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Background  Neonatal  Staphylococcus aureus  ( S. aureus ) bacteremia is an important cause of morbidity and mortality. In this study, we examined whether methicillin-susceptible  S. aureus  (MSSA) transmission and genetic makeup contribute to the occurrence of neonatal  S. aureus  bacteremia.    Methods  A retrospective, single-centre study was performed. All patients were included who suffered from  S. aureus  bacteremia in the neonatal intensive care unit (NICU), Erasmus MC-Sophia, Rotterdam, the Netherlands, between January 2011 and November 2017. Whole-genome sequencing (WGS) was used to characterize the  S. aureus  isolates, as was also done in comparison to reference genomes. Transmission was considered likely in case of genetically indistinguishable  S. aureus  isolates.    Results  Excluding coagulase-negative staphylococci (CoNS),  S. aureus  was the most common cause of neonatal bacteremia. Twelve percent ( n  = 112) of all 926 positive blood cultures from neonates grew  S. aureus . Based on core genome multilocus sequence typing (cgMLST), 12 clusters of genetically indistinguishable MSSA isolates were found, containing 33 isolates in total (2–4 isolates per cluster). In seven of these clusters, at least two of the identified MSSA isolates were collected within a time period of one month. Six virulence genes were present in 98–100% of all MSSA isolates. In comparison to  S. aureus  reference genomes, toxin genes encoding staphylococcal enterotoxin A ( sea ) and toxic shock syndrome toxin 1 ( tsst-1 ) were present more often in the genomes of bacteremia isolates.    Conclusion  Transmission of MSSA is a contributing factor to the occurrence of  S. aureus  bacteremia in neonates.  Sea  and  tsst-1  might play a role in neonatal  S. aureus  bacteremia.

Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia