Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-30T20:22:24.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Ribotyping of Nosocomial Methicillin-Resistant Staphylococcus aureus Isolates From a Canadian Hospital

Published online by Cambridge University Press:  02 January 2015

Swapan K. Nath ,
Barb Shea ,
Susan Jackson  and
Coleman Rotstein
Swapan K. Nath
Affiliation:
Department of Laboratory Medicine, McMaster University, Hamilton, Ontario, Canada Department of Pathology, McMaster University, Hamilton, Ontario, Canada
Barb Shea
Affiliation:
Department of Laboratory Medicine, McMaster University, Hamilton, Ontario, Canada
Susan Jackson
Affiliation:
Hamilton Regional Public Health Laboratory, McMaster University, Hamilton, Ontario, Canada Department of Pathology, McMaster University, Hamilton, Ontario, Canada
Coleman Rotstein*
Affiliation:
Division of Infectious Diseases, McMaster Medical Unit, Henderson General Hospital, McMaster University, Hamilton, Ontario, Canada Department of Medicine, McMaster University, Hamilton, Ontario, Canada
*
Division of Infectious Diseases, McMaster Medical Unit, Henderson General Hospital, Hamilton, Ontario, Canada L8V 1C3
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the clonality of methicillin-resistant Staphylococcus aureus (MRSA) strains among hospitalized patients.

Setting:

University-affiliated, 465-bed tertiary-care teaching hospital with adjacent cancer clinic in Hamilton, Ontario, Canada.

Design:

Thirty-five colonized and 30 infected patients from January 2, 1992, through August 31, 1993, were investigated retrospectively. Analysis by restriction fragment-length polymorphisms of ribosomal RNA genes (ie, ribotyping) of 103 nosocomial isolates of MRSA from these 65 patients and of 25 selected unrelated strains was completed. Ribotyping results were compared with the phage typing data obtained prospectively during the course of prospective MRSA surveillance.

Results:

HindIII ribotyping was more discriminating than phage typing when epidemiologically unrelated strains were differentiated by these methods (19 different ribotypes versus 14 phage types; P< .005). Two early index cases were identified. Isolates from the index cases were two different strains, identified by ribotyping analysis as ribotype A (clonal group 1) and ribotype B (clonal group 2), respectively. These two ribotypes were not found when typing the unrelated control strains. Thirty-six colonized and infected patients (55%) had clonal group 1 isolates, and 20 (31%) had clonal group 2 isolates. These two clones emerged in the hospital in January and February 1992 and dominated the entire investigated period. There also were six patients with an additional clonal group (group 4) that emerged and disappeared in the second quarter of 1993.

Conclusions:

