Preoptimized phage cocktail for use in aerosols against nosocomial transmission of carbapenem-resistant Acinetobacter baumannii: A 3-year prospective intervention study
Preoptimized phage cocktail for use in aerosols against nosocomial transmission of carbapenem-resistant Acinetobacter baumannii: A 3-year prospective intervention study
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DOI：
10.1016/j.ecoenv.2022.113476
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发表时间：
2022-03-31
影响因子：
6.8
通讯作者：
Tseng, Chun-Chieh
中科院分区：
文献类型：
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作者：
Chen, Li-Kuang;Chang, Jui-Chih;Tseng, Chun-Chieh
使用噬菌体作为环境消毒剂已被认为是一种潜在的替代方法，以消除细菌污染的体外，然而，很少有研究可用于在医院感染控制的噬菌体的应用。在这里，我们进行了一项为期3年的前瞻性干预研究，使用雾化噬菌体鸡尾酒作为生物控制剂对碳青霉烯类耐药鲍曼不动杆菌（CRAB）感染的医院。当在重症监护室（ICU）中确定CRAB感染患者时，选择其周围环境进行噬菌体气溶胶去污。在去污前，对501例患者的临床标本进行了抗生素耐药性分析和噬菌体分型。最佳的噬菌体混合物是不同噬菌体家族的组合，或者通过下一个进化噬菌体分型构建，其中宿主裂解区的得分最高，以防止环境CRAB噬菌体抗性的发展。抗虫A.鲍曼不动杆菌感染率为97.1%，而对鲍曼不动杆菌敏感的菌株感染率为79.3%。在2017年至2019年的噬菌体去污期间，碳青霉烯类耐药A.鲍曼不动杆菌感染率从65.3%显著下降至55%。在三年中，CRAB感染的新获得率为4.4/1000患者-天，这显著低于从未进行噬菌体去污的对照病房（8.9/1000患者-天）。总之，我们的研究结果支持噬菌体鸡尾酒的潜力，以降低CRAB感染率，和气溶胶生成过程可能使这种方法更全面和节省时间。
Using bacteriophages (phages) as environmental sanitizers has been recognized as a potential alternative method to remove bacterial contamination in vitro; however, very few studies are available on the application of phages for infection control in hospitals. Here, we performed a 3-year prospective intervention study using aerosolized phage cocktails as biocontrol agents against carbapenem-resistant Acinetobacter baumannii (CRAB) infection in the hospital. When a CRAB-infected patient was identified in an intensive care unit (ICU), their surrounding environment was chosen for phage aerosol decontamination. Before decontamination, 501 clinical specimens from the patients were subjected to antibiotic resistance analysis and phage typing. The optimal phage cocktails were a combination of different phage families or were constructed by next-evolutionary phage typing with the highest score for the host lysis zone to prevent the development of environmental CRAB phage resistance. The phage infection percentage of the antibiotic-resistant A. baumannii strains was 97.1%, whereas the infection percentage in the antibiotic-susceptible strains was 79.3%. During the phage decontamination periods from 2017 to 2019, the percentage of carbapenem-resistant A. baumannii in test ICUs decreased significantly from 65.3% to 55%. The rate of new acquisitions of CRAB infection over the three years was 4.4 per 1000 patient-days, which was significantly lower than that in the control wards (8.9 per 1000 patient-days) where phage decontamination had never been performed. In conclusion, our results support the potential of phage cocktails to decrease CRAB infection rates, and the aerosol generation process may make this approach more comprehensive and time-saving.