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Transmission of endemic ST22-MRSA-IV on four acute hospital wards investigated using a combination of spa, dru and pulsed-field gel electrophoresis typing

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Abstract

The transmission of meticillin-resistant Staphylococcus aureus (MRSA) between individual patients is difficult to track in institutions where MRSA is endemic. We investigated the transmission of MRSA where ST22-MRSA-IV is endemic on four wards using demographic data, patient and environmental screening, and molecular typing of isolates. A total of 939 patients were screened, 636 within 72 h of admission (on admission) and 303 >72 h after admission, and 1,252 environmental samples were obtained. Isolates were typed by spa, dru and pulsed-field gel electrophoresis (PFGE) typing. A composite dendrogram generated from the three sets of typing data was used to divide isolates into ‘dendrogram groups’ (DGs). Ten percent of patients (92/939) were MRSA-positive; 7 % (44/636) on admission and 16 % (48/303) >72 h after admission (p = 0.0007). MRSA was recovered from 5 % of environmental specimens (65/1,252). Most isolates from patients (97 %, 85/88) and the environment (97 %, 63/65) exhibited the ST22-MRSA-IV genotype. Four DGs (DG1, DG4, DG16 and DG17) accounted for 58 % of ST22-MRSA-IV isolates from patients. Epidemiological evidence suggested cross-transmission among 44/92 patients (48 %) but molecular typing confirmed probable cross-transmission in only 11 instances (13 %, 11/88), with the majority of cross-transmission (64 %; 7/11) occurring on one ward. In the setting of highly clonal endemic MRSA, the combination of local epidemiology, PFGE, spa and dru typing provided valuable insights into MRSA transmission.

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Acknowledgements

This study was funded by the Health Research Board, Ireland (TRA/2006/4). We are grateful to all members of the Infection Prevention and Control Team and the Department of Microbiology at Beaumont Hospital, and we gratefully acknowledge the co-operation, encouragement and support from all nursing, medical and other hospital staff and the willing participation of patients.

Transparency declaration

All authors confirm that no conflict of interest exists in relation to this manuscript. H.H. has had recent research collaborations with Steris Corporation, Inov8 Science Ltd., Pfizer Inc. and Cepheid. He has also recently received lecture and other fees from Novartis, AstraZenca and Astellas.

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Authors and Affiliations

  1. Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland

    E. Creamer, A. Dolan, O. Sherlock, D. Fitzgerald-Hughes & H. Humphreys

  2. Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland

    A. C. Shore, D. J. Sullivan, P. M. Kinnevey & D. C. Coleman

  3. Department of Clinical Microbiology, School of Medicine, University of Dublin, Trinity College, St. James’s Hospital, James’s St., Dublin, Ireland

    A. C. Shore

  4. National MRSA Reference Laboratory, St. James’s Hospital, James’s St., Dublin, Ireland

    A. S. Rossney

  5. Health Protection Surveillance Centre, Dublin, Ireland

    P. O’Lorcain & R. Cunney

  6. Department of Microbiology, Children’s University Hospital, Temple Street, Dublin, Ireland

    R. Cunney

  7. Department of Microbiology, Beaumont Hospital, Dublin, Ireland

    H. Humphreys

  8. Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, P.O. Box 9063, Beaumont Road, Dublin 9, Ireland

    H. Humphreys

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  1. E. Creamer
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  2. A. C. Shore
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  3. A. S. Rossney
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  4. A. Dolan
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  5. O. Sherlock
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  6. D. Fitzgerald-Hughes
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  7. D. J. Sullivan
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  8. P. M. Kinnevey
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  9. P. O’Lorcain
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  10. R. Cunney
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  11. D. C. Coleman
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  12. H. Humphreys
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Correspondence to H. Humphreys.

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Creamer, E., Shore, A.C., Rossney, A.S. et al. Transmission of endemic ST22-MRSA-IV on four acute hospital wards investigated using a combination of spa, dru and pulsed-field gel electrophoresis typing. Eur J Clin Microbiol Infect Dis 31, 3151–3161 (2012). https://doi.org/10.1007/s10096-012-1678-7

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  • DOI: https://doi.org/10.1007/s10096-012-1678-7

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