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Abstract

In May 2016, an unusual outbreak with the Panton-Valentine leukocidin-positive human variant of meticillin-resistant (MRSA) clonal complex 398 occurred among mothers and infants in the maternity unit of a Danish hospital. MRSA sharing genotypic and phenotypic characteristics was confirmed in 36 cases, including 26 patients, nine household members and a healthcare worker (HCW) who had contact with all the patients. The national MRSA database contained 37 seemingly unlinked MRSA cases whose isolates shared the same genotypic and phenotypic characteristics as the outbreak strain. Whole genome sequencing showed that three of these isolates clustered together with the 36 outbreak isolates, suggesting spread outside the hospital. The HCW and 21 of 37 cases from the national MRSA database had links to south-eastern Asia, where the outbreak strain is endemic. These findings suggest that the HCW acquired the outbreak strain while travelling in south-eastern Asia and then introduced it into the hospital; from there, it spread within the patients’ households and into the community. Screening of travellers returning from countries with high levels of MRSA could be an important intervention to prevent spread of these bacteria into hospitals via patients or HCWs.

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/content/10.2807/1560-7917.ES.2019.24.42.1800680
2019-10-17
2024-11-28
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.42.1800680
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References

  1. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56-66.  https://doi.org/10.1016/S1473-3099(18)30605-4  PMID: 30409683 
  2. European Centre for Disease Prevention and Control (ECDC). Surveillance of antibiotic resistance in Europe 2016. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/AMR-surveillance-Europe-2016.pdf
  3. Danish Integrated Antimicrobial Resistance Monitoring and Research Programme. DANMAP 2016 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Copenhagen: Statens Serum Institut, National Veterinary Institute and National Food Institute, Technical University of Denmark; October 2017. [Accessed 15 Nov 2018]. Available from: https://www.danmap.org/-/media/arkiv/projekt-sites/danmap/danmap-reports/danmap-2016/danmap_2016_web.pdf?la=en
  4. Böcher S, Skov RL, Knudsen MA, Guardabassi L, Mølbak K, Schouenborg P, et al. The search and destroy strategy prevents spread and long-term carriage of methicillin-resistant Staphylococcus aureus: results from the follow-up screening of a large ST22 (E-MRSA 15) outbreak in Denmark. Clin Microbiol Infect. 2010;16(9):1427-34.  https://doi.org/10.1111/j.1469-0691.2010.03137.x  PMID: 20041904 
  5. Danish Health Authority. Guidance on preventing the spread of MRSA. 3rd edition. Copenhagen: Danish Health Authority; December 2016. [Accessed 15 Nov 2018]. Available from: https://www.sst.dk/da/sygdom-og-behandling/smitsomme-sygdomme/mrsa/~/media/F3F52EC1C6A94C6080F50F435DA02E59.ashx
  6. Østergaard C, Møller JK. Subdivision of MRSA CC398 isolates using MALDI-TOF MS. Int J Med Microbiol. 2018;308(4):476-85.  https://doi.org/10.1016/j.ijmm.2018.04.001  PMID: 29801990 
  7. Larsen J, Petersen A, Sørum M, Stegger M, van Alphen L, Valentiner-Branth P, et al. Meticillin-resistant Staphylococcus aureus CC398 is an increasing cause of disease in people with no livestock contact in Denmark, 1999 to 2011. Euro Surveill. 2015;20(37):30021.  https://doi.org/10.2807/1560-7917.ES.2015.20.37.30021  PMID: 26535590 
  8. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 8.1. Växjö: EUCAST; May 2018. [Accessed 15 Nov 2018]. Available from: http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_8.1_Breakpoint_Tables.pdf
  9. Østergaard C, Hansen SG, Møller JK. Rapid first-line discrimination of methicillin resistant Staphylococcus aureus strains using MALDI-TOF MS. Int J Med Microbiol. 2015;305(8):838-47.  https://doi.org/10.1016/j.ijmm.2015.08.002  PMID: 26365166 
  10. Larsen AR, Stegger M, Sørum M. spa typing directly from a mecA, spa and pvl multiplex PCR assay-a cost-effective improvement for methicillin-resistant Staphylococcus aureus surveillance. Clin Microbiol Infect. 2008;14(6):611-4.  https://doi.org/10.1111/j.1469-0691.2008.01995.x  PMID: 18393997 
  11. Stegger M, Liu CM, Larsen J, Soldanova K, Aziz M, Contente-Cuomo T, et al. Rapid differentiation between livestock-associated and livestock-independent Staphylococcus aureus CC398 clades. PLoS One. 2013;8(11):e79645.  https://doi.org/10.1371/journal.pone.0079645  PMID: 24244535 
  12. Yu F, Chen Z, Liu C, Zhang X, Lin X, Chi S, et al. Prevalence of Staphylococcus aureus carrying Panton-Valentine leukocidin genes among isolates from hospitalised patients in China. Clin Microbiol Infect. 2008;14(4):381-4.  https://doi.org/10.1111/j.1469-0691.2007.01927.x  PMID: 18190580 
  13. Welinder-Olsson C, Florén-Johansson K, Larsson L, Oberg S, Karlsson L, Ahrén C. Infection with Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus t034. Emerg Infect Dis. 2008;14(8):1271-2.  https://doi.org/10.3201/eid1408.071427  PMID: 18680653 
