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Whole genome SNP typing to investigate methicillin-resistant Staphylococcus aureus carriage in a health-care provider as the source of multiple surgical site infections

View ORCID ProfileChandler C Roe, Kimberly S Horn, Elizabeth M Driebe, Jolene Bowers, Joel A Terriquez, Paul Keim, David M Engelthaler
doi: https://doi.org/10.1101/047597
Chandler C Roe
1Translational Genomics Research Institute, Flagstaff, AZ, USA
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  • ORCID record for Chandler C Roe
  • For correspondence: croe@tgen.org edriebe@tgen.org jbowers@tgen.org pkeim@tgen.org dengelthaler@tgen.org hornkimatflag@gmail.com joel.Terriquez2@nahealth.com
Kimberly S Horn
2Flagstaff Medical Center, Flagstaff, AZ, USA
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Elizabeth M Driebe
1Translational Genomics Research Institute, Flagstaff, AZ, USA
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Jolene Bowers
1Translational Genomics Research Institute, Flagstaff, AZ, USA
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Joel A Terriquez
2Flagstaff Medical Center, Flagstaff, AZ, USA
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Paul Keim
1Translational Genomics Research Institute, Flagstaff, AZ, USA
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David M Engelthaler
1Translational Genomics Research Institute, Flagstaff, AZ, USA
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ABSTRACT

Background Prevention of nosocomial transmission of infections is a central responsibility in the healthcare environment, and accurate identification of transmission events presents the first challenge. Phylogenetic analysis based on whole genome sequencing provides a high-resolution approach for accurately relating isolates to one another, allowing precise identification or exclusion of transmission events and sources for nearly all cases. We sequenced 24 methicillin-resistant Staphylococcus aureus (MRSA) genomes to retrospectively investigate a suspected point source of three surgical site infections (SSIs) that occurred over a one-year period. The source of transmission was believed to be a surgical team member colonized with MRSA, involved in all surgeries preceding the SSI cases, who was subsequently decolonized. Genetic relatedness among isolates was determined using whole genome single nucleotide polymorphism (SNP) data.

Results Whole genome SNP typing (WGST) revealed 283 informative SNPs between the surgical team member’s isolate and the closest SSI isolate. The second isolate was 286 and the third was thousands of SNPs different, indicating the nasal carriage strain from the surgical team member was not the source of the SSIs. Given the mutation rates estimated for S. aureus, none of the SSI isolates share a common ancestor within the past 14 years, further discounting any common point source for these infections. The decolonization procedures and resources spent on the point source infection control could have been prevented if WGST was performed at the time of the suspected transmission, instead of retrospectively.

Conclusions Whole genome sequence analysis is an ideal method to exclude isolates involved in transmission events and nosocomial outbreaks, and coupling this method with epidemiological data can determine if a transmission event occurred. These methods promise to direct infection control resources more appropriately.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.
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Posted April 08, 2016.
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Whole genome SNP typing to investigate methicillin-resistant Staphylococcus aureus carriage in a health-care provider as the source of multiple surgical site infections
Chandler C Roe, Kimberly S Horn, Elizabeth M Driebe, Jolene Bowers, Joel A Terriquez, Paul Keim, David M Engelthaler
bioRxiv 047597; doi: https://doi.org/10.1101/047597
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Whole genome SNP typing to investigate methicillin-resistant Staphylococcus aureus carriage in a health-care provider as the source of multiple surgical site infections
Chandler C Roe, Kimberly S Horn, Elizabeth M Driebe, Jolene Bowers, Joel A Terriquez, Paul Keim, David M Engelthaler
bioRxiv 047597; doi: https://doi.org/10.1101/047597

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