title: Wide geographical dissemination of the multiresistant Staphylococcus capitis NRCS-A clone in neonatal intensive-care units.
abstract: Nosocomial late-onset sepsis represents a frequent cause of morbidity and mortality in preterm neonates. The Staphylococcus capitis clone NRCS-A has been previously described as an emerging cause of nosocomial bacteraemia in French neonatal intensive-care units (NICUs). In this study, we aimed to explore the possible unrecognized dissemination of this clone on a larger geographical scale. One hundred methicillin-resistant S. capitis strains isolated from neonates (n = 86) and adult patients (n = 14) between 2000 and 2013 in four different countries (France, Belgium, the UK, and Australia) were analysed with SmaI pulsed-field gel electrophoresis (PFGE) and dru typing. The vast majority of NICU strains showed the NRCS-A pulsotype and the dt11c type (96%). We then randomly selected 14 isolates (from neonates, n = 12, three per country; from adult patients, n = 2), considered to be a subset of representative isolates, and performed further molecular typing (SacII PFGE, SCCmec typing, and multilocus sequence typing-like analysis), confirming the clonality of the S. capitis strains isolated from neonates, despite their distant geographical origin. Whole genome single-nucleotide polymorphism-based phylogenetic analysis of five NICU isolates (from the different countries) attested to high genetic relatedness within the NRCS-A clone. Finally, all of the NRCS-A strains showed multidrug resistance (e.g. methicillin and aminoglycoside resistance, and decreased vancomycin susceptibility), with potential therapeutic implications for infected neonates. In conclusion, this study represents the first report of clonal dissemination of methicillin-resistant coagulase-negative Staphylococcus clone on a large geographical scale. Questions remain regarding the origin and means of international spread, and the reasons for this clone's apparent predilection for neonates.
authors.affiliation: Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France; International Centre for Research in Infectious Diseases (CIRI), INSERM U1111, CNRS UMR5308, Université Lyon 1, ENS de Lyon, Lyon, France. Electronic address: marine.butin@chu-lyon.fr.
authors.forename: M
authors.initials: M
authors.lastname: Butin
authors.affiliation: Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France; International Centre for Research in Infectious Diseases (CIRI), INSERM U1111, CNRS UMR5308, Université Lyon 1, ENS de Lyon, Lyon, France; National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Villeurbanne, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Rasigade
authors.affiliation: Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France; International Centre for Research in Infectious Diseases (CIRI), INSERM U1111, CNRS UMR5308, Université Lyon 1, ENS de Lyon, Lyon, France; National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Martins-Simões
authors.affiliation: International Centre for Research in Infectious Diseases (CIRI), INSERM U1111, CNRS UMR5308, Université Lyon 1, ENS de Lyon, Lyon, France; National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France.
authors.forename: H
authors.initials: H
authors.lastname: Meugnier
authors.affiliation: Laboratory of Biotechnology, Faculty of Medicine and Pharmacy of Rabat, Mohamed V University of Rabat, Rabat, Morocco.
authors.forename: H
authors.initials: H
authors.lastname: Lemriss
authors.affiliation: Creighton University, Omaha, NE, USA.
authors.forename: R V
authors.initials: RV
authors.lastname: Goering
authors.affiliation: Public Health England, Staphylococcus Reference Service, Colindale, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kearns
authors.affiliation: RMIT University, Bundoora, Victoria, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Deighton
authors.affiliation: Erasme Hospital, Université Libre de Bruxelles, Laboratoire de Référence MRSA, Staphylocoques, Department of Microbiology, Brussels, Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Denis
authors.affiliation: Laboratory of Biotechnology, Faculty of Medicine and Pharmacy of Rabat, Mohamed V University of Rabat, Rabat, Morocco.
authors.forename: A
authors.initials: A
authors.lastname: Ibrahimi
authors.affiliation: Claude Bernard University Lyon 1, Villeurbanne, France; Neonatal Intensive Care Unit, Eastern Hospital Group, Hospices Civils de Lyon, Bron, France.
authors.forename: O
authors.initials: O
authors.lastname: Claris
authors.affiliation: International Centre for Research in Infectious Diseases (CIRI), INSERM U1111, CNRS UMR5308, Université Lyon 1, ENS de Lyon, Lyon, France; National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Villeurbanne, France.
authors.forename: F
authors.initials: F
authors.lastname: Vandenesch
authors.affiliation: Claude Bernard University Lyon 1, Villeurbanne, France; Neonatal Intensive Care Unit, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Picaud
authors.affiliation: Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France; International Centre for Research in Infectious Diseases (CIRI), INSERM U1111, CNRS UMR5308, Université Lyon 1, ENS de Lyon, Lyon, France; National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Villeurbanne, France.
authors.forename: F
authors.initials: F
authors.lastname: Laurent
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005060:Europe / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D017720:Molecular Epidemiology; D058889:Molecular Typing; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; clone; coagulase-negative Staphylococcus; neonatology; vancomycin