Abstract
BackgroundLong-term care facilities (LTCF) are potential reservoirs for methicillin-resistant Staphylococcus aureus (MRSA), control of which may reduce MRSA transmission and infection elsewhere in the healthcare system. Whole-genome sequencing (WGS) has been used successfully to understand MRSA epidemiology and transmission in hospitals and has the potential to identify transmission between these and LTCF.MethodsTwo prospective observational studies of MRSA carriage were conducted in LTCF in England and Ireland. MRSA isolates were whole-genome sequenced and analyzed using established methods. Genomic data were available for MRSA isolated in the local healthcare systems (isolates submitted by hospitals and general practitioners).ResultsWe sequenced a total of 181 MRSA isolates from the two study sites. The majority of MRSA were multilocus sequence type (ST)22. WGS identified one likely transmission event between residents in the English LTCF and three putative transmission events in the Irish LTCF. WGS also identified closely related isolates present in colonized Irish residents and their immediate environment. Based on phylogenetic reconstruction, closely related MRSA clades were identified between the LTCF and their healthcare referral network, together with putative MRSA acquisition by LTCF residents during hospital admission.ConclusionsThese data confirm that MRSA is transmitted between residents of LTCF and is both acquired and transmitted to others in referral hospitals and beyond. Our data present compelling evidence for the importance of environmental contamination in MRSA transmission, reinforcing the importance of environmental cleaning. The use of WGS in this study highlights the need to consider infection control in hospitals and community healthcare facilities as a continuum.Electronic supplementary materialThe online version of this article (doi:10.1186/s13073-016-0353-5) contains supplementary material, which is available to authorized users.
Highlights
Long-term care facilities (LTCF) are potential reservoirs for methicillin-resistant Staphylococcus aureus (MRSA), control of which may reduce MRSA transmission and infection elsewhere in the healthcare system
Three putative transmission events were identified based on genetic relatedness (
We identified 1132 CC22 isolates from this collection, which were combined in a phylogenetic tree with the Cambridge LTCF isolates, and used a cutoff of 50 SNPs (10 SNPs greater than the maximum number of 40 SNPs, found with isolates from a single individual [31,32,33]) to identify the most closely related MRSA from the diagnostic laboratory
Summary
Long-term care facilities (LTCF) are potential reservoirs for methicillin-resistant Staphylococcus aureus (MRSA), control of which may reduce MRSA transmission and infection elsewhere in the healthcare system. In the United Kingdom (UK) and Ireland, rates of MRSA bacteremia have been reduced by more than 85 and 60 % in the past decade, respectively, following the introduction of mandatory surveillance and numerous infection control measures [3, 4]. This has led to calls for a zero tolerance approach to MRSA bacteremia [5]. LTCF residents have frequent contact with healthcare providers in hospitals and primary care, which represent opportunities for both onward transmission of MRSA and new acquisition events [11, 12]
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