  14. Nurjadi D, Fleck R, Lindner A, Schäfer J, Gertler M, Mueller A, et al. Import of community-associated, methicillin-resistant Staphylococcus aureus to Europe through skin and soft-tissue infection in intercontinental travellers, 2011-2016. Clin Microbiol Infect. 2019;25(6):739-46.  https://doi.org/10.1016/j.cmi.2018.09.023  PMID: 30315958 
  15. Boyle-Vavra S, Ereshefsky B, Wang CC, Daum RS. Successful multiresistant community-associated methicillin-resistant Staphylococcus aureus lineage from Taipei, Taiwan, that carries either the novel Staphylococcal chromosome cassette mec (SCCmec) type VT or SCCmec type IV. J Clin Microbiol. 2005;43(9):4719-30.  https://doi.org/10.1128/JCM.43.9.4719-4730.2005  PMID: 16145133 
  16. Chuang YY, Huang YC. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Asia. Lancet Infect Dis. 2013;13(8):698-708.  https://doi.org/10.1016/S1473-3099(13)70136-1  PMID: 23827369 
  17. Statistics Denmark. IND05: Admissions, bed-days and hospital patients by region, number of bed-days, age and sex. Copenhagen: Statistics Denmark; 2018. [Accessed 15 Nov 2018]. Available from: https://www.statbank.dk/IND05.
  18. Zanger P, Nurjadi D, Schleucher R, Scherbaum H, Wolz C, Kremsner PG, et al. Import and spread of Panton-Valentine Leukocidin-positive Staphylococcus aureus through nasal carriage and skin infections in travelers returning from the tropics and subtropics. Clin Infect Dis. 2012;54(4):483-92.  https://doi.org/10.1093/cid/cir822  PMID: 22104084 
  19. Nurjadi D, Friedrich-Jänicke B, Schäfer J, Van Genderen PJ, Goorhuis A, Perignon A, et al. Skin and soft tissue infections in intercontinental travellers and the import of multi-resistant Staphylococcus aureus to Europe. Clin Microbiol Infect. 2015;21(6):567.e1-10.  https://doi.org/10.1016/j.cmi.2015.01.016  PMID: 25753191 
  20. Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010;15(41):19688.  https://doi.org/10.2807/ese.15.41.19688-en  PMID: 20961515 
  21. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010;23(3):616-87.  https://doi.org/10.1128/CMR.00081-09  PMID: 20610826 
  22. Saeed K, Gould I, Esposito S, Ahmad-Saeed N, Ahmed SS, Alp E, et al. Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents. 2018;51(1):16-25.  https://doi.org/10.1016/j.ijantimicag.2017.11.002  PMID: 29174420 
  23. Orendi JM, Coetzee N, Ellington MJ, Boakes E, Cookson BD, Hardy KJ, et al. Community and nosocomial transmission of Panton-Valentine leucocidin-positive community-associated meticillin-resistant Staphylococcus aureus: implications for healthcare. J Hosp Infect. 2010;75(4):258-64.  https://doi.org/10.1016/j.jhin.2010.03.023  PMID: 20542589 
  24. Ali H, Nash JQ, Kearns AM, Pichon B, Vasu V, Nixon Z, et al. Outbreak of a South West Pacific clone Panton-Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus infection in a UK neonatal intensive care unit. J Hosp Infect. 2012;80(4):293-8.  https://doi.org/10.1016/j.jhin.2011.12.019  PMID: 22361299 
  25. Shore AC, Tecklenborg SC, Brennan GI, Ehricht R, Monecke S, Coleman DC. Panton-Valentine leukocidin-positive Staphylococcus aureus in Ireland from 2002 to 2011: 21 clones, frequent importation of clones, temporal shifts of predominant methicillin-resistant S. aureus clones, and increasing multiresistance. J Clin Microbiol. 2014;52(3):859-70.  https://doi.org/10.1128/JCM.02799-13  PMID: 24371244 
  26. Voldstedlund M, Haarh M, Mølbak K, the MiBa Board of Representatives CMiBa Board of Representatives. The Danish Microbiology Database (MiBa) 2010 to 2013. Euro Surveill. 2014;19(1):20667.  https://doi.org/10.2807/1560-7917.ES2014.19.1.20667  PMID: 24434175 
  27. Olesen B, Anhøj J, Rasmussen KP, Mølbak K, Voldstedlund M. MiBAlert-a new information tool to fight multidrug-resistant bacteria in the hospital setting. Int J Med Inform. 2016;95:43-8.  https://doi.org/10.1016/j.ijmedinf.2016.09.001  PMID: 27697231 
International travel as source of a hospital outbreak with an unusual meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Jens+Kj%C3%B8lseth+M%C3%B8ller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Møller Jens Kjølseth</a>, <a href="/search?value1=Anders+Rhod+Larsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Larsen Anders Rhod</a>, <a href="/search?value1=Claus+%C3%98stergaard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Østergaard Claus</a>, <a href="/search?value1=Camilla+Holten+M%C3%B8ller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Møller Camilla Holten</a>, <a href="/search?value1=Mette+Assenholm+Kristensen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kristensen Mette Assenholm</a>, <a href="/search?value1=Jesper+Larsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Larsen Jesper</a></span>. International travel as source of a hospital outbreak with an unusual meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(42):pii=1800680. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.42.1800680" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.42.1800680</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 07 Dec 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 10 Apr 2019 </span> </p>
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