Possible Interplay Between Hospital and Community Transmission of a Novel Clostridium Difficile Sequence Type 295 Recognized by Next-Generation Sequencing
Possible Interplay Between Hospital and Community Transmission of a Novel Clostridium Difficile Sequence Type 295 Recognized by Next-Generation Sequencing
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DOI：
10.1017/ice.2016.52
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发表时间：
2016-06-01
影响因子：
4.5
通讯作者：
Rogers, Thomas R.
中科院分区：
文献类型：
--
作者：
Moloney, Geraldine;Mac Aogain, Michel;Rogers, Thomas R.
目标。利用新一代测序（NGS）分析增强流行病学信息，以识别和解决艰难梭菌爆发，并评估其在现有标准PCR核糖体分型能力之外的有效性。NGS分析是对某大学医院所有检测到的难辨梭菌分离株进行前瞻性监测的一部分。在一家医院和一家收容无家可归成年人的社区招待所发现了一种新型艰难梭菌序列型(ST)-295的暴发。对所有ST-295和最接近的ST-2分离株进行系统发育分析。流行病学资料来自医院记录和社区招待所的公共卫生审查。我们在2013年6月至2015年4月间确定了7例艰难梭菌ST-295感染患者。在这些患者中，3人在医院接触过这种感染，3人可能在旅馆接触过这种感染。当前美国卫生保健流行病学学会(SHEA)-美国传染病学会（IDSA）监测定义（2010年）是根据我们的NGS研究结果考虑的。由于从ST-295接触到出现症状有16周的时间，使用现行标准无法检测到最初的传播。我们纳入了3例因住院而符合医院获得性感染监测标准的旅舍暴露患者。NGS分析增强了流行病学信息，并帮助确定和解决了超出标准PCR核糖分型能力的疫情。在这一聚集性病例中，利用NGS确定了一家旅馆可能是社区艰难梭菌传播的来源。
OBJECTIVE. To use next-generation sequencing (NGS) analysis to enhance epidemiological information to identify and resolve a Clostridium difficile outbreak and to evaluate its effectiveness beyond the capacity of current standard PCR ribotyping.METHODS. NGS analysis was performed as part of prospective surveillance of all detected C. difficile isolates at a university hospital. An outbreak of a novel C. difficile sequence type (ST)-295 was identified in a hospital and a community hostel for homeless adults. Phylogenetic analysis was performed of all ST-295 and closest ST-2 isolates. Epidemiological details were obtained from hospital records and the public health review of the community hostel.RESULTS. We identified 7 patients with C. difficile ST-295 infections between June 2013 and April 2015. Of these patients, 3 had nosocomial exposure to this infection and 3 had possible hostel exposure. Current Society for Healthcare Epidemiology of America (SHEA)-Infectious Diseases Society of America (IDSA) surveillance definitions (2010) were considered in light of our NGS findings. The initial transmission was not detectable using current criteria, because of 16 weeks between ST-295 exposure and symptoms. We included 3 patients with hostel exposure who met surveillance criteria of hospital-acquired infection due to their hospital admissions.CONCLUSION. NGS analysis enhanced epidemiological information and helped identify and resolve an outbreak beyond the capacity of standard PCR ribotyping. In this cluster of cases, NGS was used to identify a hostel as the likely source of community-based C. difficile transmission.