Pervasive transmission of a carbapenem resistance plasmid in the gut microbiota of hospitalized patients.
Pervasive transmission of a carbapenem resistance plasmid in the gut microbiota of hospitalized patients.
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DOI：
10.1038/s41564-021-00879-y
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发表时间：
2021-05
影响因子：
28.3
通讯作者：
San Millán Á
中科院分区：
文献类型：
--
作者：
León-Sampedro R;DelaFuente J;Díaz-Agero C;Crellen T;Musicha P;Rodríguez-Beltrán J;de la Vega C;Hernández-García M;R-GNOSIS WP5 Study Group;López-Fresneña N;Ruiz-Garbajosa P;Cantón R;Cooper BS;San Millán Á
产碳青霉烯酶肠杆菌（CPE）引起的感染是全球临床环境中的主要问题。两个根本不同的过程塑造了CPE在医院中的流行病学：CPE克隆在患者之间的传播（患者间转移），以及编码碳青霉烯酶的质粒在个体患者肠道微生物群中的肠杆菌之间的转移（患者内转移）。每个过程对医院中碳青霉烯类耐药总体传播的相对贡献仍然知之甚少。在这里，我们使用机制模型结合来自9,000多名患者的流行病学数据和来自250个肠杆菌克隆的全基因组序列信息，以确定两年期间医院环境中pOXA-48样碳青霉烯酶编码质粒的传播途径。我们的研究结果显示，高风险的pOXA-48携带克隆，主要是肺炎克雷伯菌和零星大肠杆菌的患者之间的频繁传播。结果还确定了医院内pOXA-48的传播热点，例如特定病房和病房内的单个房间。使用高分辨率质粒序列分析，我们发现pOXA-48在患者体内普遍转移，这表明几乎每个定植患者的肠道中都发生了水平质粒转移。本研究揭示的复杂和多方面的流行病学情况为制定干预策略以控制CPE的院内传播提供了见解。
Infections caused by carbapenemase-producing enterobacteria (CPE) are a major concern in clinical settings worldwide. Two fundamentally different processes shape the epidemiology of CPE in hospitals: the dissemination of CPE clones from patient to patient (between-patient transfer), and the transfer of carbapenemase-encoding plasmids between enterobacteria in the gut microbiota of individual patients (within-patient transfer). The relative contribution of each process to the overall dissemination of carbapenem resistance in hospitals remains poorly understood. Here, we used mechanistic models combining epidemiological data from more than 9,000 patients with whole genome sequence information from 250 enterobacteria clones to characterise the dissemination routes of a pOXA-48-like carbapenemase-encoding plasmid in a hospital setting over a two-year period. Our results revealed frequent between-patient transmission of high-risk pOXA-48-carrying clones, mostly of Klebsiella pneumoniae and sporadically Escherichia coli. The results also identified pOXA-48 dissemination hotspots within the hospital, such as specific wards and individual rooms within wards. Using high-resolution plasmid sequence analysis, we uncovered the pervasive within-patient transfer of pOXA-48, suggesting that horizontal plasmid transfer occurs in the gut of virtually every colonised patient. The complex and multifaceted epidemiological scenario exposed by this study provides insights for the development of intervention strategies to control the in-hospital spread of CPE.
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影响因子：
46.9
作者：
Bikard, David;Euler, Chad W.;Jiang, Wenyan;Nussenzweig, Philip M.;Goldberg, Gregory W.;Duportet, Xavier;Fischetti, Vincent A.;Marraffini, Luciano A.
通讯作者：
Marraffini, Luciano A.
影响因子：
14.9
作者：
Haft DH;DiCuccio M;Badretdin A;Brover V;Chetvernin V;O'Neill K;Li W;Chitsaz F;Derbyshire MK;Gonzales NR;Gwadz M;Lu F;Marchler GH;Song JS;Thanki N;Yamashita RA;Zheng C;Thibaud-Nissen F;Geer LY;Marchler-Bauer A;Pruitt KD
通讯作者：
Pruitt KD
影响因子：
11.8
作者：
Goettig, Stephan;Gruber, Teresa M.;Kempf, Volkhard A. J.
通讯作者：
Kempf, Volkhard A. J.
影响因子：
4.9
作者：
Decraene, V.;Phan, H. T. T.;Cawthorne, J.
通讯作者：
Cawthorne, J.
影响因子：
1.7
作者：
Bankevich, Anton;Nurk, Sergey;Pevzner, Pavel A.
通讯作者：
Pevzner, Pavel A.