Sampling and host-strain interactions shape detection of Staphylococcus aureus transmission in hospitals

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ID: 321212
2026
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Abstract
Abstract Background In principle, whole-genome sequencing of Staphylococcus aureus in hospitals is most effective when used prospectively, but its practical limits are unclear. Methods We performed large-scale genomic surveillance across two interconnected hospitals, sequencing 4,779 S. aureus isolates from admission screening and clinical cultures. Integration of genomic and epidemiologic data identified 361 transmission events undetected by standard surveillance. Results Despite dense sampling, most events (90%) were detected only at readmission, indicating that transmission escapes recognition during the index hospitalization. Serial or discharge screening is likely required to capture transmission. Detection depended on sampling: clinical isolates alone were insufficient, and nearly all events required screening and repeated sampling. Conclusions Because such approaches are unlikely to scale if applied universally, surveillance must be targeted. Transmission concentrated in methicillin-resistant strains, and it increased when healthcare exposure coincided with hospital-associated strain lineage. These findings help define the limits of prospective genomic surveillance and provide a framework for targeted detection.
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Authors Kristine B. Rabii, Courtney Takats, Gregory Putzel, Alice Tillman, Magdalena Podkowik, Julian McWilliams, Nora Samhadaneh, Julia Shenderovich, Natalia Argüelles, Anusha Srivastava, Karl Drlica, Victor J. Torres, Alejandro Pironti, Sarah Hochman, Audrey Renson, Bo Shopsin
Journal The Journal of infectious diseases
Year 2026
DOI
10.1093/infdis/jiag361
URL
https://doi.org/10.1093/infdis/jiag361
Keywords Keywords not found

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