title: Whole genome SNP typing to investigate methicillin-resistantStaphylococcus aureuscarriage in a health-care provider as the source of multiple surgical site infections.
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-resistantStaphylococcus 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 forS. aureus,none of the SSI isolates share a common ancestor within the past 16 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.
authors.affiliation: Pathogen Genomics Division, Translational Genomics Research Institute, 3051 W. Shamrell Blvd., Suite 106, Flagstaff, AZ 86001 USA.
authors.forename: Chandler C
authors.initials: CC
authors.lastname: Roe
authors.affiliation: Flagstaff Medical Center, Flagstaff, AZ USA.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Horn
authors.affiliation: Pathogen Genomics Division, Translational Genomics Research Institute, 3051 W. Shamrell Blvd., Suite 106, Flagstaff, AZ 86001 USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Driebe
authors.affiliation: Pathogen Genomics Division, Translational Genomics Research Institute, 3051 W. Shamrell Blvd., Suite 106, Flagstaff, AZ 86001 USA.
authors.forename: Jolene
authors.initials: J
authors.lastname: Bowers
authors.affiliation: Flagstaff Medical Center, Flagstaff, AZ USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Terriquez
authors.affiliation: Pathogen Genomics Division, Translational Genomics Research Institute, 3051 W. Shamrell Blvd., Suite 106, Flagstaff, AZ 86001 USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Keim
authors.affiliation: Pathogen Genomics Division, Translational Genomics Research Institute, 3051 W. Shamrell Blvd., Suite 106, Flagstaff, AZ 86001 USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Engelthaler
mesh_terms: D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D016680:Genome, Bacterial; D006282:Health Personnel; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics*; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000382:microbiology*
chemical_list: D004269:DNA, Bacterial
keywords: MRSA; Nasal carriage; Surgical site infections; Transmission; Whole genome sequencing