Abstract
Emergence of a genetically distinct, multidrug-resistant Staphylococcus capitis clone (NRCS-A) present in neonatal intensive care units has recently been extensively reported. The aims of the present study were to investigate which clones of S. capitis isolated from blood in a Swedish neonatal intensive care unit (NICU) have been present since 1987 and to investigate whether the NRCS-A clone has disseminated in Sweden. All S. capitis isolates from blood cultures of neonates (≤ 28 days of age) between 1987 and 2017 (n = 46) were whole-genome sequenced, and core genome multilocus sequence typing (cgMLST) was performed. Single-nucleotide polymorphism (SNP)-based phylogenetic relationships between the S. capitis isolates and in silico predictions of presence of genetic traits specific to the NRCS-A clone were identified. Furthermore, antibiotic susceptibility testing, including screening for heterogeneous glycopeptide-intermediate resistance, was performed. Thirty-five isolates clustered closely to the isolates previously determined as belonging to the NRCS-A clone and had fewer than 81 core genome loci differences out of 1063. Twenty-one of these isolates were multidrug resistant. The NRCS-A clone was found in 2001. Six pairs of isolates had differences of fewer than two SNPs. Genetic traits associated with the NRCS-A clone such as nsr, ebh, tarJ, and CRISPR were found in all 35 isolates. The increasing incidence of S. capitis blood cultures of neonates is predominantly represented by the NRSC-A clone at our NICU in Sweden. Furthermore, there were indications of transmission between cases; adherence to basic hygiene procedures and surveillance measures are thus warranted.
Highlights
IntroductionThe emergence of a genetically distinct, multidrug-resistant (MDR), including methicillin-resistant, S. capitis clone has been reported present in neonatal intensive care unit (NICU), initially from France but later from the UK, Belgium, Australia, and New Zealand [7,8,9]
Staphylococcus capitis has been considered a commensal, since it is rarely reported as a pathogen in healthy adults, unless in the presence of cofactors such as foreign bodies or Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.S. capitis has been shown to cause approximately 20% of all cases of neonatal sepsis at neonatal intensive care units (NICUs) [5, 6]
We have previously shown that the incidence of neonatal sepsis due to S. capitis has increased from 1987 to 2014 in Örebro County, Sweden, and multilocus sequence typing
Summary
The emergence of a genetically distinct, multidrug-resistant (MDR), including methicillin-resistant, S. capitis clone has been reported present in NICUs, initially from France but later from the UK, Belgium, Australia, and New Zealand [7,8,9]. This specific clone, named NRCS-A, has been thoroughly investigated, and the genomic features of a prototype strain CR01 described [7]. This S. capitis clone displays reduced susceptibility to lastline antistaphylococcal agents such as vancomycin, both as heteroresistance and resistance [5, 7].
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