Rapid containment of nosocomial transmission of a rare community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone, responsible for the Staphylococcal Scalded Skin Syndrome (SSSS)

Onofrio Lamanna,Viviana Cafiso,Floriana Campanile,Giovanni Battista Pozzan,Flavia Baesso,Lisa Bertoncello,Michela Chirico,Mario Cutrone,Stefania Stefani,Dafne Bongiorno,Sandra Mazzucato,Stefano Grandesso,Pierluigi Brugnaro

doi:10.1186/s13052-016-0323-y

Onofrio Lamanna, Viviana Cafiso + Show 11 more

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https://doi.org/10.1186/s13052-016-0323-y

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Abstract

BackgroundThe aims of this study were to identify the source and the transmission pathway for a Staphylococcal Scalded Skin Syndrome (SSSS) outbreak in a maternity setting in Italy over 2 months, during 2014; to implement appropriate control measures in order to prevent the epidemic spread within the maternity ward; and to identify the Methicillin-Resistant Staphylococcus aureus (MRSA) epidemic clone.MethodsEpidemiological and microbiological investigations, based on phenotyping and genotyping methods, were performed. All neonates involved in the outbreak underwent clinical and microbiological investigations to detect the cause of illness. Parents and healthcare workers were screened for Staphylococcus aureus to identify asymptomatic carriers.ResultsThe SSSS outbreak was due to the cross-transmission of a rare clone of ST5-CA-MRSA-SCCmecV-spa type t311, exfoliative toxin A-producer, isolated from three neonates, one mother (from her nose and from dermatological lesions due to pre-existing hand eczema) and from a nurse (colonized in her nose by this microorganism). The epidemiological and microbiological investigation confirmed these as two potential carriers.ConclusionsA rapid containment of these infections was obtained only after implementation of robust swabbing of mothers and healthcare workers. The use of molecular methodologies for typing was able to identify all carriers and to trace the transmission.

Highlights

The aims of this study were to identify the source and the transmission pathway for a Staphylococcal Scalded Skin Syndrome (SSSS) outbreak in a maternity setting in Italy over 2 months, during 2014; to implement appropriate control measures in order to prevent the epidemic spread within the maternity ward; and to identify the Methicillin-Resistant Staphylococcus aureus (MRSA) epidemic clone
Staphylococcal Scalded Skin Syndrome (SSSS) describes a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of Staphylococcus aureus, predominantly, but not exclusively, affecting neonates and children under the age of 5 years [1]
Our study reports the experience of an SSSS outbreak, due to the cross transmission of a methicillin-resistant S.aureus isolate belonging to a rare clone of ST5-CAMRSA-SCCmecV-spa type t311, ETA toxin producer, among three infants hospitalized in the maternity ward of an Italian hospital

Summary

Introduction

The aims of this study were to identify the source and the transmission pathway for a Staphylococcal Scalded Skin Syndrome (SSSS) outbreak in a maternity setting in Italy over 2 months, during 2014; to implement appropriate control measures in order to prevent the epidemic spread within the maternity ward; and to identify the Methicillin-Resistant Staphylococcus aureus (MRSA) epidemic clone. Staphylococcal Scalded Skin Syndrome (SSSS) describes a spectrum of superficial blistering skin disorders caused by the exfoliative (or epidermolytic) toxins of Staphylococcus aureus, predominantly, but not exclusively, affecting neonates and children under the age of 5 years [1]. SSSS is caused by the release of two exfoliative epidermolytic toxins, ETA or ETB, from Staphylococcus aureus toxigenic strains. These toxins induce epidermal blistering through the cleavage of the cell-cell adhesion molecule desmoglein-1, which is only expressed by keratinocytes in the granular cell layer, leading to a spectrum of illnesses ranging from mild localized blistering to extensive generalized lesions [2, 5]. ETs producing S. aureus strains have been associated with specific genetic backgrounds, on the basis of their phage types, accessory gene regulator (agr) groups and macrorestriction profiles [3,4,5,6,7,8,9,10]

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