Abstract
Antibiotic resistance forms a serious threat to the health of hospitalised patients, rendering otherwise treatable bacterial infections potentially life-threatening. A thorough understanding of the mechanisms by which resistance spreads between patients in different hospitals is required in order to design effective control strategies. We measured the differences between bacterial populations of 52 hospitals in the United Kingdom and Ireland, using whole-genome sequences from 1085 MRSA clonal complex 22 isolates collected between 1998 and 2012. The genetic differences between bacterial populations were compared with the number of patients transferred between hospitals and their regional structure. The MRSA populations within single hospitals, regions and countries were genetically distinct from the rest of the bacterial population at each of these levels. Hospitals from the same patient referral regions showed more similar MRSA populations, as did hospitals sharing many patients. Furthermore, the bacterial populations from different time-periods within the same hospital were generally more similar to each other than contemporaneous bacterial populations from different hospitals. We conclude that, while a large part of the dispersal and expansion of MRSA takes place among patients seeking care in single hospitals, inter-hospital spread of resistant bacteria is by no means a rare occurrence. Hospitals are exposed to constant introductions of MRSA on a number of levels: (1) most MRSA is received from hospitals that directly transfer large numbers of patients, while (2) fewer introductions happen between regions or (3) across national borders, reflecting lower numbers of transferred patients. A joint coordinated control effort between hospitals, is therefore paramount for the national control of MRSA, antibiotic-resistant bacteria and other hospital-associated pathogens.
Highlights
The increase in antibiotic resistance represents a global threat to public health in general, and to the health of hospitalised patients in particular
In order to obtain a comprehensive view of how the patient referral network affects the dispersal of antibiotic-resistant bacteria, we studied a single Methicillin-resistant Staphylococcus aureus (MRSA) clonal complex, CC22, isolated in hospitals in the United Kingdom and the Republic of Ireland (UK and I)
Our data indicate that there is a high level of temporal stability of the bacterial population circulating within any given hospital, suggesting that a large part of the dispersal and expansion of MRSA takes place among patients seeking care in single hospitals
Summary
The increase in antibiotic resistance represents a global threat to public health in general, and to the health of hospitalised patients in particular. Hospitalised patients are more susceptible to infections, often with 000113 ã 2017 The Authors. In order to design control strategies, a thorough understanding of the mechanisms by which resistance spreads between patients and bacterial populations in different hospitals is required
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