Environmental surveillance of ESBL and carbapenemase-producing gram-negative bacteria in a Ghanaian Tertiary Hospital.
Environmental surveillance of ESBL and carbapenemase-producing gram-negative bacteria in a Ghanaian Tertiary Hospital.
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DOI：
10.1186/s13756-022-01090-2
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发表时间：
2022-03-16
影响因子：
5.5
通讯作者：
Spiller OB
中科院分区：
文献类型：
--
作者：
Acolatse JEE;Portal EAR;Boostrom I;Akafity G;Dakroah MP;Chalker VJ;Sands K;Spiller OB
抗生素耐药性感染的负担主要发生在中低收入国家，这些国家的抗生素耐药性率在很大程度上没有得到充分调查，并且面临着不受管制、不同且往往是自我指导获得抗生素的巨大压力。来自医院环境的医院感染已被证明是多药耐药菌株的特别普遍的来源，但医院环境污染的监测往往没有调查。这项研究是前瞻性的，观察性的和横断面的，从2021年3月15日到4月13日，从加纳海岸角教学医院的五个病房抽取了231个高和低触摸表面。在万古霉素和美罗培南或头孢噻肟存在下检查微生物生长，并通过MALDI-TOF鉴定细菌种类。通过PCR筛选出常见的超广谱β-内酰胺酶（ESBL）和碳青霉烯酶耐药基因（ARG），并通过表型药敏试验进行确证。使用多平台方法对碳青霉烯耐药基因阳性的分离株进行测序。我们从99%的拭子（n = 229/231）中回收了微生物生长，这些拭子在不存在抗菌剂的情况下接种在琼脂上。在整个医院环境中，发现多个部位存在耐药菌。从高接触点和低接触点分离出具有多重耐药性和ARG的细菌，有证据表明菌株在整个环境中传播。共分离出21种不同的携带ARG的细菌。通过全基因组测序和系统发育分析进一步表征观察到的携带blaNDM-1的鲍曼不动杆菌的高流行率，以确定在不同病房中发现的耐药菌株之间的关系。 在加纳的一家地区医院的两个独立病房中发现了具有高脓毒症风险的MDR细菌多克隆侵入的证据。在非洲，携带多种blaNDM的物种与ESBLs组合的流行尤其令人担忧和出乎意料。我们还鉴定了携带泰特（X3）、blaVIM-5或blaDIM-1的菌株，这些菌株显示出作为医院环境中的储库存在的碳青霉烯酶的高度多样性。来自整个医院多个环境地点的多重耐药细菌的发现将为未来的IPC实践提供信息，并有助于加纳AMR的研究优先级。在线版本包含补充材料，可通过10.1186/s13756-022-01090-2获得。
The burden of antibiotic resistant infection is mainly felt in low-to-middle income countries, where the rate of antimicrobial resistance is largely under-surveyed and under huge pressure from unregulated, disparate and often self-guided access to antimicrobials. Nosocomial infections from hospital environments have been shown to be a particularly prevalent source of multi-drug resistant strains, yet surveillance of hospital environmental contamination is often not investigated. The study was prospective, observational and cross-sectional, sampling 231 high and low touch surfaces from 15th March to 13th April 2021, from five wards in the Cape Coast Teaching Hospital, Ghana. Microbial growth in the presence of vancomycin and either meropenem or cefotaxime was examined and bacterial species were identified by MALDI-TOF. The presence of common extended-spectrum β-lactamases (ESBL) and carbapenemase antimicrobial resistance genes (ARG) were identified through PCR screening, which were confirmed by phenotypic antimicrobial susceptibility determination. Isolates positive for carbapenem resistance genes were sequenced using a multi-platform approach. We recovered microbial growth from 99% of swabs (n = 229/231) plated on agar in the absence of antimicrobials. Multiple sites were found to be colonised with resistant bacteria throughout the hospital setting. Bacteria with multi-drug resistance and ARG of concern were isolated from high and low touch points with evidence of strain dissemination throughout the environment. A total of 21 differing species of bacteria carrying ARG were isolated. The high prevalence of Acinetobacter baumannii carrying blaNDM-1 observed was further characterised by whole genome sequencing and phylogenetic analysis to determine the relationship between resistant strains found in different wards. Evidence of multiple clonal incursions of MDR bacteria of high sepsis risk were found in two separate wards for a regional hospital in Ghana. The prevalence of multiple blaNDM carrying species in combination with combinations of ESBLs was particularly concerning and unexpected in Africa. We also identify strains carrying tet(X3), blaVIM-5 or blaDIM-1 showing a high diversity of carbapenamases present as a reservoir in a hospital setting. Findings of multi-drug resistant bacteria from multiple environmental sites throughout the hospital will inform future IPC practices and aid research prioritisation for AMR in Ghana. The online version contains supplementary material available at 10.1186/s13756-022-01090-2.
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开放式细菌种群基因组学：BIGSDB软件，pubmlst.org网站及其应用。
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