Abstract
BackgroundMandatory reporting of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) has occurred in England for over 15years. Epidemiological information is recorded, but routine collection of isolates for characterisation has not been routinely undertaken. Ongoing developments in whole-genome sequencing (WGS) have demonstrated its value in outbreak investigations and for determining the spread of antimicrobial resistance and bacterial population structure. Benefits of adding genomics to routine epidemiological MRSA surveillance are unknown.AimTo determine feasibility and potential utility of adding genomics to epidemiological surveillance of MRSA.MethodsWe conducted an epidemiological and genomic survey of MRSA BSI in England over a 1-year period (1 October 2012–30 September 2013).ResultsDuring the study period, 903 cases of MRSA BSI were reported; 425 isolates were available for sequencing of which, 276 (65%) were clonal complex (CC) 22. Addition of 64 MRSA genomes from published outbreak investigations showed that the study genomes could provide context for outbreak isolates and supported cluster identification. Comparison to other MRSA genome collections demonstrated variation in clonal diversity achieved through different sampling strategies and identified potentially high-risk clones e.g. USA300 and local expansion of CC5 MRSA in South West England.ConclusionsWe demonstrate the potential utility of combined epidemiological and genomic MRSA BSI surveillance to determine the national population structure of MRSA, contextualise previous MRSA outbreaks, and detect potentially high-risk lineages. These findings support the integration of epidemiological and genomic surveillance for MRSA BSI as a step towards a comprehensive surveillance programme in England.
Highlights
In 2001, faced with increasingly high rates of meticillinresistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) at the turn of the century, the United Kingdom (UK) Department of Health mandated surveillance of meticillin-resistant Staphylococcus aureus (MRSA) BSI in England
Surveillance and infection prevention and control (IPC) interventions are likely to have played a major role in this success, it is unclear whether potential changes in the epidemiology of MRSA may have contributed [5,6]
Mid-point rooted maximum likelihood tree based on SNPs in the core genome alignment generated after mapping against the reference genome EMRSA-15
Summary
In 2001, faced with increasingly high rates of meticillinresistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) at the turn of the century, the United Kingdom (UK) Department of Health mandated surveillance of MRSA BSI in England This was followed in 2005 by enhanced surveillance to collect clinical and epidemiological information [1,2]. Conclusions: We demonstrate the potential utility of combined epidemiological and genomic MRSA BSI surveillance to determine the national population structure of MRSA, contextualise previous MRSA outbreaks, and detect potentially highrisk lineages.
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