1887

Abstract

To investigate the distribution of molecular types of methicillin-resistant (MRSA) in a paediatric intensive care unit (PICU) according to their community-associated (CA) and hospital-associated (HA) source of acquisition, and thus assess the degree to which CA-MRSA has been introduced into the PICU.

We implemented an MRSA surveillance in a PICU during 2013–2016 and investigated the genetic diversity of the isolates retrospectively using three genetic typing methods, as well as antibiograms and virulence factor profiles.

From 2684 specimens, we identified 60 MRSA isolates, 43 of which were ST59 CA-MRSA. These 43 ST59 MRSA isolates could be further subtyped into 2 clusters and 7 sporadic isolates by pulsed-field gel electrophoresis, and 3 types, which demonstrated the genetic diversity in ST59 MRSA. Phenotypic diversity was also demonstrated among these ST59 MRSA isolates, with 12 virulence factor profiles and 4 antibiograms being identified. Epidemiological information showed that 43 ST59 MRSA isolates were both community-associated (15 isolates) and hospital-associated (28 isolates) and caused colonization and various types of infections in different age groups of children.

Our results show that a predominant ST59 CA-MRSA has been introduced into the PICU to a significant extent. This has caused the ST59 HA-MRSA and CA-MRSA in the PICU to be indistinguishable. Our results also demonstrate that when we are interpreting situations where the causative agents of infections focus on very limited pathogenic clones, combined typing methods and epidemiological information are needed to investigate isolates’ genetic and phenotypic diversity to distinguish an outbreak from endemic cases.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000693
2018-03-01
2024-04-20
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/3/408.html?itemId=/content/journal/jmm/10.1099/jmm.0.000693&mimeType=html&fmt=ahah

