Staphylococcus aureus in critical care

The Article by James Price and colleagues1Price JR Cole K Bexley A et al.Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencing.Lancet Infect Dis. 2017; 17: 207-214Summary Full Text Full Text PDF PubMed Scopus (109) Google Scholar describes an important study that explores the role of health-care workers and the environment in patient acquisition of Staphylococcus aureus. We congratulate the team on the study, which, impressively, enrolled 95% of eligible health-care workers who, along with patients and the environment, were screened for S aureus; the large number of isolates were then analysed using whole-genome sequencing. However, we feel the authors' conclusion that “health-care workers were infrequently sources of transmission to patients” is not warranted, in light of the study's limitations. Several of these limitations, including the fact that the study was done at a single hospital with a low prevalence of meticillin-resistant S aureus, were cited by the authors, and in the accompanying Comment.2Denis O Route of transmission of Staphylococcus aureus.Lancet Infect Dis. 2017; 17: 124-125Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar However, in addition, large numbers of health-care workers (eg, visiting medical teams, radiographers, allied health staff other than physiotherapists, food handlers, cleaners, porters) and visitors were not screened and the intervals between samplings of those who were screened were long. Members of staff were only considered to be sources of acquisition for patient colonisation if the staff member's isolate was obtained before, or at the same time as, the patient's isolate. However, the order of sampling does not necessarily reflect the direction of transmission, and staff might only be found to be colonised after transmission has occurred. Considering the high proportion of health-care workers who were transient S aureus carriers, the median staff screening interval of 4 weeks, and the relatively poor sensitivity of nasal swabs alone (70·3%), the conclusion that health-care workers were only infrequent sources of acquisition seem unjustified. Almost 40% (727 of 1854) of patients admitted to the units were screened only once and none were screened after discharge, so a large number of patient acquisitions were likely to be unrecognised. Potential sources of S aureus were not identified in 72 (76%) of 97 recognised patient acquisitions. Although the authors suggest that these might not be true acquisitions, but rather explained by false-negative admission screens, it also raises an alternative possibility that nosocomial acquisition of S aureus is much more frequent than suggested by this study. Identifying sources of S aureus transmission is difficult, but can be facilitated by more frequent sampling and rapid screening of isolates, using a high-throughput, inexpensive strain-typing tool, supplemented by whole-genome sequencing, to detect transmissions events.3O'Sullivan MV Zhou F Sintchenko V Gilbert GL Prospective genotyping of hospital-acquired methicillin-resistant Staphylococcus aureus isolates by use of a novel, highly discriminatory binary typing system.J Clin Microbiol. 2012; 50: 3513-3519Crossref PubMed Scopus (21) Google Scholar RD's PhD is supported by Australian Postgraduate Awards (2016). MOS and GG declare no competing interests. Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencingIn the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct subtypes rather than transmission of genetically related strains. Full-Text PDF Open AccessRoute of transmission of Staphylococcus aureusHealth-care-associated infections represent a major health concern with a substantial impact on morbidity and mortality. The prevalence of nosocomial infections is especially high in intensive care units (ICUs), where the occurrence of multidrug-resistant pathogens is highest in the hospital.1 Staphylococcus aureus is a major agent of health-care-associated infections that causes a wide range of diseases from mild to life-threatening conditions. It is one of the most prevalent causes of nosocomial bacteraemia, hospital-acquired pneumonia, and surgical site infections. Full-Text PDF Open AccessBoosters for meningococcal B vaccines?Two new meningococcal vaccines are licensed for prevention of serogroup B meningococcal disease: 4CMenB (Bexsero, Novartis, Siena, Italy) is licensed in 35 countries including the USA, Europe, Canada, and Australia, and bivalent rLP2086 (Trumenba; Pfizer, Philadelphia, PA, USA)—a bivalent factor H binding protein meningococcal vaccine—is licensed in the USA and under European review.1 Both vaccines target variable, non-capsular surface antigens, generate an established immunological correlate of protection (human complement serum bactericidal activity [hSBA]) used for licensure, and have shown initial favourable safety and tolerability profiles. Full-Text PDF Staphylococcus aureus in critical care – Authors' replyRavindra Dotel and colleagues highlight several limitations of our study1 and argue that, taken together, these limitations undermine our conclusion that health-care workers are infrequently sources of Staphylococcus aureus transmission. Although we acknowledge the criticisms made, we do not agree with this analysis. Full-Text PDF

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