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
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Article Info
Publication History
Published online: September 17, 2021
Footnotes
Conflicts of interest: None to report.
Previous submission of abstract: Rubin LG, Beachy J, Uhlemann A-C, Annavajhala M, Balamohan A, Jendresky L. Prolonged Outbreak of Clonal, Mupirocin-resistant Methicillin-resistant Staphylococcus aureus (MRSA) in a Neonatal Intensive Care Unit (NICU): association with Personnel and Possible Environmental Reservoir, analysed using Whole Genome Sequencing (WGS). Pediatric Academic Societies (PAS) 2020 Meeting, May 2-5, 2020, in Philadelphia, PA (accepted but not presented due to meeting cancellation related to COVID-19 pandemic).
Abbreviated title: NICU outbreak of mupirocin-resistant MRSA
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
