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Title: Genome sequencing defines phylogeny and spread of methicillin-resistant Staphylococcus aureus in a high transmission setting
Authors: Steven Y.C. Tong
Matthew T.G. Holden
Emma K. Nickerson
Ben S. Cooper
Claudio U. Koser
Anne Cori
Thibaut Jombart
Simon Cauchemez
Christophe Fraser
Vanaporn Wuthiekanun
Janjira Thaipadungpanit
Maliwan Hongsuwan
Nicholas P. Day
Direk Limmathurotsakul
Julian Parkhill
Sharon J. Peacock
Wellcome Trust Sanger Institute
Menzies School of Health Research
Cambridge University Hospitals NHS Foundation Trust
Mahidol University
University of Cambridge
Public Health England
Imperial College London
University of St Andrews, School of Medicine
Keywords: Biochemistry, Genetics and Molecular Biology
Issue Date: 1-Jan-2015
Citation: Genome Research. Vol.25, No.1 (2015), 111-118
Abstract: © 2015 Hormozdiari et al. Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infection. Whole-genome sequencing of MRSA has been used to define phylogeny and transmission in well-resourced healthcare settings, yet the greatest burden of nosocomial infection occurs in resource-restricted settings where barriers to transmission are lower. Here, we study the flux and genetic diversity of MRSA on ward and individual patient levels in a hospital where transmission was common. We repeatedly screened all patients on two intensive care units for MRSA carriage over a 3-mo period. All MRSA belonged to multilocus sequence type 239 (ST 239). We defined the population structure and charted the spread of MRSA by sequencing 79 isolates from 46 patients and five members of staff, including the first MRSA-positive screen isolates and up to two repeat isolates where available. Phylogenetic analysis identified a flux of distinct ST 239 clades over time in each intensive care unit. In total, five main clades were identified, which varied in the carriage of plasmids encoding antiseptic and antimicrobial resistance determinants. Sequence data confirmed intra- and interwards transmission events and identified individual patients who were colonized by more than one clade. One patient on each unit was the source of numerous transmission events, and deep sampling of one of these cases demonstrated colonization with a "cloud" of related MRSA variants. The application of whole-genome sequencing and analysis provides novel insights into the transmission of MRSA in under-resourced healthcare settings and has relevance to wider global health.
ISSN: 15495469
Appears in Collections:Scopus 2011-2015

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