Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones

ObjectiveTo outline the epidemiology of puerperal mastitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and evaluate the effect of an infection control bundle on its incidence.MethodsA surge in MRSA puerperal mastitis was noted in a community hospital in September 2009. MRSA samples...

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Main Authors: Yu-Cheng Lin, Yu-Lin Lee, Yi-Hsin Chen, Shih-Ming Tsao, Wei-Yao Wang
Format: Article
Language:English
Published: Frontiers Media S.A. 2024-04-01
Series:Frontiers in Medicine
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2024.1378207/full
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author Yu-Cheng Lin
Yu-Lin Lee
Yu-Lin Lee
Yi-Hsin Chen
Yi-Hsin Chen
Yi-Hsin Chen
Shih-Ming Tsao
Shih-Ming Tsao
Wei-Yao Wang
Wei-Yao Wang
author_facet Yu-Cheng Lin
Yu-Lin Lee
Yu-Lin Lee
Yi-Hsin Chen
Yi-Hsin Chen
Yi-Hsin Chen
Shih-Ming Tsao
Shih-Ming Tsao
Wei-Yao Wang
Wei-Yao Wang
author_sort Yu-Cheng Lin
collection DOAJ
description ObjectiveTo outline the epidemiology of puerperal mastitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and evaluate the effect of an infection control bundle on its incidence.MethodsA surge in MRSA puerperal mastitis was noted in a community hospital in September 2009. MRSA samples from mastitis cases and the environment underwent typing using multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec), gene encoding surface protein A (spa), accessory gene regulator (agr), and pulsed-field gel electrophoresis (PFGE). The phenotypic characteristics, including superantigen toxin profiles, gene encoding Panton-Valentine leucocidin (pvl), and minimal inhibitory concentration (MIC) against vancomycin, were ascertained. Subsequently, an infection control bundle emphasizing contact precautions was introduced, and mastitis incidence rates pre- and post-intervention were compared.ResultsThe majority of cases occurred within 6 weeks post-delivery in first-time mothers. Of the 42 S. aureus isolates (27 from mastitis and 15 from colonized staff and environmental sources), 25 (92.6%) clinical and 3 (20%) colonized MRSA were identified as ST59-SCCmecVT-spa t437-agr group I with a vancomycin MIC of 1 mg/L, pvl-positive, and predominantly with a consistent toxin profile (seb-selk-selr). PFGE revealed 13 patterns; pulsotype B exhibited clonal relatedness between two clinical and three colonized MRSA samples. Post-intervention, the incidence of both mastitis and MRSA mastitis notably decreased from 13.01 to 1.78 and from 3.70 to 0.99 episodes per 100 deliveries, respectively.ConclusionDistinct community-associated MRSA (CA-MRSA) clones were detected among puerperal mastitis patients and colonized staff. The outbreak was effectively controlled following the implementation of a targeted infection control bundle.
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spelling doaj.art-ee3cd7f845e64b32a8efd24acc13bedf2024-04-19T04:28:06ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-04-011110.3389/fmed.2024.13782071378207Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clonesYu-Cheng Lin0Yu-Lin Lee1Yu-Lin Lee2Yi-Hsin Chen3Yi-Hsin Chen4Yi-Hsin Chen5Shih-Ming Tsao6Shih-Ming Tsao7Wei-Yao Wang8Wei-Yao Wang9Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, TaiwanSchool of Medicine, Chung Shan Medical University, Taichung, TaiwanDepartment of Internal Medicine, Chung Shan Medical University Hospital, Taichung, TaiwanDepartment of Nephrology, Taichung Tzu Chi Hospital, Taichung, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Artificial Intelligence and Data Science, National Chung Hsing University, Taichung, TaiwanSchool of Medicine, Chung Shan Medical University, Taichung, TaiwanDepartment of Internal Medicine, Chung Shan Medical University Hospital, Taichung, TaiwanSchool of Medicine, Chung Shan Medical University, Taichung, TaiwanDepartment of Internal Medicine, Chung Shan Medical University Hospital, Taichung, TaiwanObjectiveTo outline the epidemiology of puerperal mastitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and evaluate the effect of an infection control bundle on its incidence.MethodsA surge in MRSA puerperal mastitis was noted in a community hospital in September 2009. MRSA samples from mastitis cases and the environment underwent typing using multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec), gene encoding surface protein A (spa), accessory gene regulator (agr), and pulsed-field gel electrophoresis (PFGE). The phenotypic characteristics, including superantigen toxin profiles, gene encoding Panton-Valentine leucocidin (pvl), and minimal inhibitory concentration (MIC) against vancomycin, were ascertained. Subsequently, an infection control bundle emphasizing contact precautions was introduced, and mastitis incidence rates pre- and post-intervention were compared.ResultsThe majority of cases occurred within 6 weeks post-delivery in first-time mothers. Of the 42 S. aureus isolates (27 from mastitis and 15 from colonized staff and environmental sources), 25 (92.6%) clinical and 3 (20%) colonized MRSA were identified as ST59-SCCmecVT-spa t437-agr group I with a vancomycin MIC of 1 mg/L, pvl-positive, and predominantly with a consistent toxin profile (seb-selk-selr). PFGE revealed 13 patterns; pulsotype B exhibited clonal relatedness between two clinical and three colonized MRSA samples. Post-intervention, the incidence of both mastitis and MRSA mastitis notably decreased from 13.01 to 1.78 and from 3.70 to 0.99 episodes per 100 deliveries, respectively.ConclusionDistinct community-associated MRSA (CA-MRSA) clones were detected among puerperal mastitis patients and colonized staff. The outbreak was effectively controlled following the implementation of a targeted infection control bundle.https://www.frontiersin.org/articles/10.3389/fmed.2024.1378207/fullpuerperal mastitisMLSTSCCmecPFGECA-MRSAinfection control bundle
spellingShingle Yu-Cheng Lin
Yu-Lin Lee
Yu-Lin Lee
Yi-Hsin Chen
Yi-Hsin Chen
Yi-Hsin Chen
Shih-Ming Tsao
Shih-Ming Tsao
Wei-Yao Wang
Wei-Yao Wang
Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones
Frontiers in Medicine
puerperal mastitis
MLST
SCCmec
PFGE
CA-MRSA
infection control bundle
title Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones
title_full Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones
title_fullStr Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones
title_full_unstemmed Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones
title_short Puerperal mastitis caused by limited community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones
title_sort puerperal mastitis caused by limited community associated methicillin resistant staphylococcus aureus ca mrsa clones
topic puerperal mastitis
MLST
SCCmec
PFGE
CA-MRSA
infection control bundle
url https://www.frontiersin.org/articles/10.3389/fmed.2024.1378207/full
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