Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore

Angela Chow; Htet Lin Htun; Pei-Yun Hon; Brenda Ang; Kala Kanagasabai; Jocelyn Koh; Matthew T. G. Holden; Li-Yang Hsu

doi:10.1016/j.cmi.2020.07.034

Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore

Angela Chow, Htet Lin Htun, Pei-Yun Hon, Brenda Ang, Kala Kanagasabai, Jocelyn Koh, Matthew T. G. Holden, Li-Yang Hsu

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

5 Downloads (Pure)

Abstract

Objectives

Methicillin-resistant Staphylococcus aureus(MRSA) has spread across countries and healthcare settings, with different ecological niches for different clones. It is crucial to understand the comparative epidemiology of MRSA clones between healthcare settings, and independent factors associated with colonization of specific clones.

Methods

We conducted annual cross-sectional surveillance studies in a network comprising an acute-care hospital and six closely-affiliated intermediate- and long-term care facilities in Singapore, in June-July, 2014-2016. 5,394 patients contributed 16,045 nasal, axillary and groin samples for culture and MRSA isolates for whole genome sequencing. Multivariable multilevel multinomial regression models were constructed to assess for independent factors associated with MRSA colonization.

Results

MRSA clonal complex(CC) 22 was more prevalent in the acute-care hospital(n=256/493; 51.9%) and intermediate-care(n=348/634; 54.9%) than long-term care(n=88/351; 25.1%) facilities, with clones besides CC22 and CC45 being more prevalent in long-term care facilities(n=144/351; 41.0%) (P<0.001). Groin colonization with CC45 was 6 times that of nasal colonization(aOR 6.21, 95%CI 4.26-9.01). Prior MRSA carriage was associated with increased odds of current MRSA colonization in all settings, with a stronger association with CC22(aOR 6.45, 95%CI 3.85-10.87) than CC45(aOR 4.15, 95%CI 2.26-7.58).

Conclusions

Colonization of MRSA clones differed between anatomic sites and across healthcare settings. With CC22 having a predilection for the nares and CC45 the groin, MRSA screening should include both sites. Prior MRSA carriage is a risk factor for colonization with predominant MRSA clones in the acute-care hospital and intermediate- and long-term care facilities. Contact precautions for prior MRSA-carriers on admission to any healthcare facility could prevent intra- and inter-institutional MRSA transmission.

Original language	English
Journal	Clinical Microbiology and Infection
Volume	In press
Early online date	29 Jul 2020
DOIs	https://doi.org/10.1016/j.cmi.2020.07.034
Publication status	E-pub ahead of print - 29 Jul 2020

Keywords

Anatomic sites
Epidemiology
HA-MRSA clones
Intermediate-care facilities
Long-term care facilities

Access to Document

10.1016/j.cmi.2020.07.034

MRSAClones_CLM-20-17265_160520
Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1016/j.cmi.2020.07.034.
Accepted author manuscript, 1.21 MBLicence: CC BY-NC-ND

Fingerprint

Dive into the research topics of 'Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore'. Together they form a unique fingerprint.

Institutional Strategic Support Fund: Insitutional Stratigic Support Fund (ISSF)
Naismith, J. (PI)
The Wellcome Trust
1/03/12 → 28/02/15
Project: Standard

Cite this

Chow, A., Htun, H. L., Hon, P.-Y., Ang, B., Kanagasabai, K., Koh, J., Holden, M. T. G., & Hsu, L.-Y. (2020). Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore. Clinical Microbiology and Infection, In press. Advance online publication. https://doi.org/10.1016/j.cmi.2020.07.034

