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Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel

Published online by Cambridge University Press:  16 June 2022

Kathleen A. Quan Open the ORCID record for Kathleen A. Quan [Opens in a new window] ,
Mohamad R. A. Sater Open the ORCID record for Mohamad R. A. Sater [Opens in a new window] ,
Cherry Uy Open the ORCID record for Cherry Uy [Opens in a new window] ,
Robin Clifton-Koeppel Open the ORCID record for Robin Clifton-Koeppel [Opens in a new window] ,
Linda L. Dickey ,
William Wilson ,
Pat Patton ,
Wayne Chang ,
Pamela Samuelson  and
Georgia K. Lagoudas Open the ORCID record for Georgia K. Lagoudas [Opens in a new window]
...Show all authors
Kathleen A. Quan*
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Mohamad R. A. Sater
Affiliation:
Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
Cherry Uy
Affiliation:
Division of Pediatrics, Neonatal Intensive Care, University of California Irvine Health, Orange, California
Robin Clifton-Koeppel
Affiliation:
University of California Irvine Health, Orange, California
Linda L. Dickey
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
William Wilson
Affiliation:
University of California Irvine Health, Orange, California
Pat Patton
Affiliation:
University of California San Francisco Health, San Francisco, California
Wayne Chang
Affiliation:
Division of Occupational and Environmental Medicine, Department of Medicine, University of California Irvine Health, Orange, California
Pamela Samuelson
Affiliation:
Department of Occupational Health, University of California Irvine Health, Orange, California
Georgia K. Lagoudas
Affiliation:
Department of Biological Engineering, MIT, Cambridge, Massachusetts Broad Institute of MIT and Harvard, Cambridge, Massachusetts
Teri Allen
Affiliation:
Respiratory Care Services, University of California Irvine Health, Orange, California
Lenny Merchant
Affiliation:
St. Luke’s University Hospital, Bethlehem, Pennsylvania
Rick Gannotta
Affiliation:
University of California Irvine Health, Orange, California
Cassiana E. Bittencourt
Affiliation:
Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Orange, California
J. C. Soto
Affiliation:
Department of Microbiology, University of California Irvine Health, Orange, California
Kaye D. Evans
Affiliation:
Department of Microbiology, University of California Irvine Health, Orange, California
Paul C. Blainey
Affiliation:
Department of Biological Engineering, MIT, Cambridge, Massachusetts Broad Institute of MIT and Harvard, Cambridge, Massachusetts Koch Institute for Integrative Cancer Research at MIT, Cambridge, Massachusetts
John Murray
Affiliation:
University of California Irvine Health, Orange, California
Dawn Shelton
Affiliation:
University of California Irvine Health, Orange, California
Helen S. Lee
Affiliation:
University of California Irvine Health, Orange, California
Matthew Zahn
Affiliation:
Orange County Health Care Agency, Santa Ana, California
Julia Wolfe
Affiliation:
Orange County Public Health Laboratory, Santa Ana, California
Keith Madey
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Jennifer Yim
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Shruti K. Gohil
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, California
Yonatan H. Grad
Affiliation:
Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
Susan S. Huang
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, California
*
Author for correspondence: Kathleen A. Quan, E-mail: katquan@uci.edu
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Abstract

Objective:

To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.

Design:

Prospective observational study.

Setting:

Neonatal intensive care unit (NICU).

Methods:

We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.

Results:

A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.

Conclusions:

In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 4 , April 2023 , pp. 589 - 596
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

