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Molecular epidemiology of methicillin-resistant Staphylococcus aureus outbreaks in an NICU: Integrating POT and

Nobuhiko Satoh1, Mayu Shibuya1, Yusuke Nomura1

  • 1Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

American Journal of Infection Control
|November 1, 2025
PubMed
Abstract

Insights

Whole-genome sequencing (WGS) offers superior accuracy for tracking Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal intensive care units (NICUs) compared to polymerase chain reaction-based open-reading frame typing (POT). A combined approach enhances infection control.

Area of Science:

  • Infectious Disease Epidemiology
  • Molecular Microbiology
  • Neonatal Intensive Care

Background:

  • Neonatal intensive care units (NICUs) face persistent challenges with Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks.
  • Effective containment strategies like surveillance, molecular typing, and decolonization are crucial but lack national guidelines in Japan.
  • Addressing MRSA in NICUs is vital for infant health and hospital safety.

Purpose of the Study:

  • To compare the effectiveness of Polymerase Chain Reaction-based Open-Reading Frame Typing (POT) and Whole-Genome Sequencing (WGS) in analyzing MRSA outbreaks in a NICU.
  • To evaluate the utility of WGS in identifying transmission routes and sources of infection.
  • To propose an optimized strategy for MRSA outbreak management in NICUs.

Main Methods:

  • Retrospective analysis of three MRSA outbreaks in a NICU (2022-2023).
  • Routine surveillance using weekly nasal cultures and monthly POT.
  • Whole-genome sequencing (WGS) of isolates from neonates, mothers, and healthcare personnel post-outbreak.

Main Results:

  • POT identified a predominant MRSA strain but could not differentiate unrelated cases.
  • WGS provided higher resolution, confirming mother-to-child transmission and community-acquired infections.
  • WGS implicated healthcare personnel as potential vectors and identified persistent strains, revealing links missed by POT.

Conclusions:

  • WGS offers superior accuracy for MRSA outbreak analysis and transmission mapping compared to POT.
  • POT remains practical for routine surveillance, but WGS is essential for complex outbreak investigations.
  • A combined strategy using POT for screening and WGS for outbreak confirmation is recommended to enhance infection control in NICUs.
Keywords:
MRSAPCR-based open-reading frame typingWhole-genome sequence

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