Transmission and Antibiotic Resistance of Achromobacter in Cystic Fibrosis.
Transmission and Antibiotic Resistance of Achromobacter in Cystic Fibrosis.
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DOI：
10.1128/jcm.02911-20
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发表时间：
2021-03-19
影响因子：
9.4
通讯作者：
Marvig RL
中科院分区：
文献类型：
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作者：
Gabrielaite M;Bartell JA;Nørskov-Lauritsen N;Pressler T;Nielsen FC;Johansen HK;Marvig RL
在囊性纤维化（CF）患者中越来越多地检测到无色杆菌属，这种新兴的病原体与抗生素耐药性和更严重的疾病结局有关。然而，对无色杆菌感染的传播程度和抗生素耐药性发展知之甚少。在囊性纤维化（CF）患者中越来越多地检测到无色杆菌属，这种新兴的病原体与抗生素耐药性和更严重的疾病结局有关。然而，对无色杆菌感染的传播程度和抗生素耐药性发展知之甚少。我们对从51例CF患者中收集的101株无色杆菌临床分离株（根据基质辅助激光解吸电离飞行时间[MALDI-TOF]或API N20分型鉴定为木糖氧化无色杆菌）的基因组进行了测序，这是迄今为止最大的纵向数据集。我们对基因组进行了系统发育分析，并将其与流行病学和抗生素耐药性数据相结合，以确定患者间的传播和抗生素耐药性的发展。我们证实MALDI-TOF或API N20方法不足以用于无色杆菌种水平的分型，并且无色杆菌分离株群体由五个不同的种组成，其中A.木糖氧化物占感染的52%。大多数患者被独特的无色杆菌克隆类型感染;尽管如此，在35%（n = 18）的患者中观察到了由共享克隆类型确定的疑似患者间传播病例。在16例病例中，15例的疑似传播得到了基于基因组或门诊访视的流行病学分析的进一步支持。最后，我们发现耐药性随着时间的推移而发展。我们表明，全基因组测序（WGS）对于无色杆菌物种分型和患者间传播的鉴定至关重要，这一点在鲁氏无色杆菌、A.木糖氧化物，以及首次发现的无色杆菌。此外，我们发现抗生素耐药性的发展与慢性无色杆菌感染有关。我们的研究结果强调，在未来的治疗策略中应考虑传播和抗生素耐药性。
Achromobacter species are increasingly being detected in patients with cystic fibrosis (CF), and this emerging pathogen is associated with antibiotic resistance and more-severe disease outcomes. Nonetheless, little is known about the extent of transmission and antibiotic resistance development in Achromobacter infections. Achromobacter species are increasingly being detected in patients with cystic fibrosis (CF), and this emerging pathogen is associated with antibiotic resistance and more-severe disease outcomes. Nonetheless, little is known about the extent of transmission and antibiotic resistance development in Achromobacter infections. We sequenced the genomes of 101 Achromobacter clinical isolates (identified as Achromobacter xylosoxidans based on matrix-assister laser desorption ionization–time of flight [MALDI-TOF] or API N20 typing) collected from 51 patients with CF—the largest longitudinal data set to date. We performed phylogenetic analysis on the genomes and combined this with epidemiological and antibiotic resistance data to identify patient-to-patient transmission and the development of antibiotic resistance. We confirmed that the MALDI-TOF or API N20 method was not sufficient for Achromobacter species-level typing and that the population of Achromobacter isolates was composed of five different species, among which A. xylosoxidans accounted for 52% of infections. Most patients were infected by unique Achromobacter clone types; nonetheless, suspected patient-to-patient transmission cases identified by shared clone types were observed in 35% (n = 18) of patients. In 15 of 16 cases, the suspected transmissions were further supported by genome- or clinic visit-based epidemiological analysis. Finally, we found that resistance developed over time. We show that whole-genome sequencing (WGS) is essential for Achromobacter species typing and identification of patient-to-patient transmission, which was revealed for Achromobacter ruhlandii, A. xylosoxidans, and, for the first time, Achromobacter insuavis. Furthermore, we show that the development of antibiotic resistance is associated with chronic Achromobacter infections. Our findings emphasize that transmission and antibiotic resistance should be considered in future treatment strategies.