Analysis of a Streptococcus pyogenes puerperal sepsis cluster by use of whole-genome sequencing

J Clin Microbiol. 2012 Jul;50(7):2224-8. doi: 10.1128/JCM.00675-12. Epub 2012 Apr 18.

Abstract

Between June and November 2010, a concerning rise in the number of cases of puerperal sepsis, a postpartum pelvic bacterial infection contracted by women after childbirth, was observed in the New South Wales, Australia, hospital system. Group A streptococcus (GAS; Streptococcus pyogenes) isolates PS001 to PS011 were recovered from nine patients. Pulsed-field gel electrophoresis and emm sequence typing revealed that GAS of emm1.40, emm75.0, emm77.0, emm89.0, and emm89.9 were each recovered from a single patient, ruling out a single source of infection. However, emm28.8 GAS were recovered from four different patients. To investigate the relatedness of these emm28 isolates, whole-genome sequencing was undertaken and the genome sequences were compared to the genome sequence of the emm28.4 reference strain, MGAS6180. A total of 186 single nucleotide polymorphisms were identified, for which the phylogenetic reconstruction indicated an outbreak of a polyclonal nature. While two isolates collected from different hospitals were not closely related, isolates from two puerperal sepsis patients from the same hospital were indistinguishable, suggesting patient-to-patient transmission or infection from a common source. The results of this study indicate that traditional typing protocols, such as pulsed-field gel electrophoresis, may not be sensitive enough to allow fine epidemiological discrimination of closely related bacterial isolates. Whole-genome sequencing presents a valid alternative that allows accurate fine-scale epidemiological investigation of bacterial infectious disease.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, Bacterial / genetics
  • Bacterial Outer Membrane Proteins / genetics
  • Carrier Proteins / genetics
  • Cluster Analysis
  • DNA, Bacterial / chemistry
  • DNA, Bacterial / genetics
  • Electrophoresis, Gel, Pulsed-Field
  • Female
  • Genome, Bacterial
  • Genome, Human
  • Humans
  • Molecular Epidemiology
  • Molecular Typing
  • New South Wales / epidemiology
  • Phylogeny
  • Polymorphism, Genetic
  • Puerperal Infection / epidemiology
  • Puerperal Infection / microbiology*
  • Sepsis / epidemiology
  • Sepsis / microbiology*
  • Sequence Analysis, DNA
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / microbiology*
  • Streptococcus pyogenes / classification*
  • Streptococcus pyogenes / genetics*
  • Streptococcus pyogenes / isolation & purification

Substances

  • Antigens, Bacterial
  • Bacterial Outer Membrane Proteins
  • Carrier Proteins
  • DNA, Bacterial
  • streptococcal M protein