References

Lake, JG, Weiner, LM, Milstone, AM, Saiman, L, Magill, SS, See, I. Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the National Healthcare Safety Network, 2011–2014. Infect Control Hosp Epidemiol 2018;39;1–11.CrossRefGoogle Scholar
Principles of Epidemiology in Public Health Practice, Third Edition. Lesson 1: Introduction to applied epidemiology and biostatistics. Centers for Disease Control and Prevention website. https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html. Published 2012. Accessed May 31, 2022.Google Scholar
Wenzel, RP, Reagan, DR, Bertino, JS Jr, Baron, EJ, Arias, K. Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel’s definition and management guidelines. Am J Infect Control 1998;26:102–110.CrossRefGoogle ScholarPubMed
Mellman, A, Friedrich, AW, Rosenkotter, N, et al. Automated DNA sequence-based early warning system for the detection of methicillin-resistant Staphylococcus aureus outbreaks. PLoS Med 2006;3:348–355.CrossRefGoogle Scholar
Huang, SS, Yokoe, DS, Stelling, J, et al. Automated detection of infectious disease outbreaks in hospitals: a retrospective cohort study. PLoS Med 2010;7:e1000238.CrossRefGoogle ScholarPubMed
Baker, MA, Huang, SS, Letourneau, AR, et al. Lack of comprehensive outbreak detection in hospitals. Infect Control Hosp Epidemiol 2016;37:466–468.CrossRefGoogle ScholarPubMed
Köser, CU, Holden, MT, Ellington, MJ, et al. Rapid whole-genome sequencing for investigation of a neonatal MRSA outbreak. N Engl J Med 2012;366:2267–2275.CrossRefGoogle ScholarPubMed
Kanjilal, S, Sater, MRA, Thayer, M, et al. Trends in antibiotic susceptibility in Staphylococcus aureus in Boston, Massachusetts, 2000–2014. J Clin Microbiol 2017;56:e01160–17.Google Scholar
Maio, ND, Wu, CH, Wilson, DJ. SCOTTI: efficient reconstruction of transmission within outbreaks with the structured coalescent. PLoS Comput Biol 2016;12:e1005130.CrossRefGoogle ScholarPubMed
Harris, SR, Cartwright, EJ, Török, MW, et al. Whole-genome sequencing for analysis of an outbreak of meticillin-resistant Staphylococcus aureus: a descriptive study. Lancet Infect Dis 2013;13:130–136.CrossRefGoogle ScholarPubMed
Blok, HE, Troelstra, A, Kamp-Hopmans, TE, et al. Role of healthcare workers in outbreaks of methicillin-resistant Staphylococcus aureus: a 10-year evaluation from a Dutch university hospital. Infect Control Hosp Epidemiol 2003;24:679–685.CrossRefGoogle ScholarPubMed
Stein, M, Navon-Venezia, N, Chmelnitsky, I, et al. An outbreak of new, nonmultidrug-resistant, methicillin-resistant Staphylococcus aureus strain (sccmed type iiia variant-1) in the neonatal intensive care unit transmitted by a staff member. Pediatr Infect Dis J 2006;25:557–559.CrossRefGoogle ScholarPubMed
Vos, MC, Behrendt, MD, Melles, DC, et al. Five years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands. Infect Control Hosp Epidemiol 2009;30:977–984.Google Scholar
Abassi-Montazeri, E, Khosravi, AD, Feizabadi, MM, et al. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolates with high-level mupirocin resistance from patients and personnel in a burn center. Burns 2013;39:650–654.CrossRefGoogle Scholar
Haill, C, Fletcher, S, Archer, R, et al. Prolonged outbreak of meticillin-resistant Staphylococcus aureus in a cardiac surgery unit linked to a single colonized healthcare worker. J Hosp Infect 2013;83:219–225.CrossRefGoogle Scholar
Scheithauer, S, Trepels-Kottek, S, Hafter, H, et al. Healthcare worker-related MRSA cluster in a German neonatology level III ICU: a true European story. Infect J Hyg Environ Health 2014;217:307–311.Google Scholar
Duckworth, G. Revised guidelines for the control of epidemic methicillin-resistatnt Staphylococcus aureus . J Hosp Infect 1990;16:351–377.Google Scholar
Cox, RA, Conquest, C. Strategies for the management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus . J Hosp Infect 1997;35:117–127.CrossRefGoogle ScholarPubMed
Berthelot, P, Grattard, F, Fascia, P, et al. Implication of a healthcare worker with chronic skin disease in the transmission of an epidemic strain of methicillin-resistant Staphylococcus aureus in a pediatric intensive care unit. Infect Control Hosp Epidemiol 2003;24:299–300.CrossRefGoogle Scholar
Bertin, ML, Vinski, J, Schmitt, S, et al. Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 2006;27:581–585.CrossRefGoogle Scholar
The microbiology laboratory database software. WHONET website. https://www.whonet.org/. Accessed April 24, 2021.Google Scholar
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