title: Rapid containment of nosocomial transmission of a rare community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone, responsible for the Staphylococcal Scalded Skin Syndrome (SSSS).
abstract: BACKGROUND
  The aims of this study were to identify the source and the transmission pathway for a Staphylococcal Scalded Skin Syndrome (SSSS) outbreak in a maternity setting in Italy over 2 months, during 2014; to implement appropriate control measures in order to prevent the epidemic spread within the maternity ward; and to identify the Methicillin-Resistant Staphylococcus aureus (MRSA) epidemic clone.
  
  
  METHODS
  Epidemiological and microbiological investigations, based on phenotyping and genotyping methods, were performed. All neonates involved in the outbreak underwent clinical and microbiological investigations to detect the cause of illness. Parents and healthcare workers were screened for Staphylococcus aureus to identify asymptomatic carriers.
  
  
  RESULTS
  The SSSS outbreak was due to the cross-transmission of a rare clone of ST5-CA-MRSA-SCCmecV-spa type t311, exfoliative toxin A-producer, isolated from three neonates, one mother (from her nose and from dermatological lesions due to pre-existing hand eczema) and from a nurse (colonized in her nose by this microorganism). The epidemiological and microbiological investigation confirmed these as two potential carriers.
  
  
  CONCLUSIONS
  A rapid containment of these infections was obtained only after implementation of robust swabbing of mothers and healthcare workers. The use of molecular methodologies for typing was able to identify all carriers and to trace the transmission.
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Lamanna
authors.affiliation: MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy.
authors.forename: Dafne
authors.initials: D
authors.lastname: Bongiorno
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bertoncello
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grandesso
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mazzucato
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Pozzan
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cutrone
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Chirico
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Baesso
authors.affiliation: Ospedale dell'Angelo, Mestre, Venice, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Brugnaro
authors.affiliation: MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Cafiso
authors.affiliation: MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
authors.affiliation: MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy. f.campanile@unict.it.
authors.forename: Floriana
authors.identifier: http://orcid.org/0000-0002-8405-5425
authors.initials: F
authors.lastname: Campanile
mesh_terms: D000328:Adult; D002353:Carrier State; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission*; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D005838:Genotype; D006801:Humans; D007231:Infant, Newborn; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D009035:Mothers; D009725:Nurseries, Hospital; D009726:Nurses; D012189:Retrospective Studies; D013206:Staphylococcal Scalded Skin Syndrome / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission*
keywords: Cross-transmission; ETA exfoliative-toxin; ST5/spa type t311 CA-MRSA clone