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

对医院内水平基因转移引起的碳青霉烯类耐药性的流行病学和遗传学调查。

• 批准号: MR/T005254/1
• 负责人: Frances Davies
• 金额: $ 31.55万
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT005254%2F1
• 关键词: Epidemiological; genetic; investigations; into; carbapenem

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.

抗生素是用来治疗感染的，但有些抗生素正在产生耐药性。这是一个严重的问题，因为它威胁到许多我们习以为常的医疗程序，包括手术和化疗。政府估计，到2050年，每年将有1000万人因抗菌素耐药性而面临生命危险。细菌可以通过获得保护它们免受抗生素侵害的基因而产生耐药性。细菌和耐药基因可以在患者之间传播，特别是在医疗保健环境中。抗生素耐药细菌的病例在世界范围内增加，也在帝国理工学院医疗信托（ICHNT）。这是非常令人担忧的，因为耐药细菌感染很难治疗，而且往往导致患者预后更差。感染控制程序试图在卫生保健环境中限制耐药细菌的传播。为了做到这一点，他们把重点放在病人之间的洗手以及良好的清洁和维护医院环境等策略上。为了支持这项工作，感染控制小组需要关于细菌类型及其潜在耐药性原因的详细信息。由于一些患者的肠道中可能携带许多不同种类的抗生素耐药细菌，因此很难追踪如何从一个患者传播到另一个患者。更复杂的是，抗生素耐药性的产生有很多不同的方式，一些细菌携带不止一种编码耐药性的基因。目前用于追踪耐药细菌传播的方法非常缓慢，并且会延迟有效的感染控制反应。如果不这样做，患者的结果会更糟，细菌可能会传播给其他患者，导致抗生素耐药性的爆发。该项目将开发新的方法来证明细菌在医院周围的传播，检测以前未发现的抗菌素耐药性病例之间的可能联系，并包括患者在医院的位置和抗生素使用量的途径。该项目将通过检测耐药细菌的基因组序列，使用更快的方法来鉴定耐药细菌的特征。它还将更详细地研究可以在不同细菌（质粒）之间传播的小片段基因。将所有这些信息放在一起，将使ICHNT能够迅速作出感染控制反应，以阻止感染的传播。测序工具还将使我们能够更好地了解哪些耐药细菌在ICHNT的患者和环境中传播，以及它们是如何变得耐药的，以便我们能够限制它们在患者之间的传播。通过识别这些额外的风险因素，ICHNT的感染控制小组将能够直接解决CPE无声传播的问题，并将为英国和世界各地试图解决这些耐药细菌威胁的其他医院提供有价值的信息。在项目完成后很长一段时间内，这些系统将继续使患者受益，因为它们将完全在医院内建造，并且可以很容易地使它们适应未来出现的抗菌素耐药性。

项目成果

Prevalence of recurrent extended-spectrum beta-lactamase (ESBL) urinary tract infections (UTIs) in patients within a urology service. Introducing the concept of faecal Microbiota transplantation (FMT) as a treatment modality

泌尿外科患者中复发性超广谱 β-内酰胺酶 (ESBL) 尿路感染 (UTI) 的患病率。

• DOI: 10.1016/s1569-9056(19)30281-7
• 发表时间: 2019
• 期刊: European Urology Supplements
• 作者: Ghani R

MP71-15 PREVALENCE OF RECURRENT EXTENDED-SPECTRUM BETA-LACTAMASE (ESBL) URINARY TRACT INFECTIONS (UTIS) IN PATIENTS WITHIN A UROLOGY SERVICE. INTRODUCING THE CONCEPT OF FAECAL MICROBIOTA TRANSPLANTATION (FMT) AS A TREATMENT MODALITY

MP71-15 泌尿科患者中复发性超广谱 β-内酰胺酶 (ESBL) 尿路感染 (UTIS) 的患病率。

• DOI: 10.1097/01.ju.0000557127.74424.ed
• 发表时间: 2019
• 期刊: Journal of Urology
• 影响因子: 6.6
• 作者: Ghani* R

The potential utility of fecal (or intestinal) microbiota transplantation in controlling infectious diseases.

• DOI: 10.1080/19490976.2022.2038856
• 发表时间: 2022-01
• 期刊: Gut microbes
• 影响因子: 12.2
• 作者: Ghani R;Mullish BH;Roberts LA;Davies FJ;Marchesi JR
• 通讯作者: Marchesi JR

P14 Optimization of real-time sequencing for rapid detection of bacterial species and antimicrobial resistance in blood and urine infections

• DOI: 10.1093/jacamr/dlad077.018
• 发表时间: 2023-08-02
• 期刊: JAC-Antimicrobial Resistance
• 影响因子: 3.4

Disease Prevention Not Decolonization: A Model for Fecal Microbiota Transplantation in Patients Colonized With Multidrug-resistant Organisms.

• DOI: 10.1093/cid/ciaa948
• 发表时间: 2021-04-26
• 期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
• 作者: Ghani R;Mullish BH;McDonald JAK;Ghazy A;Williams HRT;Brannigan ET;Mookerjee S;Satta G;Gilchrist M;Duncan N;Corbett R;Innes AJ;Pavlů J;Thursz MR;Davies F;Marchesi JR
• 通讯作者: Marchesi JR