@article{f3e52fe3378e471e9b0ac8dbfa39996c,

title = "Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore",

abstract = "ObjectivesMethicillin-resistant Staphylococcus aureus(MRSA) has spread across countries and healthcare settings, with different ecological niches for different clones. It is crucial to understand the comparative epidemiology of MRSA clones between healthcare settings, and independent factors associated with colonization of specific clones.MethodsWe conducted annual cross-sectional surveillance studies in a network comprising an acute-care hospital and six closely-affiliated intermediate- and long-term care facilities in Singapore, in June-July, 2014-2016. 5,394 patients contributed 16,045 nasal, axillary and groin samples for culture and MRSA isolates for whole genome sequencing. Multivariable multilevel multinomial regression models were constructed to assess for independent factors associated with MRSA colonization.ResultsMRSA clonal complex(CC) 22 was more prevalent in the acute-care hospital(n=256/493; 51.9%) and intermediate-care(n=348/634; 54.9%) than long-term care(n=88/351; 25.1%) facilities, with clones besides CC22 and CC45 being more prevalent in long-term care facilities(n=144/351; 41.0%) (P<0.001). Groin colonization with CC45 was 6 times that of nasal colonization(aOR 6.21, 95%CI 4.26-9.01). Prior MRSA carriage was associated with increased odds of current MRSA colonization in all settings, with a stronger association with CC22(aOR 6.45, 95%CI 3.85-10.87) than CC45(aOR 4.15, 95%CI 2.26-7.58).ConclusionsColonization of MRSA clones differed between anatomic sites and across healthcare settings. With CC22 having a predilection for the nares and CC45 the groin, MRSA screening should include both sites. Prior MRSA carriage is a risk factor for colonization with predominant MRSA clones in the acute-care hospital and intermediate- and long-term care facilities. Contact precautions for prior MRSA-carriers on admission to any healthcare facility could prevent intra- and inter-institutional MRSA transmission.",

keywords = "Anatomic sites, Epidemiology, HA-MRSA clones, Intermediate-care facilities, Long-term care facilities",

author = "Angela Chow and Htun, {Htet Lin} and Pei-Yun Hon and Brenda Ang and Kala Kanagasabai and Jocelyn Koh and Holden, {Matthew T. G.} and Li-Yang Hsu",

note = "Funding: Bioinformatics and Computational Biology analyses were supported by the University of St Andrews Bioinformatics Unit that is funded by a Wellcome Trust ISSF award (grant 097831/Z/11/Z). M.T.G.H is supported by the Scottish Infection Research Network and Chief Scientist Office through the Scottish Healthcare Associated Infection Prevention Institute consortium funding (CSO Reference: SIRN10).",

year = "2020",

month = jul,

day = "29",

doi = "10.1016/j.cmi.2020.07.034",

language = "English",

volume = "In press",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Blackwell",

}

Chow, A, Htun, HL, Hon, P-Y, Ang, B, Kanagasabai, K, Koh, J, Holden, MTG & Hsu, L-Y 2020, 'Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore', Clinical Microbiology and Infection, vol. In press. https://doi.org/10.1016/j.cmi.2020.07.034

Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore. / Chow, Angela; Htun, Htet Lin; Hon, Pei-Yun et al.
In: Clinical Microbiology and Infection, Vol. In press, 29.07.2020.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore

AU - Chow, Angela

AU - Htun, Htet Lin

AU - Hon, Pei-Yun

AU - Ang, Brenda

AU - Kanagasabai, Kala

AU - Koh, Jocelyn

AU - Holden, Matthew T. G.

AU - Hsu, Li-Yang

N1 - Funding: Bioinformatics and Computational Biology analyses were supported by the University of St Andrews Bioinformatics Unit that is funded by a Wellcome Trust ISSF award (grant 097831/Z/11/Z). M.T.G.H is supported by the Scottish Infection Research Network and Chief Scientist Office through the Scottish Healthcare Associated Infection Prevention Institute consortium funding (CSO Reference: SIRN10).

