Background

A cluster of seven cases of skin and wound infections caused by a multiply resistant MRSA were detected in a small-town community in South Yorkshire. Initial microbiological investigations showed that all isolates belonged to a spa type observed rarely in England (t1476).

Aim

To describe the epidemiology of t1476 meticillin-resistant Staphylococcus aureus (MRSA) in South Yorkshire.

Methods

Retrospective and prospective case ascertainment was promoted through communication with local microbiology laboratories. Public health investigation included a detailed review of clinical notes for a subset of nine cases. Genomic and phylogenetic analysis was undertaken on t1476 MRSA.

Findings

Thirty-two cases of t1476 MRSA infection or colonization were identified between December 2014 and February 2018. Cases were older adults (aged 50–98 years). Healthcare exposures for a subset of nine cases indicated frequent contact with a team of district nurses, with all but one case receiving treatment on the same day as another case prior to their own diagnosis. No cases were admitted to hospital at the time of specimen collection. Despite detailed investigations, no carriers were detected among district nursing staff. A long-term carrier/super-shedder was not found. Phylogenetic analysis indicated that t1476 MRSA cases from South Yorkshire were monophyletic and distant from both MRSA of the same lineage from elsewhere in the UK (N = 15) and from publicly available sequences from Tanzania.

Conclusion

Genomic and epidemiological analyses indicate community-based transmission of a multiply resistant MRSA clone within South Yorkshire introduced around 2012–2013, prior to the detection of a spatial–temporal cluster associated with a distinct risk group. Surveillance data indicate continued circulation.

中文翻译：

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全基因组测序确定社区卫生保健相关的耐多重耐甲氧西林金黄色葡萄球菌谱系在南约克郡的流通

背景

在南约克郡的一个小镇社区中发现了由多重耐药性MRSA引起的七例皮肤和伤口感染病例。最初的微生物学调查表明，所有分离物均属于在英国很少见的水疗类型（t1476）。

目的

描述t1476耐甲氧西林金黄色葡萄球菌（MRSA）在南约克郡的流行病学。

方法

通过与当地微生物学实验室的沟通促进了回顾性和前瞻性病例确定。公共卫生调查包括对9例病例的临床笔记的详细审查。在t1476 MRSA上进行了基因组和系统发育分析。

发现

在2014年12月至2018年2月之间，共鉴定出32例t1476 MRSA感染或定植。病例为老年人（年龄在50-98岁之间）。9名患者中有一部分暴露于医疗保健中，这表明他们经常与一组地区护士接触，除一名患者外，其他所有患者均在同一天接受治疗，而另一名患者则在自己诊断之前接受治疗。标本采集时没有病例被送进医院。尽管进行了详细的调查，但在地区护理人员中未发现携带者。找不到长期的携带者/超级抛撒者。系统发育分析表明，来自南约克郡的t1476 MRSA病例是单系的，并且与来自英国其他地区（N = 15）的同一血统的MRSA以及坦桑尼亚的可公开获得的序列相距甚远。

结论

基因组学和流行病学分析表明，在发现与不同风险群体相关的时空集群之前，南约克郡在2012-2013年左右引入了多重耐药性MRSA克隆的社区传播。监视数据表明持续流通。