# Unravelling the Persistence of the Rare Serovar Salmonella Mikawasima in a Hospital Setting: A Whole-Genome Sequencing Study

## TL;DR

This study uses whole-genome sequencing to investigate the persistence of a rare Salmonella strain in a hospital, revealing its genetic traits and spread patterns.

## Contribution

The study provides the first genomic analysis of Salmonella Mikawasima in a hospital outbreak, revealing its clonal spread and resistance traits.

## Key findings

- Sequenced isolates were classified as ST2030 with resistance to aminoglycosides and beta-lactams.
- Spatial and temporal analysis showed clonal expansion and possible transmission between hospital wards.
- Biofilm formation genes suggest the strain's ability to persist in hospital environments.

## Abstract

Salmonella Mikawasima is a rare, mainly environmental serovar. In 2020, an outbreak was observed in neonatal and maternal wards of the University Hospital of Split and was established as an endemic until the end of 2024. Using whole-genome sequencing, this study aimed to analyse the phenotypic and genotypic characteristics of S. Mikawasima isolates and to elaborate whether the spread of the same clone occurred. Sequenced isolates were classified as ST2030, with the presence of aminoglycoside and extended spectrum beta-lactam resistance genes. Ten percent of the sequenced isolates exhibit multi-drug resistance. Identified virulence factors that include biofilm formation genes suggest the potential persistence of S. Mikawasima in the hospital environment, while spatial and temporal analysis reveal clonal expansion and possible horizontal transmission between different hospital wards. This study provides a deep understanding of the genomic composition of S. Mikawasima and emphasises the need for more stringent infection prevention measures, especially in vulnerable neonatal and postpartum settings, to mitigate the risk of healthcare-associated infections, and it should be followed by further microbiological and epidemiological investigations to identify the source of infection.