References

  1. Nelson MU, Bizzarro MJ, Baltimore RS, Dembry LM, Gallagher PG. Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in the decade following implementation of an active detection and isolation program. J Clin Microbiol 2015; 53:2492–2501 [View Article][PubMed]
    [Google Scholar]
  2. Polin RA, Denson S, Brady MT. Committee on Fetus and NewbornCommittee on Infectious Diseases Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics 2012; 129:e1104-9 [View Article][PubMed]
    [Google Scholar]
  3. Maraqa NF, Aigbivbalu L, Masnita-Iusan C, Wludyka P, Shareef Z et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control 2011; 39:35–41 [View Article][PubMed]
    [Google Scholar]
  4. Lessa FC, Edwards JR, Fridkin SK, Tenover FC, Horan TC et al. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the national nosocomial infections surveillance system, 1995–2004. Pediatr Infect Dis J 2009; 28:577–581 [View Article][PubMed]
    [Google Scholar]
  5. Ning X, Sun M, Qiao Y, Dong F, Song W et al. Characterization of pediatric hospital-associated infection caused by methicillin-resistant Staphylococcus aureus in mainland China. Infect Dis 2015; 47:410–417 [View Article][PubMed]
    [Google Scholar]
  6. Chen CJ, Huang YC. New epidemiology of Staphylococcus aureus infection in Asia. Clin Microbiol Infect 2014; 20:605–623 [View Article][PubMed]
    [Google Scholar]
  7. Gordon RJ, Lowy FD. Pathogenesis of methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008; 46:S350–S359 [View Article][PubMed]
    [Google Scholar]
  8. Calfee DP. The epidemiology, treatment, and prevention of transmission of methicillin-resistant Staphylococcus aureus. J Infus Nurs 2011; 34:359–364 [View Article][PubMed]
    [Google Scholar]
  9. Tavares A, Miragaia M, Rolo J, Coelho C, de Lencastre H et al. High prevalence of hospital-associated methicillin-resistant Staphylococcus aureus in the community in Portugal: evidence for the blurring of community-hospital boundaries. Eur J Clin Microbiol Infect Dis 2013; 32:1269–1283 [View Article][PubMed]
    [Google Scholar]
  10. Reich PJ, Boyle MG, Hogan PG, Johnson AJ, Wallace MA et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge. Clin Microbiol Infect 2016; 22:645.e1–645.e8 [View Article][PubMed]
    [Google Scholar]
  11. Naimi TS, Ledell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976–2984 [View Article][PubMed]
    [Google Scholar]
  12. Milstone AM, Goldner BW, Ross T, Shepard JW, Carroll KC et al. Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clin Infect Dis 2011; 53:853–859 [View Article][PubMed]
    [Google Scholar]
  13. Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev 2006; 19:637–657 [View Article][PubMed]
    [Google Scholar]
  14. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315:801–810 [View Article][PubMed]
    [Google Scholar]
  15. CLSI Performance Standards for Antimicrobial Susceptibility Testing, Twenty-sixth Informational Supplement. CLSI document M100-S26 Wayne, PA: Clinical and Laboratory Standards Institute; 2016
    [Google Scholar]
  16. Maes N, Magdalena J, Rottiers S, de Gheldre Y, Struelens MJ. Evaluation of a triplex PCR assay to discriminate Staphylococcus aureus from coagulase-negative Staphylococci and determine methicillin resistance from blood cultures. J Clin Microbiol 2002; 40:1514–1517 [View Article][PubMed]
    [Google Scholar]
  17. Shopsin B, Gomez M, Montgomery SO, Smith DH, Waddington M et al. Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol 1999; 37:3556–3563[PubMed]
    [Google Scholar]
  18. Zhang K, McClure JA, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005; 43:5026–5033 [View Article][PubMed]
    [Google Scholar]
  19. Campbell SJ, Deshmukh HS, Nelson CL, Bae IG, Stryjewski ME et al. Genotypic characteristics of Staphylococcus aureus isolates from a multinational trial of complicated skin and skin structure infections. J Clin Microbiol 2008; 46:678–684 [View Article][PubMed]
    [Google Scholar]
  20. Lina G, Piémont Y, Godail-Gamot F, Bes M, Peter MO et al. Involvement of panton-valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29:1128–1132 [View Article][PubMed]
    [Google Scholar]
  21. Chen CJ, Unger C, Hoffmann W, Lindsay JA, Huang YC et al. Characterization and comparison of 2 distinct epidemic community-associated methicillin-resistant Staphylococcus aureus clones of ST59 lineage. PLoS One 2013; 8:e63210 [View Article][PubMed]
    [Google Scholar]
  22. Li M, Dai Y, Zhu Y, Fu CL, Tan VY et al. Virulence determinants associated with the Asian community-associated methicillin-resistant Staphylococcus aureus lineage ST59. Sci Rep 2016; 6:27899 [View Article][PubMed]
    [Google Scholar]
  23. Higuchi W, Hung WC, Takano T, Iwao Y, Ozaki K et al. Molecular characteristics of the Taiwanese multiple drug-resistant ST59 clone of Panton-Valentine leucocidin-positive community-acquired methicillin-resistant Staphylococcus aureus from pediatric cellulitis. J Infect Chemother 2010; 16:144–149 [View Article][PubMed]
    [Google Scholar]
  24. Li S, Sun J, Zhang J, Li X, Tao X et al. Comparative analysis of the virulence characteristics of epidemic methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from Chinese children: ST59 MRSA highly expresses core gene-encoded toxin. APMIS 2014; 122:101–114 [View Article][PubMed]
    [Google Scholar]
  25. Yu F, Li T, Huang X, Xie J, Xu Y et al. Virulence gene profiling and molecular characterization of hospital-acquired Staphylococcus aureus isolates associated with bloodstream infection. Diagn Microbiol Infect Dis 2012; 74:363–368 [View Article][PubMed]
    [Google Scholar]
  26. Varshney AK, Mediavilla JR, Robiou N, Guh A, Wang X et al. Diverse enterotoxin gene profiles among clonal complexes of Staphylococcus aureus isolates from the Bronx, New York. Appl Environ Microbiol 2009; 75:6839–6849 [View Article][PubMed]
    [Google Scholar]
  27. Krakauer T, Stiles BG. The staphylococcal enterotoxin (SE) family: SEB and siblings. Virulence 2013; 4:759–773 [View Article][PubMed]
    [Google Scholar]
  28. Morgan MS. Diagnosis and treatment of Panton-Valentine leukocidin (PVL)-associated staphylococcal pneumonia. Int J Antimicrob Agents 2007; 30:289–296 [View Article][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000693
Loading
/content/journal/jmm/10.1099/jmm.0.000693
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error