Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Oct 3;8(1):102.
doi: 10.1186/s13073-016-0353-5.

Transmission of methicillin-resistant Staphylococcus aureus in long-term care facilities and their related healthcare networks

Ewan M Harrison  1 , Catherine Ludden  2 , Hayley J Brodrick  3 , Beth Blane  3 , Gráinne Brennan  4 , Dearbháile Morris  5 , Francesc Coll  3 , Sandra Reuter  3 , Nicholas M Brown  6   7 , Mark A Holmes  8 , Brian O'Connell  4 , Julian Parkhill  9 , M Estee Török  3   6   7 , Martin Cormican  5 , Sharon J Peacock  3   2   6   9
Affiliations
Observational Study

Transmission of methicillin-resistant Staphylococcus aureus in long-term care facilities and their related healthcare networks

Ewan M Harrison et al. Genome Med. .

Abstract

Background: 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. 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.

Methods: Two 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).

Results: We 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.

Conclusions: These 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.

Keywords: Long-term care facilities; MRSA; Molecular epidemiology; Nursing home; Staphylococcus aureus; Transmission; Whole-genome sequencing.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The epidemiology and phylogeny of MRSA in the Galway study facility. a Time line of positive and negative swabs. Blue, pink, and orange shapes representing ST22, ST5, and an MRSA-positive sample that could not be recovered on re-culture, respectively. b Maximum likelihood tree generated from core genome SNPs of ST22 MRSA isolates from the Galway LTCF residents (blue), environmental swabs (black), and isolates from Galway University Hospital (red). The outgroup is MSSA476. A tree with bootstrap values is shown in Additional file 1
Fig. 2
Fig. 2
The epidemiology and phylogeny of MRSA in the Cambridge LTCF. a Time line of positive and negative swabs, with blue shapes representing ST22 isolates. b Maximum likelihood tree generated from core genome SNPs of MRSA isolates from the Cambridge LTCF (blue) and closely related isolates from Cambridge University Hospitals NHS Foundation Trust or Hinchingbrooke Health Care NHS Trust (red). The outgroup is MSSA476. A tree with bootstraps values is shown in Additional file 2
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2010;51(Supplement 2):S183–97. doi: 10.1086/653519. - DOI - PubMed
    1. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001;344(1):11–6. doi: 10.1056/NEJM200101043440102. - DOI - PubMed
    1. Duerden B, Fry C, Johnson AP, Wilcox MH. The control of methicillin-resistant Staphylococcus aureus blood stream infections in England. Open Forum Infect Dis. 2015;2(2). - PMC - PubMed
    1. Data on S. aureus/MRSA bloodstream infections from acute hospitals, 2004 – Q1 2016. http://www.hpsc.ie/AZ/MicrobiologyAntimicrobialResistance/EuropeanAntimi.... Accessed 26 Aug 2016.
    1. NHS Commissioning Board. Everyone Counts: Planning for Patients 2013/14. https://www.england.nhs.uk/everyonecounts/.

Publication types

MeSH terms