Outbreak Investigation Including Molecular Characterization of Community Associated Methicillin-resistant Staphylococcus Aureus in a Primary and Secondary School in Eastern Switzerland

Overview

Journal Sci Rep

Specialty Science

Date 2022 Nov 18

PMID 36400917

Authors

Frederike Waldeck

Salome N Seiffert

Susanne Manser

Danuta Zemp

Angela Walt

Christoph Berger

Werner C Albrich

Matthias Schlegel

Tim Roloff

Adrian Egli

Oliver Nolte

Christian R Kahlert

Affiliations

Soon will be listed here.

Abstract

At our tertiary children's hospital, infections with newly detected methicillin-resistant Staphylococcus aureus (MRSA) among children attending primary (age 6-12 years) and secondary school (age 13-16 years) nearly doubled in 2018 compared to previous years. This observation initiated an epidemiological outbreak investigation including phenotypic (susceptibility testing) and genotypic (whole genome sequencing) characterization of the isolates. In addition, a cross-sectional study was conducted to determine source of the outbreak, colonization frequency and to identify risk factors for transmission using a questionnaire. As a result, 49 individuals were detected with 57 corresponding isolates. Based on the case definition combined with whole genome sequencing, a core cluster was identified that shared common genetic features and a similar antimicrobial susceptibility pattern (efflux-mediated macrolide resistance, tetracycline susceptibility along with presence of Panton-Valentine leukocidin). Epidemiologic evaluation identified a distinct school as a common risk factor. However, the source of the clustered infections within that school could not be further specified. No further cases could be detected after decolonization of infected and colonized children.

References

Meyer Sauteur P, Leimer N, Chan P, Relly C, Seidl K, Zinkernagel A . Methicillin-resistant Staphylococcus aureus eradication in young infants should include the diaper area and treat housing contacts. Acta Paediatr. 2015; 104(12):e581-4. DOI: 10.1111/apa.13179. View

Cunningham S, Chia N, Jeraldo P, Quest D, Johnson J, Boxrud D . Comparison of Whole-Genome Sequencing Methods for Analysis of Three Methicillin-Resistant Staphylococcus aureus Outbreaks. J Clin Microbiol. 2017; 55(6):1946-1953. PMC: 5442552. DOI: 10.1128/JCM.00029-17. View

Sax H, Posfay-Barbe K, Harbarth S, Francois P, Touveneau S, Pessoa-Silva C . Control of a cluster of community-associated, methicillin-resistant Staphylococcus aureus in neonatology. J Hosp Infect. 2006; 63(1):93-100. DOI: 10.1016/j.jhin.2005.11.016. View

Heininger U, Datta F, Gervaix A, Schaad U, Berger C, Vaudaux B . Prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) in children a multicenter cross-sectional study. Pediatr Infect Dis J. 2007; 26(6):544-6. DOI: 10.1097/INF.0b013e31804d244a. View

Saeed K, Gould I, Esposito S, Ahmad-Saeed N, Ahmed S, Alp E . Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents. 2017; 51(1):16-25. DOI: 10.1016/j.ijantimicag.2017.11.002. View

Faron M, Buchan B, Vismara C, Lacchini C, Bielli A, Gesu G . Automated Scoring of Chromogenic Media for Detection of Methicillin-Resistant Staphylococcus aureus by Use of WASPLab Image Analysis Software. J Clin Microbiol. 2016; 54(3):620-4. PMC: 4767952. DOI: 10.1128/JCM.02778-15. View

Albrich W, Harbarth S . Health-care workers: source, vector, or victim of MRSA?. Lancet Infect Dis. 2008; 8(5):289-301. DOI: 10.1016/S1473-3099(08)70097-5. View

Johnson K, Frei R, Heininger U . Prospective, cross-sectional study on MSSA and MRSA colonisation in hospitalised children. Eur J Pediatr. 2015; 174(9):1255-62. DOI: 10.1007/s00431-015-2606-5. View

Szymanek-Majchrzak K, Kosinski J, Zak K, Sulek K, Mlynarczyk A, Mlynarczyk G . Prevalence of methicillin resistant and mupirocin-resistant Staphylococcus aureus strains among medical students of Medical University in Warsaw. Przegl Epidemiol. 2019; 73(1):39-48. DOI: 10.32394/pe.73.05. View

10.

Williamson D, Roberts S, Ritchie S, Coombs G, Fraser J, Heffernan H . Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus in New Zealand: rapid emergence of sequence type 5 (ST5)-SCCmec-IV as the dominant community-associated MRSA clone. PLoS One. 2013; 8(4):e62020. PMC: 3636228. DOI: 10.1371/journal.pone.0062020. View

11.

Morgenstern M, Erichsen C, Hackl S, Mily J, Militz M, Friederichs J . Antibiotic Resistance of Commensal Staphylococcus aureus and Coagulase-Negative Staphylococci in an International Cohort of Surgeons: A Prospective Point-Prevalence Study. PLoS One. 2016; 11(2):e0148437. PMC: 4739597. DOI: 10.1371/journal.pone.0148437. View

12.

Herold B, Immergluck L, Maranan M, Lauderdale D, Gaskin R, Leitch C . Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998; 279(8):593-8. DOI: 10.1001/jama.279.8.593. View

13.

DeLeo F, Otto M, Kreiswirth B, Chambers H . Community-associated meticillin-resistant Staphylococcus aureus. Lancet. 2010; 375(9725):1557-68. PMC: 3511788. DOI: 10.1016/S0140-6736(09)61999-1. View

14.

Aramburu C, Harbarth S, Liassine N, Girard M, Gervaix A, Scherenzel J . Community-acquired methicillin-resistant Staphylococcus aureus in Switzerland: first surveillance report. Euro Surveill. 2006; 11(1):42-3. View

15.

Huang S, Singh R, McKinnell J, Park S, Gombosev A, Eells S . Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers. N Engl J Med. 2019; 380(7):638-650. PMC: 6475519. DOI: 10.1056/NEJMoa1716771. View

16.

March A, Aschbacher R, Dhanji H, Livermore D, Bottcher A, Sleghel F . Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria. Clin Microbiol Infect. 2009; 16(7):934-44. DOI: 10.1111/j.1469-0691.2009.03024.x. View

17.

Packer S, Pichon B, Thompson S, Neale J, Njoroge J, Kwiatkowska R . Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017. Euro Surveill. 2019; 24(13). PMC: 6446509. DOI: 10.2807/1560-7917.ES.2019.24.13.1800124. View

18.

Moschou A, Maraki S, Giormezis N, Moraitaki H, Stafylaki D, Militsopoulou M . Prevalence and molecular epidemiology of Staphylococcus aureus nasal colonization in four nursing home residents in Crete, Greece. J Infect Chemother. 2019; 26(2):199-204. DOI: 10.1016/j.jiac.2019.08.008. View

19.

Sola C, Paganini H, Egea A, Moyano A, Garnero A, Kevric I . Spread of epidemic MRSA-ST5-IV clone encoding PVL as a major cause of community onset staphylococcal infections in Argentinean children. PLoS One. 2012; 7(1):e30487. PMC: 3264586. DOI: 10.1371/journal.pone.0030487. View

20.

Olearo F, Albrich W, Vernaz N, Harbarth S, Kronenberg A . Staphylococcus aureus and methicillin resistance in Switzerland: regional differences and trends from 2004 to 2014. Swiss Med Wkly. 2016; 146:w14339. DOI: 10.4414/smw.2016.14339. View