Staphylococcus aureus: 'SCCmec IV multiplex'. J Antimicrob Chemother 2007;60:42-8.   DOI
20 Harmsen D, Claus H, Witte W, Rothganger J, Claus H, Turnwald D, et al. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442-8.   DOI
21 Moodley A, Stegger M, Bagcigil AF, Baptiste KE, Loeffler A, Lloyd DH, et al. spa typing of methicillin-resistant Staphylococcus aureus isolated from domestic animals and veterinary staff in the UK and Ireland. J Antimicrob Chemother 2006;58:1118-23.   DOI
22 Maeda T, Saga T, Miyazaki T, Kouyama Y, Harada S, Iwata M, et al. Genotyping of skin and soft tissue infection (SSTI)-associated methicillin-resistant Staphylococcus aureus (MRSA) strains among outpatients in a teaching hospital in Japan: application of a phage-open reading frame typing (POT) kit. J Infect Chemother 2012;18:906-14.   DOI
23 Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128-32.   DOI
24 Yang JA, Park DW, Sohn JW, Yang IS, Kim KH, Kim MJ. Molecular analysis of isoleucyl-tRNA synthetase mutations in clinical isolates of methicillin-resistant Staphylococcus aureus with low-level mupirocin resistance. J Korean Med Sci 2006;21:827-32.   DOI
25 Jeon H, Ma SH, Jo HJ, Woo MS, An H, Park H, et al. Long-term persistence of sequence type 89 methicillin-resistant Staphylococcus aureus isolated from cases of staphylococcal scalded skin syndrome in a Korean community. J Med Microbiol 2016;65:1542-4.   DOI
26 Park SH, Kim KJ, Kim BK, Hwang SM. Molecular characterization of community-associated methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates from children with skin infections in Busan, Korea. J Bacteriol Virol 2015;45:104-11.   DOI
27 Bae IG, Kim JS, Kim S, Heo ST, Chang C, Lee EY. Genetic correlation of community-associated methicillin-resistant Staphylococcus aureus strains from carriers and from patients with clinical infection in one region of Korea. J Korean Med Sci 2010;25:197-202.   DOI
28 Antonio M, McFerran N, Pallen MJ. Mutations affecting the Rossman fold of isoleucyl-tRNA synthetase are correlated with low-level mupirocin resistance in Staphylococcus aureus. Antimicrob Agents Chemother 2002;46:438-42.   DOI
29 Hetem DJ, Bonten MJ. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect 2013;85:249-56.   DOI
30 Yun HJ, Lee SW, Yoon GM, Kim SY, Choi S, Lee YS, et al. Prevalence and mechanisms of low- and high-level mupirocin resistance in staphylococci isolated from a Korean hospital. J Antimicrob Chemother 2003;51:619-23.   DOI
31 Hurdle JG, O'Neill AJ, Chopra I. The isoleucyl-tRNA synthetase mutation V588F conferring mupirocin resistance in glycopeptide-intermediate Staphylococcus aureus is not associated with a significant fitness burden. J Antimicrob Chemother 2004;53:102-4.   DOI
32 Udo EE, Jacob LE, Mathew B. Genetic analysis of methicillin-resistant Staphylococcus aureus expressing high- and low-level mupirocin resistance. J Med Microbiol 2001;50:909-15.   DOI
33 Washam M, Woltmann J, Haberman B, Haslam D, Staat MA. Risk factors for methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit: a systematic review and meta-analysis. Am J Infect Control 2017;45:1388-93.   DOI
34 Regev-Yochay G, Rubinstein E, Barzilai A, Carmeli Y, Kuint J, Etienne J, et al. Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit. Emerg Infect Dis 2005;11:453-6.   DOI
35 Huang YC, Lien RI, Lin TY. Effect of mupirocin decolonization on subsequent methicillin-resistant Staphylococcus aureus infection in infants in neonatal intensive care units. Pediatr Infect Dis J 2015;34:241-5.   DOI
36 Seah C, Alexander DC, Louie L, Simor A, Low DE, Longtin J, et al. MupB, a new high-level mupirocin resistance mechanism in Staphylococcus aureus. Antimicrob Agents Chemother 2012;56:1916-20.   DOI
37 Hwang Y, Kang JS, Kim BK, Kim SW. Colonization of Staphylococcus aureus and sensitivity to antibiotics in children with atopic dermatitis. Allergy Asthma Respir Dis 2017;5:21-6.   DOI
38 Couppie P, Cribier B, Prevost G. Leukocidin from Staphylococcus aureus and cutaneous infections: an epidemiologic study. Arch Dermatol 1994;130:1208-9.   DOI
39 Baba-Moussa L, Sina H, Scheftel JM, Moreau B, Sainte-Marie D, Kotchoni SO, et al. Staphylococcal Panton-Valentine leucocidin as a major virulence factor associated to furuncles. PLoS One 2011;6:e25716.   DOI