Epidemiological and genetic investigations into carbapenem resistance caused by horizontal gene transfer within hospitals.

点击翻译按钮获取中文摘要

Antibiotics are used to treat infections but some are developing resistance (AMR). This is a serious problem as it threatens many of the medical procedures we take for granted, including surgery and chemotherapy. The government estimates that by 2050, 10 million lives a year are at risk due to AMR. Bacteria can develop resistance by acquiring genes that protect them from antibiotics. The bacteria and the resistance genes can spread between patients, particularly within healthcare environments.Cases of antibiotic resistant bacteria are increasing worldwide and also within Imperial College Healthcare Trust (ICHNT). This is of great concern as infections with resistant bacteria are hard to treat and often result in worse patient outcomes. Infection control procedures try and restrict the spread of resistant bacteria within healthcare settings. To do this they focus on strategies such as hand washing between patients and good cleaning and maintenance of the hospital environment. To support this work, infection control teams need detailed information on the type of bacteria and their underlying cause of resistance. As some patients can carry many different species of antibiotic resistant bacteria in their gut, it can be difficult to track how spread from one patient to another has occurred. To complicate the picture more, there are lots of different ways that antibiotic resistance can occur, and some bacteria carry more than one gene coding for resistance.The methods used to track the spread of antibiotic resistant bacteria currently are very slow and delay effective infection control responses. Without this patient outcomes are worse and the bacteria can spread to other patients causing outbreaks of AMR. This project will develop new ways to demonstrate the spread of bacteria around hospitals, detecting possible links between cases of AMR that have not been found before, and including pathways of where patients have been in the hospital and how much antibiotic use there has been. The project will use faster methods to characterise resistant bacteria by examining their genome sequence. It will also look at the small pieces of genes that can be spread between different bacteria (plasmids) in more detail.Putting all this information together will allow rapid infection control responses at ICHNT, to stop the spread of infections. The sequencing tool will also allow us to better understand which resistant bacteria are circulating within patients and the environment at ICHNT and how they have become resistant so that we can limit their patient to patient spread. By identifying these additional risk factors, the infection control team at ICHNT will be able to directly tackle the problem of silent CPE spread, and it will provide valuable information to other hospitals in both in the UK and across the world attempting to tackle the threat of these resistant bacteria. The systems put in place will continue to benefit patients long after the project has finished, as they will be built entirely within the hospital, and it will be possible to easily adapt them to future emerging AMR.