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In this study, we examined whether methicillin-susceptible<jats:italic>S. aureus<\/jats:italic>(MSSA) transmission and genetic makeup contribute to the occurrence of neonatal<jats:italic>S. aureus<\/jats:italic>bacteremia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective, single-centre study was performed. All patients were included who suffered from<jats:italic>S. aureus<\/jats:italic>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<jats:italic>S. aureus<\/jats:italic>isolates, as was also done in comparison to reference genomes. Transmission was considered likely in case of genetically indistinguishable<jats:italic>S. aureus<\/jats:italic>isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Excluding coagulase-negative staphylococci (CoNS),<jats:italic>S. aureus<\/jats:italic>was the most common cause of neonatal bacteremia. Twelve percent (<jats:italic>n<\/jats:italic>\u2009=\u2009112) of all 926 positive blood cultures from neonates grew<jats:italic>S. aureus<\/jats:italic>. Based on core genome multilocus sequence typing (cgMLST), 12 clusters of genetically indistinguishable MSSA isolates were found, containing 33 isolates in total (2\u20134 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\u2013100% of all MSSA isolates. In comparison to<jats:italic>S. aureus<\/jats:italic>reference genomes, toxin genes encoding staphylococcal enterotoxin A (<jats:italic>sea<\/jats:italic>) and toxic shock syndrome toxin 1 (<jats:italic>tsst-1<\/jats:italic>) were present more often in the genomes of bacteremia isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Transmission of MSSA is a contributing factor to the occurrence of<jats:italic>S. aureus<\/jats:italic>bacteremia in neonates.<jats:italic>Sea<\/jats:italic>and<jats:italic>tsst-1<\/jats:italic>might play a role in neonatal<jats:italic>S. aureus<\/jats:italic>bacteremia.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13756-020-0699-8","type":"journal-article","created":{"date-parts":[[2020,2,22]],"date-time":"2020-02-22T15:02:47Z","timestamp":1582383767000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2013-5696","authenticated-orcid":false,"given":"Bibi C. 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The Institutional Ethics Review Board of the Erasmus MC reviewed the study protocol and provided an exemption from formal ethical assessment (MEC-2015-306), based on the non-interventional design. The study was carried out in accordance with the current ethical guidelines for epidemiological research.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All other authors declare that there are no competing personal or institutional interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"39"}}