Whole Genome Sequencing detects Inter-Facility Transmission of Carbapenem-resistant Klebsiella pneumoniae
Whole Genome Sequencing detects Inter-Facility Transmission of Carbapenem-resistant Klebsiella pneumoniae
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DOI：
10.1016/j.jinf.2018.11.003
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发表时间：
2019-03-01
影响因子：
28.2
通讯作者：
Fodor, Anthony A.
中科院分区：
文献类型：
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作者：
Spencer, Melanie D.;Winglee, Kathryn;Fodor, Anthony A.
目的：确定某大型三级医疗机构暴发期间耐碳青霉烯类肺炎克雷伯菌感染的传播模式，并检测暴发微生物是否传播到综合医疗网络中的其他设施。从暴发前、期间和之后的临床标本中收集肺炎杆菌全基因组序列，并查阅相应的患者病历。序列和患者数据被用来建模可能的传播和评估与暴发相关的因素。结果：我们在研究期间采样的耐碳青霉烯类肺炎克雷伯菌之间确定了密切的遗传关系。传播树分析结合患者记录发现，在许多研究患者中，沉默定植的时间较长，传播途径可能是无症状患者在不同机构之间转换的结果。结论：在患者流行率、无症状携带和流动性不断上升的环境中，检测耐碳青霉烯类肺炎克雷伯菌感染的传播方式和地点是具有挑战性的。全基因组测序提高了研究设施间传播的精确度。我们的结果强调，遏制对碳青霉烯耐药肺炎克雷伯菌感染需要医疗网络和护理环境之间的协调努力，以承认和减少未被发现的携带和设施之间的患者转移所带来的传播风险。(C)2018年作者。由爱思唯尔有限公司代表英国感染协会出版。
Objectives: To identify transmission patterns of Carbapenem-resistant Klebsiella pneumoniae infection during an outbreak at a large, tertiary care hospital and to detect whether the outbreak organisms spread to other facilities in the integrated healthcare network.Methods: We analyzed 71K. pneumoniae whole genome sequences collected from clinical specimens before, during and after the outbreak and reviewed corresponding patient medical records. Sequence and patient data were used to model probable transmissions and assess factors associated with the outbreak.Results: We identified close genetic relationships among carbapenem-resistant K. pneumoniae isolates sampled during the study period. Transmission tree analysis combined with patient records uncovered extended periods of silent colonization in many study patients and transmission routes that were likely the result of asymptomatic patients transitioning between facilities.Conclusions: Detecting how and where Carbapenem-resistant K. pneumoniae infections spread is challenging in an environment of rising prevalence, asymptomatic carriage and mobility of patients. Whole genome sequencing improved the precision of investigating inter-facility transmissions. Our results emphasize that containment of Carbapenem-resistant K. pneumoniae infections requires coordinated efforts between healthcare networks and settings of care that acknowledge and mitigate transmission risk conferred by undetected carriage and by patient transfers between facilities. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association.