Transmission of Methicillin-Resistant Staphylococcus aureus Infection Through Solid Organ Transplantation: Confirmation Via Whole Genome Sequencing

Abstract

We describe two cases of donor-derived methicillin-resistant Staphylococcus aureus (MRSA) bacteremia that developed after transplantation of organs from a common donor who died from acute MRSA endocarditis. Both recipients developed recurrent MRSA infection despite appropriate antibiotic therapy, and required prolonged hospitalization and hospital readmission. Comparison of S. aureus whole genome sequence of DNA extracted from fixed donor tissue and recipients’ isolates confirmed donor-derived transmission. Current guidelines emphasize the risk posed by donors with bacteremia from multidrug-resistant organisms. This investigation suggests that, particularly in the setting of donor endocarditis, even a standard course of prophylactic antibiotics may not be sufficient to prevent donor-derived infection.

Whole genome SNP typing to investigate methicillin-resistant Staphylococcus aureus carriage in a health-care provider as the source of multiple surgical site infections

“…WGST has been successfully used as a molecular epidemiology tool for numerous outbreak investigations [13–15, 17–19, 36], replacing older standards such as PFGE due to increased sensitivity and specificity [37]. Our study further establishes the effectiveness of WGST for epidemiological investigations within a hospital setting, which is especially critical for rapid analysis during an ongoing outbreak.…”

“…The surgical team member was decolonized per hospital protocol, and the MRSA decolonization was documented as successful, based on further nasal screening. In this study, we retrospectively examine the MRSA strain from the colonized surgical team member along with patient and control strains to determine whether it was the source of the cluster of SSIs using whole genome single nucleotide polymorphism (SNP) typing (WGST) [13–15]. These results demonstrate the utility of WGST for hospital molecular epidemiology and provide confirmation that the source of infection for three patients was not related to the surgical team member isolate.…”

Multidrug‐resistant organisms in liver transplant: Mitigating risk and managing infections

“…Other cited risk factors for MRSA infection have been summarized elsewhere but include prolonged hospitalization, broad‐spectrum antibiotic use, primary cytomegalovirus infection, extended ICU stay, and peritonitis. Donor‐derived MRSA infections have been described …”

“…Donor-derived MRSA infections have been described. (17)(18)(19) Isolated MRSA colonization has not been directly associated with mortality. (11,15) The association between MRSA infection and mortality in LT is evolving.…”

Next-Generation Sequencing for Pathogen Detection and Identification

“…Carbapenemase genes are often encoded on plasmids with repetitive sequence content and flanked by transposons; so in this case, the long reads obtained by PacBio sequencing avoided assembly issues typical to other sequencing chemistries and produced contiguous plasmid sequences that allowed for improved discrimination among transmission modes (Conlan et al, 2014). Furthermore, NGS was recently shown to allow for fine-scale strain typing of Streptococcus pyogenes isolates from cases of puerperal sepsis that traditional typing did not (Ben Zakour, Venturini, Beatson, & Walker, 2012) and two case reports were recently published in which NGS was used to definitively prove transmission of methicillin-resistant Staphylococcus aureus associated with organ transplantation (Altman et al, 2014;Wendt et al, 2014).…”