BACKGROUND Livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) clonal complex (CC) 398 may be transmitted and cause morbidity and mortality in hospitals. The economic cost of stopping hospital transmission of LA-MRSA CC398 is poorly described. Early detection of transmission may limit the extent of the intervention. AIM To evaluate core genome multi-locus sequence typing (cgMLST) for detecting transmission chains and to estimate the costs for interventions to prevent further spread after discovery of hospital transmission of LA-MRSA CC398. METHODS Five patients were involved in two episodes of transmission of LA-MRSA CC398 in a hospital. Standard interventions including MRSA screening of patients and healthcare workers were initiated. Whole genome sequences of the five isolates and 17 epidemiologically unrelated MRSA CC398 isolates from other hospitalized patients were analysed by single nucleotide polymorphism (SNP) comparisons and cgMLST. The economic costs of constraining transmission were calculated from relevant sources. FINDINGS The five isolates suspected to be involved in hospital transmission clustered with ≤2 SNPs in the draft genome sequences with some distance to other isolates. cgMLST allocated the five isolates to the same type, which was different from all but two of the sporadic isolates. Furthermore, cgMLST separated the five transmission isolates from all other isolates. The economic costs of the outbreak interventions exceeded €11,000 per patient. CONCLUSION LA-MRSA CC398 is transmittable in hospitals, and intervention against transmission may reach considerable costs. cgMLST is useful in surveillance of hospital transmission of LA-MRSA.

中文翻译：

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核心基因组多基因座序列分型是高成本家畜相关的耐甲氧西林金黄色葡萄球菌CC398医院暴发的基本工具。

背景技术与牲畜相关的耐甲氧西林金黄色葡萄球菌（LA-MRSA）克隆复合物（CC）398可能会传播并在医院中引起发病和死亡。停止对LA-MRSA CC398进行医院传播的经济成本的描述很少。及早发现传播可能会限制干预的程度。目的评估核心基因组多位点序列分型（cgMLST），以检测传播链，并估计在发现LA-MRSA CC398医院传播后防止进一步传播的干预费用。方法5例患者在医院中经历了两次LA-MRSA CC398传播。启动了包括对患者和医护人员进行MRSA筛查在内的标准干预措施。通过单核苷酸多态性（SNP）比较和cgMLST分析了来自其他住院患者的5个分离株和17个与流行病学无关的MRSA CC398分离株的全基因组序列。约束传输的经济成本是从相关来源计算得出的。结果发现，怀疑与医院传播有关的五种分离株在基因组草案序列中以≤2个SNP聚类，与其他分离株有一定距离。cgMLST将五个隔离株分配为同一类型，这与除了两个散发隔离株之外的所有隔离株都不同。此外，cgMLST将这五个传播隔离株与所有其他隔离株分开。暴发干预的经济成本超过每位患者11,000欧元。结论LA-MRSA CC398可在医院传播，干预传播可能会花费可观的费用。cgMLST可用于监视LA-MRSA的医院传播。