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. 2019 Oct;24(42):1800680.
doi: 10.2807/1560-7917.ES.2019.24.42.1800680.

International travel as source of a hospital outbreak with an unusual meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016

Jens Kjølseth Møller  1   2 , Anders Rhod Larsen  3 , Claus Østergaard  1 , Camilla Holten Møller  4 , Mette Assenholm Kristensen  1 , Jesper Larsen  3
Affiliations

International travel as source of a hospital outbreak with an unusual meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016

Jens Kjølseth Møller et al. Euro Surveill. 2019 Oct.

Abstract

In May 2016, an unusual outbreak with the Panton-Valentine leukocidin-positive human variant of meticillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 occurred among mothers and infants in the maternity unit of a Danish hospital. MRSA sharing genotypic and phenotypic characteristics was confirmed in 36 cases, including 26 patients, nine household members and a healthcare worker (HCW) who had contact with all the patients. The national MRSA database contained 37 seemingly unlinked MRSA cases whose isolates shared the same genotypic and phenotypic characteristics as the outbreak strain. Whole genome sequencing showed that three of these isolates clustered together with the 36 outbreak isolates, suggesting spread outside the hospital. The HCW and 21 of 37 cases from the national MRSA database had links to south-eastern Asia, where the outbreak strain is endemic. These findings suggest that the HCW acquired the outbreak strain while travelling in south-eastern Asia and then introduced it into the hospital; from there, it spread within the patients' households and into the community. Screening of travellers returning from countries with high levels of MRSA could be an important intervention to prevent spread of these bacteria into hospitals via patients or HCWs.

Keywords: MRSA; PVL; Panton-Valentine leukocidin; epidemiology; hospital outbreak; meticillin-resistant Staphylococcus aureus; surveillance; travel.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Timeline of the Staphylococcus aureus clonal complex 398 hospital outbreak, Kolding, Denmark, 1 January 2016–30 April 2017 (n = 39)
Figure 2
Figure 2
Maximum-likelihood phylogeny of Panton-Valentine leukocidin-positive meticillin-resistant Staphylococcus aureus clonal complex 398 isolates, Denmark, 2006–2017 (n = 73)
Figure 3
Figure 3
Temporal trend of Panton-Valentine leukocidin-positive meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2006–2017 (n = 73)
See this image and copyright information in PMC

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