Advertisement

Prolonged outbreak of clonal, mupirocin-resistant methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: association with personnel and a possible environmental reservoir, analyzed using whole genome sequencing

Published:September 17, 2021DOI:https://doi.org/10.1016/j.ajic.2021.09.010

      Highlights

      • A clonal MRSA can cause a prolonged outbreak in NICU with quiescent periods
      • Whole genome sequencing is a valuable tool for analyzing an MRSA outbreak
      • Healthcare personnel can be implicated in MRSA transmission to infants
      • Room location within a NICU can be associated with MRSA transmission

      Abstract

      Background

      Outbreaks of MRSA occur in NICUs and may be difficult to control. We describe an outbreak of mupirocin-resistant MRSA, molecular epidemiology of isolates and control.

      Methods

      Medical record review of personnel contact with infants. MRSA isolates were analyzed by whole genome sequencing (WGS); single nucleotide polymorphisms (SNPs) were identified.

      Results

      A 31-month outbreak of MRSA infection occurred. Weekly colonization surveillance of infants was initiated; initial prevalence was 45%. Isolates exhibited high level mupirocin-resistance. There were 3 periods of increased colonization and new infections despite implementation of multiple infection prevention interventions. During the second period, an analysis identified a frontline staff member associated with newly colonized infants whose nasal culture grew the clonal MRSA. A marked reduction in colonization followed removal from patient contact. WGS of isolates from years 1-3 showed clonality with maximum SNP differences of 33. Importantly, the year 3 isolates were more closely related to the early year 1 isolates (15-20 SNP differences) than to the late year 1 or year 2 isolates (18-33 SNP differences).

      Discussion/Conclusions

      During a recrudescent MRSA outbreak due to a clonal strain, both contact with a colonized staff member and a putative environmental or personnel reservoir were associated with MRSA acquisition.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hocevar SN
        • Edwards JR
        • Horan TC
        • Morrell GC
        • Iwamoto M
        • Lessa FC.
        Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safely Network, 2006-2008.
        Infect Control Hosp Epidemiol. 2012; 33: 1200-1206
        • Weiner-Lastinger LM
        • Abner S
        • Edwards JR
        • et al.
        Antimicrobial-resistant pathogens associated with healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017.
        Infect Control Hosp Epidemiol. 2020; 41: 19-30
        • Shane AL
        • Hansen NI
        • Stoll BJ
        • et al.
        Methicillin-resistant and susceptible Staphylococcus aureus bacteremia and meningitis in preterm infants.
        Pediatrics. 2012; 129: e914-e922
        • Al Shaik B
        • Yusuf K
        • Sauve R
        Neurodevelopmental outcomes of very low birth weight infants with neonatal sepsis: systematic review and meta-analysis.
        J Perinatol. 2013; 33: 558-564
        • Park S-H
        • Kim S-Y
        • Lee J-H
        • Park C
        • Lee D-G.
        Community-genotype strains of methicillin-resistant Staphylococcus aureus with high-level mupirocin resistance in a neonatal intensive care unit.
        Early Human Development. 2013; 89: 661-665
        • Balamohan A
        • Beachy J
        • Kohn N
        • Rubin L.
        The effect of routine surveillance and decolonization on the rate of Staphylococcus aureus infections in a level iv neonatal intensive care unit.
        J Perinatol. 2020; 40: 1644-1651
        • Pires D
        • Bellissimo-Rodrigues F
        • Hervé Soule H
        • Gayet-Ageron A
        • Pittet D
        Revisiting the WHO "How to Handrub" hand hygiene technique: fingertips first?.
        Infect Control Hosp Epidemiol. 2017; 38: 230-233
        • Balamohan A
        • Beachy J
        • Kohn N
        • Rubin LG.
        Risk factors for nosocomial methicillin resistant Staphylococcus aureus (MRSA) colonization in a neonatal intensive care unit: a case-control study.
        Am J Infect Control. 2021; (in press)
        • Sullivan MJ
        • Altman DR
        • Chacko KI
        • et al.
        A complete genome screening program of clinical methicillin-resistant Staphylococcus aureus isolates identifies the origin and progression of a neonatal intensive care unit outbreak.
        J Clin Microbiol. 2019; 57 (e01261-19)
        • Madigan T
        • Cunningham SA
        • Patel R
        • et al.
        Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2018; 39: 1412-1418
        • Harris SR
        • Cartwright EJP
        • Török ME
        • et al.
        Whole-genome sequencing for analysis of an outbreak of methicillin-resistant Staphylococcus aureus: a descriptive study.
        Lancet Infect Dis. 2013; 13: 130-136
        • Brown NM
        • Reacher M
        • Rice W
        • et al.
        An outbreak of meticillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit: use of a case control study to investigate and control it and lessons learnt.
        J Hospital Infect. 2019; 103 (35e43)
        • Rubin LG
        • Ostovar GA.
        Prevention of infections with multidrug-resistant (MDR) organisms.
        in: Bryant KA Guzman-Cottrill JA Handbook of Pediatric Infection Prevention and Control. Oxford University Press, NY2019: 141-172
        • Gerber SI
        • Jones RC
        • Scott MV
        • et al.
        Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement.
        Infect Control Hosp Epidemiol. 2006; 27: 139-145
        • Azarian T
        • Cook RL
        • Johnson JA
        • et al.
        Whole-genome sequencing for outbreak investigations of methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit: time for routine practice?.
        Infect Control Hosp Epidemiol. 2015; 36: 777-785
        • Goldstein ND
        • Tuttle D
        • Tabb LP
        • Paul DA
        • Eppes SC.
        Spatial and environmental correlates of organism colonization and infection in the neonatal intensive care unit.
        J Perinatol. 2018; 38: 567-573
        • Grohs E
        • Hill-Ricciuti A
        • Kelly N
        • et al.
        Spa typing of Staphylococcus aureus in a neonatal intensive care unit during routine surveillance.
        J Pediatric Infect Dis Soc. 2021; 10: 766-773
        • Bozzella MJ
        • Soghier L
        • Harris T
        • et al.
        Impact of decolonization on methicillin-resistant Staphylococcus aureus transmission and infection in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2019; 40: 1123-1127