PY - 2020/7/29

Y1 - 2020/7/29

N2 - ObjectivesMethicillin-resistant Staphylococcus aureus(MRSA) has spread across countries and healthcare settings, with different ecological niches for different clones. It is crucial to understand the comparative epidemiology of MRSA clones between healthcare settings, and independent factors associated with colonization of specific clones.MethodsWe conducted annual cross-sectional surveillance studies in a network comprising an acute-care hospital and six closely-affiliated intermediate- and long-term care facilities in Singapore, in June-July, 2014-2016. 5,394 patients contributed 16,045 nasal, axillary and groin samples for culture and MRSA isolates for whole genome sequencing. Multivariable multilevel multinomial regression models were constructed to assess for independent factors associated with MRSA colonization.ResultsMRSA clonal complex(CC) 22 was more prevalent in the acute-care hospital(n=256/493; 51.9%) and intermediate-care(n=348/634; 54.9%) than long-term care(n=88/351; 25.1%) facilities, with clones besides CC22 and CC45 being more prevalent in long-term care facilities(n=144/351; 41.0%) (P<0.001). Groin colonization with CC45 was 6 times that of nasal colonization(aOR 6.21, 95%CI 4.26-9.01). Prior MRSA carriage was associated with increased odds of current MRSA colonization in all settings, with a stronger association with CC22(aOR 6.45, 95%CI 3.85-10.87) than CC45(aOR 4.15, 95%CI 2.26-7.58).ConclusionsColonization of MRSA clones differed between anatomic sites and across healthcare settings. With CC22 having a predilection for the nares and CC45 the groin, MRSA screening should include both sites. Prior MRSA carriage is a risk factor for colonization with predominant MRSA clones in the acute-care hospital and intermediate- and long-term care facilities. Contact precautions for prior MRSA-carriers on admission to any healthcare facility could prevent intra- and inter-institutional MRSA transmission.

AB - ObjectivesMethicillin-resistant Staphylococcus aureus(MRSA) has spread across countries and healthcare settings, with different ecological niches for different clones. It is crucial to understand the comparative epidemiology of MRSA clones between healthcare settings, and independent factors associated with colonization of specific clones.MethodsWe conducted annual cross-sectional surveillance studies in a network comprising an acute-care hospital and six closely-affiliated intermediate- and long-term care facilities in Singapore, in June-July, 2014-2016. 5,394 patients contributed 16,045 nasal, axillary and groin samples for culture and MRSA isolates for whole genome sequencing. Multivariable multilevel multinomial regression models were constructed to assess for independent factors associated with MRSA colonization.ResultsMRSA clonal complex(CC) 22 was more prevalent in the acute-care hospital(n=256/493; 51.9%) and intermediate-care(n=348/634; 54.9%) than long-term care(n=88/351; 25.1%) facilities, with clones besides CC22 and CC45 being more prevalent in long-term care facilities(n=144/351; 41.0%) (P<0.001). Groin colonization with CC45 was 6 times that of nasal colonization(aOR 6.21, 95%CI 4.26-9.01). Prior MRSA carriage was associated with increased odds of current MRSA colonization in all settings, with a stronger association with CC22(aOR 6.45, 95%CI 3.85-10.87) than CC45(aOR 4.15, 95%CI 2.26-7.58).ConclusionsColonization of MRSA clones differed between anatomic sites and across healthcare settings. With CC22 having a predilection for the nares and CC45 the groin, MRSA screening should include both sites. Prior MRSA carriage is a risk factor for colonization with predominant MRSA clones in the acute-care hospital and intermediate- and long-term care facilities. Contact precautions for prior MRSA-carriers on admission to any healthcare facility could prevent intra- and inter-institutional MRSA transmission.

KW - Anatomic sites

KW - Epidemiology

KW - HA-MRSA clones

KW - Intermediate-care facilities

KW - Long-term care facilities

U2 - 10.1016/j.cmi.2020.07.034

DO - 10.1016/j.cmi.2020.07.034

M3 - Article

SN - 1198-743X

VL - In press

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

ER -

Chow A, Htun HL, Hon PY, Ang B, Kanagasabai K, Koh J et al. Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore. Clinical Microbiology and Infection. 2020 Jul 29;In press. Epub 2020 Jul 29. doi: 10.1016/j.cmi.2020.07.034

Comparative epidemiology and factors associated with major healthcare-associated methicillin-resistant Staphylococcus aureus clones among interconnected acute-, intermediate- and long-term healthcare facilities in Singapore

Abstract

Keywords

Access to Document

Fingerprint

Projects

Institutional Strategic Support Fund: Insitutional Stratigic Support Fund (ISSF)

Cite this