MULTIPLE DISTINCT OUTBREAKS OF PANTON-VALENTINE LEUKOCIDIN (PVL)-POSITIVE COMMUNITY-ASSOCIATED METHICILLIN-RESISTANT Staphylococcus aureus (CA-MRSA) IN IRELAND INVESTIGATED BY WHOLE-GENOME SEQUENCING
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2021Access:
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McMANUS BA, ALOBA BK, EARLS MR, BRENNAN GI, O CONNELL B, MONECKE S, EHRICHT R, SHORE AC, COLEMAN DC, MULTIPLE DISTINCT OUTBREAKS OF PANTON-VALENTINE LEUKOCIDIN (PVL)-POSITIVE COMMUNITY-ASSOCIATED METHICILLIN-RESISTANT Staphylococcus aureus (CA-MRSA) IN IRELAND INVESTIGATED BY WHOLE-GENOME SEQUENCING, JOURNAL OF HOSPITAL INFECTION, 108, February 2021, 2021, 72 - 80Abstract:
Background: Panton–Valentine leucocidin (PVL)-positive community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is increasingly associated with infection outbreaks.
Aim: To investigate multiple suspected PVL-positive CA-MRSA outbreaks using whole-genome sequencing (WGS).
Methods: Forty-six suspected outbreak-associated isolates from 36 individuals at three separate Irish hospitals (H1–H3) and from separate incidents involving separate families associated with H2 were investigated by whole-genome multi-locus sequence typing (wgMLST).
Findings: Two clusters (CH1 and CH2) consisting of 8/10 and 6/6 PVL-positive t008 ST8-MRSA-IVa isolates from H1 and H2, respectively, were identified. Within each cluster, neighbouring isolates were separated by ≤5 allelic differences; however, ≥73 allelic differences were identified between the clusters, indicating two independent outbreaks. Isolates from the H3 maternity unit formed two clusters (CH3–SCI and CH3–SCII) composed of four PVL-negative t4667 ST5-MRSA-V and 14 PVL-positive t002 ST5-MRSA-IVc isolates, respectively. Within clusters, neighbouring isolates were separated by ≤24 allelic differences, whereas both clusters were separated by 1822 allelic differences, indicating two distinct H3 outbreaks. Eight PVL-positive t127 ST1-MRSA-V+fus and three PVL-negative t267 ST97-MRSA-V+fus isolates from two distinct H2-associated families FC1 (N = 4) and FC2 (N = 7) formed three separate clusters (FC1 (t127), FC2 (t127) and FC2 (t267)). Neighbouring isolates within clusters were closely related and exhibited ≤7 allelic differences. Intrafamilial transmission was apparent, but the detection of ≥48 allelic differences between clusters indicated no interfamilial transmission.
Conclusion: The frequent importation of PVL-positive CA-MRSA into healthcare settings, transmission and association with outbreaks is a serious ongoing concern. WGS is a highly discriminatory, informative method for deciphering such outbreaks conclusively.
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http://people.tcd.ie/dcolemanhttp://people.tcd.ie/bmcmanu
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PUBLISHED28th November 2020; Epup ahead of print
Author: Coleman, David; Mc Manus, Brenda
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JOURNAL OF HOSPITAL INFECTION108
February 2021
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Community-associated MRSA, Panton–Valentine leucocidin, PVL toxin, Healthcare-associated infection outbreaks, Whole-genome sequencingSubject (TCD):
Genes & Society , Immunology, Inflammation & Infection , COMMUNITY-ACQUIRED MRSA , Community MRSA , Hospital outbreaks of infection , MRSA clones , MRSA outbreaks , MRSA spread , Panton-Valentine Leucocidin producing MRSA , whole-genome sequencingDOI:
https://doi.org/10.1016/j.jhin.2020.11.021Metadata
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