Multiple introductions and subsequent transmission of multidrug-resistant Candida auris in the USA: a molecular epidemiological survey
Multiple introductions and subsequent transmission of multidrug-resistant Candida auris in the USA: a molecular epidemiological survey
复制标题
DOI：
10.1016/s1473-3099(18)30597-8
复制
发表时间：
2018-12-01
影响因子：
56.3
通讯作者：
Litvintseva, Anastasia P.
中科院分区：
文献类型：
--
作者：
Chow, Nancy A.;Gade, Lalitha;Litvintseva, Anastasia P.
背景耐多药金黄色念珠菌感染的传播在美国已有报道。为了更好地了解它的出现和传播动态，并指导临床和公共卫生反应，我们对美国的Auris病例进行了分子流行病学调查。方法在分子流行病学调查中，我们使用全基因组测序来评估从美国10个州(加利福尼亚州、康涅狄格州、佛罗里达州、伊利诺伊州、印第安纳州、马里兰州、马萨诸塞州、新泽西州、纽约州和俄克拉何马州)收集的分离株与其他几个国家(哥伦比亚、印度、日本、巴基斯坦、南非、韩国和委内瑞拉)分离的分离株之间的遗传相似性。我们与州卫生部门合作，他们为我们提供了用于测序的分离株。这些金黄色葡萄球菌分离株是在正常的临床护理过程中(临床病例)或作为接触调查或点流行调查(筛查病例)的一部分收集的。我们整合了来自标准化病例报告表和接触者调查的数据，包括旅行史和流行病学联系(即与C Auris患者共用一个房间或病房的患者)。从2013年5月11日至2017年8月31日收集133例病例(73例临床病例和60例筛查病例)，通过单核苷酸多态(SNPs)的成对差异分析，评价患者、机构和州内Auris的遗传多样性。73例临床病例中，66例(90%)涉及南亚分离株，5例(7%)涉及南美分离株，1例(1%)涉及非洲分离株，1例(1%)涉及东亚分离株。大多数(60例[82%])临床病例是在纽约和新泽西发现的；这些分离株虽然与南亚分离株有关，但在基因上是不同的。基因组数据证实了5例(7%)临床病例，在这些病例中，患者可能通过在国外的医疗保健暴露而感染了C-Auris。在临床和筛查病例中，一个人体内的C Auris分离株的遗传多样性与暴发期间设施内的相似(SNP差异的中位数为3个SNP，范围0-12)。美国的C Auris解释分离株与来自全球四个地区的C Auris分离株在遗传上有亲缘关系，这表明C Auris曾多次引入美国。这五个与旅行相关的案例是介绍如何发生的例子。来自相同患者、卫生保健机构和各州的分离株之间的遗传多样性表明存在地方性和持续的传播。版权所有(C)2018爱思唯尔有限公司。保留所有权利。
Background Transmission of multidrug-resistant Candida auris infection has been reported in the USA. To better understand its emergence and transmission dynamics and to guide clinical and public health responses, we did a molecular epidemiological investigation of C auris cases in the USA.Methods In this molecular epidemiological survey, we used whole-genome sequencing to assess the genetic similarity between isolates collected from patients in ten US states (California, Connecticut, Florida, Illinois, Indiana, Maryland, Massachusetts, New Jersey, New York, and Oklahoma) and those identified in several other countries (Colombia, India, Japan, Pakistan, South Africa, South Korea, and Venezuela). We worked with state health departments, who provided us with isolates for sequencing. These isolates of C auris were collected during the normal course of clinical care (clinical cases) or as part of contact investigations or point prevalence surveys (screening cases). We integrated data from standardised case report forms and contact investigations, including travel history and epidemiological links (ie, patients that had shared a room or ward with a patient with C auris). Genetic diversity of C auris within a patient, a facility, and a state were evaluated by pairwise differences in single-nucleotide polymorphisms (SNPs).Findings From May 11, 2013, to Aug 31, 2017, isolates that corresponded to 133 cases (73 clinical cases and 60 screening cases) were collected. Of 73 clinical cases, 66 (90%) cases involved isolates related to south Asian isolates, five (7%) cases were related to South American isolates, one (1%) case to African isolates, and one (1%) case to east Asian isolates. Most (60 [82%]) clinical cases were identified in New York and New Jersey; these isolates, although related to south Asian isolates, were genetically distinct. Genomic data corroborated five (7%) clinical cases in which patients probably acquired C auris through health-care exposures abroad. Among clinical and screening cases, the genetic diversity of C auris isolates within a person was similar to that within a facility during an outbreak (median SNP difference three SNPs, range 0-12).Interpretation Isolates of C auris in the USA were genetically related to those from four global regions, suggesting that C auris was introduced into the USA several times. The five travel-related cases are examples of how introductions can occur. Genetic diversity among isolates from the same patients, health-care facilities, and states indicates that there is local and ongoing transmission. Copyright (c) 2018 Elsevier Ltd. All rights reserved.