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Cross-Canada spread of methicillin-resistant Staphylococcus aureus via transplant organs
1Queen Elizabeth II Health Sciences Centre, and Department of Medicine, Dalhousie University, Halifax, Nova Scotia. ljohnsto@is.dal.ca
Abstract:
We report our investigation of the transmission of methicillin-resistant Staphylococcus aureus (MRSA) through transplantation. The kidneys, liver, and corneas were harvested from a child who died in Nova Scotia. Several days postmortem it was learned that culture of a premortem endotracheal tube aspirate from the donor yielded MRSA. Both kidneys were transplanted into a child in Nova Scotia and the liver into a child in Alberta. Both recipients subsequently became blood culture-positive for MRSA. One corneal ring from the donor was MRSA-positive. All four MRSA isolates were mecA-positive by polymerase chain reaction (PCR). The relatedness of the MRSA isolates was examined by restriction fragment length polymorphism (RFLP) analysis, a 16S-23S ribosomal PCR typing method, and comparison of antibiograms. Results were identical for all four MRSA isolates. These findings indicate that MRSA from the donor was transferred to recipients during implantation of harvested organs in Alberta and Nova Scotia, a cross-Canada spread.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) transmission occurred via organ transplantation. A single donor transmitted MRSA to recipients across Canada through kidneys, liver, and corneas.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Microbiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings.
- Organ transplantation is a life-saving procedure but carries risks of infectious complications.
- Donor-derived infections can lead to severe outcomes in transplant recipients.
Purpose of the Study:
- To investigate the transmission of MRSA from a deceased donor to organ recipients.
- To determine the molecular relatedness of MRSA isolates from the donor and recipients.
- To highlight the potential for cross-Canada spread of healthcare-associated pathogens through organ donation.
Main Methods:
- Culture of donor tissues and recipient blood samples for MRSA detection.
- Polymerase chain reaction (PCR) to confirm the presence of the mecA gene in MRSA isolates.
- Molecular typing techniques including restriction fragment length polymorphism (RFLP) and 16S-23S ribosomal PCR.
- Antibiogram comparison of all identified MRSA strains.
Main Results:
- MRSA was detected in premortem donor samples and harvested organs (kidneys, liver, cornea).
- Both organ recipients developed MRSA bloodstream infections.
- Molecular typing (RFLP, ribosomal PCR) and antibiograms confirmed that all MRSA isolates were identical, originating from the donor.
- The transmission event spanned multiple Canadian provinces, indicating a cross-Canada spread.
Conclusions:
- Organ transplantation can serve as a route for MRSA transmission.
- A single MRSA-positive donor can infect multiple recipients across different geographical locations.
- Robust donor screening and molecular surveillance are crucial to prevent transmission of multidrug-resistant organisms in transplantation.