RT Journal
A1 Reuter, Sandra
A1 Török, M. Estée
A1 Holden, Matthew T.G.
A1 Reynolds, Rosy
A1 Raven, Kathy E.
A1 Blane, Beth
A1 Donker, Tjibbe
A1 Bentley, Stephen D.
A1 Aanensen, David M.
A1 Grundmann, Hajo
A1 Feil, Edward J.
A1 Spratt, Brian G.
A1 Parkhill, Julian
A1 Peacock, Sharon J.
T1 Building a genomic framework for prospective MRSA surveillance in the United Kingdom and the Republic of Ireland
JF Genome Research 
JO Genome Research 
YR 2016 
FD February 01 
VO 26 
IS 2 
SP 263 
OP 270 
DO 10.1101/gr.196709.115 
UL http://genome.cshlp.org/content/26/2/263.abstract 
AB The correct interpretation of microbial sequencing data applied to surveillance and outbreak investigation depends on accessible genomic databases to provide vital genetic context. Our aim was to construct and describe a United Kingdom MRSA database containing over 1000 methicillin-resistant Staphylococcus aureus (MRSA) genomes drawn from England, Northern Ireland, Wales, Scotland, and the Republic of Ireland over a decade. We sequenced 1013 MRSA submitted to the British Society for Antimicrobial Chemotherapy by 46 laboratories between 2001 and 2010. Each isolate was assigned to a regional healthcare referral network in England and was otherwise grouped based on country of origin. Phylogenetic reconstructions were used to contextualize MRSA outbreak investigations and to detect the spread of resistance. The majority of isolates (n = 783, 77%) belonged to CC22, which contains the dominant United Kingdom epidemic clone (EMRSA-15). There was marked geographic structuring of EMRSA-15, consistent with widespread dissemination prior to the sampling decade followed by local diversification. The addition of MRSA genomes from two outbreaks and one pseudo-outbreak demonstrated the certainty with which outbreaks could be confirmed or refuted. We identified local and regional differences in antibiotic resistance profiles, with examples of local expansion, as well as widespread circulation of mobile genetic elements across the bacterial population. We have generated a resource for the future surveillance and outbreak investigation of MRSA in the United Kingdom and Ireland and have shown the value of this during outbreak investigation and tracking of antimicrobial resistance.