Skip to content

Research at St Andrews

MRSA transmission dynamics among interconnected acute, intermediate-term, and long-term healthcare facilities in Singapore

Research output: Research - peer-reviewArticle



Angela Chow, Vanessa W. Lim, Ateeb Khan, Kerry Pettigrew, David C. B. Lye, Kala Kanagasabai, Kelvin Phua, Prabha Krishnan, Brenda Ang, Kalisvar Marimuthu, Pei-Yun Hon, Jocelyn Koh, Ian Leong, Julian Parkhill, Li-Yang Hsu, Matthew T G Holden

School/Research organisations


Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common healthcare-associated multidrug-resistant organism. Despite the interconnectedness between acute care hospitals (ACHs) and intermediate- and long-term care facilities (ILTCFs), the transmission dynamics of MRSA between healthcare settings is not well understood.

Methods: We conducted a cross-sectional study in a network comprising an ACH and 5 closely affiliated ILTCFs in Singapore. A total of 1700 inpatients were screened for MRSA over a 6-week period in 2014. MRSA isolates underwent whole-genome sequencing, with a pairwise single-nucleotide polymorphism (Hamming distance) cutoff of 60 core genome single-nucleotide polymorphisms used to define recent transmission clusters (clades) for the 3 major clones.

Results: MRSA prevalence was significantly higher in intermediate-term (29.9%) and long-term (20.4%) care facilities than in the ACH (11.8%) (P < .001). The predominant clones were sequence type [ST] 22 (n = 183; 47.8%), ST45 (n = 129; 33.7%), and ST239 (n = 26; 6.8%), with greater diversity of STs in ILTCFs relative to the ACH. A large proportion of the clades in ST22 (14 of 21 clades; 67%) and ST45 (7 of 13; 54%) included inpatients from the ACH and ILTCFs. The most frequent source of the interfacility transmissions was the ACH (n = 28 transmission events; 36.4%).

Conclusions: MRSA transmission dynamics between the ACH and ILTCFs were complex. The greater diversity of STs in ILTCFs suggests that the ecosystem in such settings might be more conducive for intrafacility transmission events. ST22 and ST45 have successfully established themselves in ILTCFs. The importance of interconnected infection prevention and control measures and strategies cannot be overemphasized.



Original languageEnglish
Pages (from-to)S76-S81
Number of pages6
JournalClinical Infectious Diseases
Issue numbersuppl_2
Early online date29 Apr 2017
StatePublished - 15 May 2017

    Research areas

  • Whole-genome sequencing, MRSA, Transmission, Intermediate-care facilities, Long-term care facilities

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. The microevolution and epidemiology of Staphylococcus aureus colonization during atopic eczema disease flare

    Harkins, C. P., Pettigrew, K. A., Oravcová, K., Gardner, J., Hearn, R. M. R., Rice, D., Mather, A. E., Parkhill, J., Brown, S. J., Proby, C. M. & Holden, M. T. G. Feb 2018 In : Journal of Investigative Dermatology. 138, 2, p. 336-343

    Research output: Research - peer-reviewArticle

  2. Genomic investigation unmasks evidence of transmission across mycobacterium abscessus cystic fibrosis patients

    Alateah, S., Peters, C., Dhasmana, D. J., Pettigrew, K., Fallon, R., Seagar, A., Sloan, D. J., Laurenson, I. F., Holden, M. & Gillespie, S. 15 Dec 2017 In : Thorax. 72, Suppl 3, p. A56-A56

    Research output: Research - peer-reviewAbstract

  3. The genetic diversity of Staphylococcus aureus colonisation in atopic eczema disease flare

    Harkins, C. P., Pettigrew, K. A., Oravcova, K., Gardner, J., Hearn, R., Rice, D., Mather, A. E., Parkhill, J., Brown, S. J., Proby, C. M. & Holden, M. T. Oct 2017 In : Journal of Investigative Dermatology. 137, 10, p. S258-S258 1 p.

    Research output: Research - peer-reviewAbstract

  4. ST3268: a geographically widespread primate MRSA clone

    Hsu, L-Y., Holden, M. T. G., Koh, T. H., Pettigrew, K. A., Cao, D., Hon, P. Y., Sergio, D. M., Pena, E. & Ogden, B. E. 1 Aug 2017 In : Journal of Antimicrobial Chemotherapy. 72, 8, p. 2401-2403 2 p.

    Research output: Research - peer-reviewLetter

  5. Distinct evolutionary patterns of Neisseria meningitidis serogroup B disease outbreaks at two universities in the USA

    Hao, L., Holden, M. T. G., Wang, X., Andrew, L., Wellnitz, S., Hu, F., Whaley, M., Sammons, S., Knipe, K., Frace, M., McNamara, L. A., Liberator, P. & Anderson, A. S. 4 Apr 2018 In : Microbial Genomics. 10 p., 4

    Research output: Research - peer-reviewArticle

Related by journal

  1. 2015 epidemic of severe Streptococcus agalactiae sequence type 283 infections in Singapore associated with the consumption of raw freshwater fish: a detailed analysis of clinical, epidemiological, and bacterial sequencing data

    Kalimuddin, S., Chen, S. L., Lim, C. T. K., Koh, T. H., Tan, T. Y., Kam, M., Wong, C. W., Mehershahi, K. S., Chau, M. L., Ng, L. C., Tang, W. Y., Badaruddin, H., Teo, J., Apisarnthanarak, A., Suwantarat, N., Ip, M., Holden, M. T. G., Hsu, L. Y., Barkham, T. & for the Singapore Group B Streptococcus Consortium 15 May 2017 In : Clinical Infectious Diseases. 64, suppl_2, p. S145-S152 8 p.

    Research output: Research - peer-reviewArticle

  2. Factors underlying Ebola virus infection among health workers, Kenema, Sierra Leone, 2014-2015

    Senga, M., Pringle, K., Ramsay, A., Brett-Major, D. M., Fowler, R. A., French, I., Vandi, M., Sellu, J., Pratt, C., Saidu, J., Shindo, N., Bausch, D. G. & for the Sierra Leone Kenema District Task Force and Kenema General Hospital 15 Aug 2016 In : Clinical Infectious Diseases. 63, 4, p. 454-459 6 p.

    Research output: Research - peer-reviewArticle

  3. Pharmacodynamic modeling of bacillary elimination rates and detection of bacterial lipid bodies in sputum to predict and understand outcomes in treatment of pulmonary tuberculosis

    Sloan, D. J., Mwandumba, H. C., Garton, N. J., Khoo, S. H., Butterworth, A. E., Allain, T. J., Heyderman, R. S., Corbett, E. L., Barer, M. R. & Davies, G. R. 1 Jul 2015 In : Clinical Infectious Diseases. 61, 1, p. 1-8 8 p.

    Research output: Research - peer-reviewArticle

  4. Genomic investigations unmask Mycoplasma amphoriforme, a new respiratory pathogen

    Gillespie, S. H., Ling, C. L., Oravcova, K., Pinheiro, M., Wells, L., Bryant, J. M., McHugh, T. D., Bébéar, C., Webster, D., Harris, S. R., Seth-Smith, H. M. B. & Thomson, N. R. 1 Feb 2015 In : Clinical Infectious Diseases. 60, 3, p. 381-388 8 p.

    Research output: Research - peer-reviewArticle

ID: 249970356