This study highlights the utility of ribotyping in investigating nosocomial MRSA. Three MRSA clones caused nosocomial colonization or infection in patients at this hospital. Two of these MRSA clones, once introduced, were maintained among our patients throughout the study period.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 12 , December 1995 , pp. 717 - 724
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11:639–642.CrossRefGoogle ScholarPubMed
2. Vortel, JJ, Bell, A, Farley, JD, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in a British Columbia Hospital—1990. Can Dis Wkly Rep 1991;17:71–72.Google Scholar
3. Boyd, N, Gidwani, R. Colonization of methicillin-resistant Staphylococcus aureus in southern Ontario. Can Dis Wkly Rep 1991;17:72–74.Google Scholar
4. Simor, AE, Augustin, A, Ng, J, Betschel, S, McArthur, M. Control of MRSA in a long-term–care facility [Letter]. Infect Control Hosp Epidemiol 1994;15:69–70.Google Scholar
5. Taylor, G, Kirkland, T, Kowalewska-Grochowska, K, Wang, Y. A multistrain cluster of methicillin-resistant Staphylococcus aureus based in a native community. Can J Infect Dis 1990;1:121–126.Google Scholar
6. Embil, J, Ramotar, K, Romance, L, et al. Methicillin-resistant Staphylococcus aureus tertair y-care institutions of the Canadian prairies 1990–1992. Infect Control Hosp Epidemiol 1994;15:646–651.Google ScholarPubMed
7. Marples, RR, Cooke, EM. Workshop on methicillin-resistant Staphylococcus aureus held at the headquarters of the Public Health Laboratory Ser vice on January 8, 1995. J Hosp Infect 1985;6:342–348.Google Scholar
8. Richardson, JF, Chitasobhon, N, Marples, RR. A supplementary phage set for the investigation of methicillin-resistant strains of Staphylococcus aureus . J Med Microbiol 1988;25:67–74.Google Scholar
9. Tenover, FC, Arbeit, R, Archer, G, et al. Comparison of traditional and molecular typing methods of typing isolates of Staphyloccus aureus . J Clin Microbiol 1994;32:407–415.Google Scholar
10. Preheim, L, Pitcher, D, Owen, R, Cookson, B. Typing of methicillin-resistant and -susceptible Staphylococcus aureus strains by ribosomal RNA gene restriction patterns using a biotinylated probe. Eur J Clin Microbiol Infect Dis 1991;10:428–436.CrossRefGoogle ScholarPubMed
11. Balows, A, Hausler, WH Jr Herrmann, KL, Isenberg, HD, Shadomy, HJ. Manual of Clinical Microbiology. 5th ed. Washington DC: American Society for Microbiology; 1991.Google Scholar
12. Hackbarth, CJ, Chambers, HF. Methicillin-resistant staphylococci: detection methods and treatment of infections. Antimicrob Agents Chemother 1989;33:995–999.CrossRefGoogle ScholarPubMed
13. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 3rd ed. Villanova, PA: NCCLS; 1993. Approved standard M7-A3.Google Scholar
14. Blair, JE, Williams, REO. Phage typing of staphylococci. Bull World Health Organ 1961;24:771–778.Google Scholar
15. Pitcher, DG, Saunders, NA, Owen, RJ. Rapid extraction of bacteria genomic DNA with guanidium thiocyanate. Letters in Applied Microbiology 1989;8:151–156.Google Scholar
16. Martinetti, G, Altwegg, M. rRNA gene restriction patterns and plasmid analysis as a tool for typing Salmonella enteritidis . Res Microbiol 1990;141:1151–1162.CrossRefGoogle ScholarPubMed
17. Hunter, PR, Gaston, MA. Numerical index of the discriminatory ability of typing systems: an application of Simpson's index of diversity. J Clin Microbiol 1988;26:2465–2466.Google Scholar
18. Grimont, F, Grimont, PAD. Ribosomal ribonucleic acid gene restriction patterns as potential taxonomic tools. Ann Inst Pasteur Microbiol 1986;137B:165–175.Google Scholar
19. Blanc, DS, Siegrist, HH, Sahli, R, Francioli, P. Ribotyping of Pseudomonas aeruginosa: discriminatory power and usefulness as a tool for epidemiological studies. J Clin Microbiol 1993;31:71–77.Google Scholar
20. Hadorn, K, Lenz, W, Kayser, FH, Shalit, I, Krasemann, C. Use of a ribosomal RNA gene probe for the epidemiological study of methicillin and ciprofloxacin resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1990;9:649–653.CrossRefGoogle ScholarPubMed
21. Blumberg, HM, Rimland, D, Kiehlbauch, JA, Terry, PM, Wachsmuth, IK. Epidemiologic typing of Staphylococcus aureus by DNA restriction fragment-length polymorphisms of rRNA genes: elucidation of the clonal nature of a group of bacteriophage-nontypeable, ciprofloxacin-resistant, methicillin-susceptible S aureus isolates. J Clin Microbiol 1992;30:362–369.Google Scholar
22. Prevost, G, Jaulhac, B, Piemont, Y. DNA fingerprinting by pulsed-field gel electrophoresis is more effective than ribotyping in distinguishing among methicillin-resistant Staphylococcus aureus isolates. J Clin Microbiol 1992;30:967–973.CrossRefGoogle ScholarPubMed
23. Swaminathan, B, Matar, GM. Molecular typing methods. In: Persing, DH, Smith, TF, Tenover, FC, White, TJ, eds. Diagnostic Molecular Microbiology: Principles and Applications. Washington DC: American Society for Microbiology; 1994:26–50.Google Scholar
24. Venezia, RA, Harris, V, Miller, C, Peck, H, San Antonio, M. Investigation of an outbreak of methicillin-resistant Staphylococcus aureus in patients with skin disease using DNA restriction patterns. Infect Cont Hosp Epidemiol 1992;13:472–476.CrossRefGoogle ScholarPubMed
25. Fang, FC, McClelland, M, Guiney, DG, et al. Value of molecular epidemiologic analysis in a nosocomial methicillin-resistant Staphylococcus aureus outbreak. JAMA 1993;270:1323–1328.Google Scholar
26. van Belkum, A, Bax, R, Peerbooms, P, et al. Comparison of phage typing and DNA fingerprinting by polymerase chain reaction for discrimination of methicillin-resistant Staphylococcus aureus strains. J Clin Microbiol 1993;31:798–803.CrossRefGoogle ScholarPubMed
27. Trilla, A, Marco, F, Moreno, A, et al. Clinical epidemiology of an outbreak of nosocomial infection caused by Staphylococcus aureus resistant to methicillin and aminoglycosides: efficacy of control measures. Med Clin (Barc) 1993;100:205–209.Google Scholar
28. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med 1981;71:53–58.CrossRefGoogle ScholarPubMed
29. Noel, GJ, Kreiswirth, BN, Edelson, PJ, et al. Multiple methicillin-resistant Staphylococcus aureus strains as a cause for a single outbreak of severe disease in hospitalized neonates. Pediatr Infect Dis 1992;11:184–188.CrossRefGoogle ScholarPubMed
30. Nicole, LE, Bialkowska-Hobrzanska, H, Romance, L, Harry, VS, Parker, S. Clonal diversity of methicillin-resistant Staphylococcus aureus in an acute-care institution. Infect Control Hosp Epidemiol 1992;13:33–37.Google Scholar
31. Trilla, A, Nettleman, MD, Hollis, RJ, Fredrickson, M, Wenzel, RP, Pfaller, MA. Restriction endonuclease analysis of plasmid DNA from methicillin-resistant Staphylococcus aureus: clinical application over a three-year period. Infect Control Hosp Epidemiol 1993;14:29–35.CrossRefGoogle Scholar