Prolonged silent carriage, genomic virulence potential and transmission between staff and patients characterize a neonatal intensive care unit (NICU) outbreak of methicillin-resistant Staphylococcus aureus (MRSA).
Prolonged silent carriage, genomic virulence potential and transmission between staff and patients characterize a neonatal intensive care unit (NICU) outbreak of methicillin-resistant Staphylococcus aureus (MRSA).
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新生儿重症监护病房 (NICU) 耐甲氧西林金黄色葡萄球菌 (MRSA) 爆发的特点是长期沉默携带、基因组毒力潜力以及工作人员和患者之间的传播。
DOI：
10.1017/ice.2022.48
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发表时间：
2023
影响因子：
4.5
通讯作者：
Y
中科院分区：
文献类型：
--
作者：
Madera,Sharline;McNeil,Nicole;Serpa,PaulaHayakawa;Kamm,Jack;Pak,Christy;Caughell,Carolyn;Nichols,Amy;Dynerman,David;Li,LucyM;Sanchez-Guerrero,Estella;Phelps,MairaS;Detweiler,AngelaM;Neff,Norma;Reyes,Helen;Miller,SteveA;Y
背景耐甲氧西林金黄色葡萄球菌（Methicillin-resistant Staphylococcus aureus，MRSA）是新生儿重症监护病房（Neonatal intensive care units，NICU）的重要致病菌，其致病率和死亡率极高。是感染预防的优先事项。MethodsWe调查了一组临床MRSA病例在新生儿重症监护室使用流行病学审查和全基因组测序（WGS）相结合的分离株从临床和监测培养获得的患者和医护人员（HCP）。ResultsPhylogenetic分析确定了2个遗传上不同的系统发育分支，并揭示了多个沉默的HCP和婴儿之间的传输事件。优势暴发菌株具有多种毒力因子。流行病学调查和基因组分析确定了一名定植有优势MRSA爆发菌株的HCP，该HCP负责照顾大多数感染或定植有相同菌株的NICU患者，包括1名在所述爆发前7个月发生严重感染的NICU患者。这些结果指导实施感染预防干预措施，防止进一步的transmissionevents.ConclusionsSilent传输HCP和新生儿重症监护病房患者之间的MRSA可能有助于新生儿重症监护病房爆发涉及一个强毒MRSA菌株。WGS实现了数据驱动的决策，为缓解疫情的感染控制政策的实施提供了信息。前瞻性WGS结合流行病学分析可用于检测传播事件并促进控制策略的早期实施。
BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in neonatal intensive care units (NICU) that confers significant morbidity and mortality.ObjectiveImproving our understanding of MRSA transmission dynamics, especially among high-risk patients, is an infection prevention priority.MethodsWe investigated a cluster of clinical MRSA cases in the NICU using a combination of epidemiologic review and whole-genome sequencing (WGS) of isolates from clinical and surveillance cultures obtained from patients and healthcare personnel (HCP).ResultsPhylogenetic analysis identified 2 genetically distinct phylogenetic clades and revealed multiple silent-transmission events between HCP and infants. The predominant outbreak strain harbored multiple virulence factors. Epidemiologic investigation and genomic analysis identified a HCP colonized with the dominant MRSA outbreak strain who cared for most NICU patients who were infected or colonized with the same strain, including 1 NICU patient with severe infection 7 months before the described outbreak. These results guided implementation of infection prevention interventions that prevented further transmission events.ConclusionsSilent transmission of MRSA between HCP and NICU patients likely contributed to a NICU outbreak involving a virulent MRSA strain. WGS enabled data-driven decision making to inform implementation of infection control policies that mitigated the outbreak. Prospective WGS coupled with epidemiologic analysis can be used to detect transmission events and prompt early implementation of control strategies.