title: Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit.
abstract: Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected.
authors: National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany. Electronic address: layerf@rki.de.
authors: Franziska
authors: F
authors: Layer
authors: Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors: Andrea
authors: A
authors: Sanchini
authors: National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.
authors: Birgit
authors: B
authors: Strommenger
authors: National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.
authors: Christiane
authors: C
authors: Cuny
authors: Institute of Hygiene and Environmental Medicine, Charité University Medical Centre, Berlin, Germany.
authors: Ann-Christin
authors: AC
authors: Breier
authors: Department of Neonatology, Charité University Medical Centre, Berlin, Germany.
authors: Hans
authors: H
authors: Proquitté
authors: Department of Neonatology, Charité University Medical Centre, Berlin, Germany.
authors: Christoph
authors: C
authors: Bührer
authors: Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Department of Infectious Disease Prevention and Control, Community Health Office City of Berlin Mitte, Berlin, Germany.
authors: Karl
authors: K
authors: Schenkel
authors: Department of Infectious Disease Epidemiology and Environmental Health Protection, State Office for Health and Social Affairs, Federal State of Berlin, Berlin, Germany.
authors: Jörg
authors: J
authors: Bätzing-Feigenbaum
authors: Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors: Benedikt
authors: B
authors: Greutelaers
authors: National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.
authors: Ulrich
authors: U
authors: Nübel
authors: Institute of Hygiene and Environmental Medicine, Charité University Medical Centre, Berlin, Germany.
authors: Petra
authors: P
authors: Gastmeier
authors: Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors: Tim
authors: T
authors: Eckmanns
authors: National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.
authors: Guido
authors: G
authors: Werner
mesh_terms: D000328:Adult; D001427:Bacterial Toxins; D004196:Disease Outbreaks; D004768:Enterotoxins / Q000378:metabolism*; D005260:Female; D005838:Genotype; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D017720:Molecular Epidemiology; D058889:Molecular Typing; D010290:Parents; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D018089:Superantigens
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal; C026066:enterotoxin A, Staphylococcal
keywords: Methicillin-susceptible Staphylococcus aureus; Neonatal intensive care unit; Outbreak; Toxic shock syndrome toxin-1