Angela Chow1,2, Vanessa W Lim1, Ateeb Khan3, Kerry Pettigrew3, David C B Lye4,5, Kala Kanagasabai6, Kelvin Phua7, Prabha Krishnan8, Brenda Ang4,5, Kalisvar Marimuthu4,5, Pei-Yun Hon8, Jocelyn Koh7, Ian Leong9, Julian Parkhill10, Li-Yang Hsu4,2, Matthew T G Holden3. 1. Departments of Clinical Epidemiology and. 2. Saw Swee Hock School of Public Health and. 3. School of Medicine, University of St Andrews, Fife, and. 4. Infectious Diseases, Institute of Infectious Diseases and Epidemiology, and Departments of. 5. Yong Loo Lin School of Medicine, National University of Singapore. 6. Ren Ci Hospital, and. 7. Ang Mo Kio-Thye Hua Kwan Hospital, Singapore. 8. Laboratory Medicine and. 9. Continuing and Community Care, Tan Tock Seng Hospital. 10. The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom.
Abstract
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common healthcare-associated multidrug-resistant organism. Despite the interconnectedness between acute care hospitals (ACHs) and intermediate- and long-term care facilities (ILTCFs), the transmission dynamics of MRSA between healthcare settings is not well understood. METHODS: We conducted a cross-sectional study in a network comprising an ACH and 5 closely affiliated ILTCFs in Singapore. A total of 1700 inpatients were screened for MRSA over a 6-week period in 2014. MRSA isolates underwent whole-genome sequencing, with a pairwise single-nucleotide polymorphism (Hamming distance) cutoff of 60 core genome single-nucleotide polymorphisms used to define recent transmission clusters (clades) for the 3 major clones. RESULTS: MRSA prevalence was significantly higher in intermediate-term (29.9%) and long-term (20.4%) care facilities than in the ACH (11.8%) (P < .001). The predominant clones were sequence type [ST] 22 (n = 183; 47.8%), ST45 (n = 129; 33.7%), and ST239 (n = 26; 6.8%), with greater diversity of STs in ILTCFs relative to the ACH. A large proportion of the clades in ST22 (14 of 21 clades; 67%) and ST45 (7 of 13; 54%) included inpatients from the ACH and ILTCFs. The most frequent source of the interfacility transmissions was the ACH (n = 28 transmission events; 36.4%). CONCLUSIONS: MRSA transmission dynamics between the ACH and ILTCFs were complex. The greater diversity of STs in ILTCFs suggests that the ecosystem in such settings might be more conducive for intrafacility transmission events. ST22 and ST45 have successfully established themselves in ILTCFs. The importance of interconnected infection prevention and control measures and strategies cannot be overemphasized.
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common healthcare-associated multidrug-resistant organism. Despite the interconnectedness between acute care hospitals (ACHs) and intermediate- and long-term care facilities (ILTCFs), the transmission dynamics of MRSA between healthcare settings is not well understood. METHODS: We conducted a cross-sectional study in a network comprising an ACH and 5 closely affiliated ILTCFs in Singapore. A total of 1700 inpatients were screened for MRSA over a 6-week period in 2014. MRSA isolates underwent whole-genome sequencing, with a pairwise single-nucleotide polymorphism (Hamming distance) cutoff of 60 core genome single-nucleotide polymorphisms used to define recent transmission clusters (clades) for the 3 major clones. RESULTS: MRSA prevalence was significantly higher in intermediate-term (29.9%) and long-term (20.4%) care facilities than in the ACH (11.8%) (P < .001). The predominant clones were sequence type [ST] 22 (n = 183; 47.8%), ST45 (n = 129; 33.7%), and ST239 (n = 26; 6.8%), with greater diversity of STs in ILTCFs relative to the ACH. A large proportion of the clades in ST22 (14 of 21 clades; 67%) and ST45 (7 of 13; 54%) included inpatients from the ACH and ILTCFs. The most frequent source of the interfacility transmissions was the ACH (n = 28 transmission events; 36.4%). CONCLUSIONS: MRSA transmission dynamics between the ACH and ILTCFs were complex. The greater diversity of STs in ILTCFs suggests that the ecosystem in such settings might be more conducive for intrafacility transmission events. ST22 and ST45 have successfully established themselves in ILTCFs. The importance of interconnected infection prevention and control measures and strategies cannot be overemphasized.
Authors: A M Bal; G W Coombs; M T G Holden; J A Lindsay; G R Nimmo; P Tattevin; R L Skov Journal: J Glob Antimicrob Resist Date: 2016-05-17 Impact factor: 4.035
Authors: Simon R Harris; Edward J Feil; Matthew T G Holden; Michael A Quail; Emma K Nickerson; Narisara Chantratita; Susana Gardete; Ana Tavares; Nick Day; Jodi A Lindsay; Jonathan D Edgeworth; Hermínia de Lencastre; Julian Parkhill; Sharon J Peacock; Stephen D Bentley Journal: Science Date: 2010-01-22 Impact factor: 47.728
Authors: James R Price; Tanya Golubchik; Kevin Cole; Daniel J Wilson; Derrick W Crook; Guy E Thwaites; Rory Bowden; A Sarah Walker; Timothy E A Peto; John Paul; Martin J Llewelyn Journal: Clin Infect Dis Date: 2013-12-12 Impact factor: 9.079
Authors: Steven Y C Tong; Matthew T G Holden; Emma K Nickerson; Ben S Cooper; Claudio U Köser; Anne Cori; Thibaut Jombart; Simon Cauchemez; Christophe Fraser; Vanaporn Wuthiekanun; Janjira Thaipadungpanit; Maliwan Hongsuwan; Nicholas P Day; Direk Limmathurotsakul; Julian Parkhill; Sharon J Peacock Journal: Genome Res Date: 2014-12-09 Impact factor: 9.043
Authors: Alvin Qijia Chua; Andrea Lay-Hoon Kwa; Thean Yen Tan; Helena Legido-Quigley; Li Yang Hsu Journal: Singapore Med J Date: 2019-08 Impact factor: 1.858
Authors: Nina Van Goethem; Tine Descamps; Brecht Devleesschauwer; Nancy H C Roosens; Nele A M Boon; Herman Van Oyen; Annie Robert Journal: Implement Sci Date: 2019-08-13 Impact factor: 7.327
Authors: Nivedita Shankar; Angela Li Ping Chow; Jolene Oon; Li Yang Hsu; Brenda Ang; Junxiong Pang; Paola Florez De Sessions; Balamurugan Periaswamy; Paul A Tambyah; Desmond B Teo; Clarence C Tam Journal: BMC Infect Dis Date: 2017-10-11 Impact factor: 3.090
Authors: Sergey Shlyapnikov; Arturo Jauregui; Nana N Khachatryan; Asok Kurup; Javier de la Cabada-Bauche; Hoe N Leong; Li Li; Mark H Wilcox Journal: Infect Dis Ther Date: 2018-07-12
Authors: Daniel Gyamfi Amoako; Anou M Somboro; Akebe Luther King Abia; Mushal Allam; Arshad Ismail; Linda A Bester; Sabiha Y Essack Journal: Pathogens Date: 2019-09-27