Longitudinal genomic surveillance of MRSA in the UK reveals transmission patterns in hospitals and the community

• Published in: Science translational medicine Vol. 9; no. 413
• Main Authors: Coll, Francesc, Harrison, Ewan M, Toleman, Michelle S, Reuter, Sandra, Raven, Kathy E, Blane, Beth, Palmer, Beverley, Kappeler, A Ruth M, Brown, Nicholas M, Török, M Estée, Parkhill, Julian, Peacock, Sharon J
• Format: Journal Article
• Language: English
• Published: United States 25-10-2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Community-Acquired Infections - transmission; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - transmission; Genome, Bacterial; Geography; Hospitals; Humans; Infant; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Phylogeny; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcal Infections - transmission; United Kingdom; Young Adult
• ISSN: 1946-6242
• DOI: 10.1126/scitranslmed.aak9745

Genome sequencing has provided snapshots of the transmission of methicillin-resistant
(MRSA) during suspected outbreaks in isolated hospital wards. Scale-up to populations is now required to establish the full potential of this technology for surveillance. We prospectively identified all individuals over a 12-month period who had at least one MRSA-positive sample processed by a routine diagnostic microbiology laboratory in the East of England, which received samples from three hospitals and 75 general practitioner (GP) practices. We sequenced at least 1 MRSA isolate from 1465 individuals (2282 MRSA isolates) and recorded epidemiological data. An integrated epidemiological and phylogenetic analysis revealed 173 transmission clusters containing between 2 and 44 cases and involving 598 people (40.8%). Of these, 118 clusters (371 people) involved hospital contacts alone, 27 clusters (72 people) involved community contacts alone, and 28 clusters (157 people) had both types of contact. Community- and hospital-associated MRSA lineages were equally capable of transmission in the community, with instances of spread in households, long-term care facilities, and GP practices. Our study provides a comprehensive picture of MRSA transmission in a sampled population of 1465 people and suggests the need to review existing infection control policy and practice.