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

抗生素用于治疗感染，但有些抗生素正在产生耐药性（AMR）。这是一个严重的问题，因为它威胁到我们认为理所当然的许多医疗程序，包括手术和化疗。政府估计，到2050年，每年将有1000万人因AMR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来产生耐药性。细菌和耐药基因可以在患者之间传播，特别是在医疗环境中。抗生素耐药细菌的病例在全球范围内以及帝国理工学院医疗信托基金（ICHNT）内都在增加。这是一个非常令人担忧的问题，因为耐药细菌感染很难治疗，而且往往会导致更糟糕的患者结局。感染控制程序试图限制耐药细菌在医疗机构内的传播。为了做到这一点，他们专注于诸如病人之间洗手和良好的清洁和维护医院环境的策略。为了支持这项工作，感染控制团队需要有关细菌类型及其耐药性根本原因的详细信息。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性细菌，因此很难跟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，有些细菌携带不止一种编码耐药性的基因。目前用于跟踪抗生素耐药性细菌传播的方法非常缓慢，并延迟了有效的感染控制反应。如果没有这个，患者的结果会更糟，细菌会传播给其他患者，导致AMR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AMR病例之间的可能联系，并包括患者在医院的路径以及抗生素使用量。该项目将使用更快的方法，通过检查它们的基因组序列来检测耐药细菌。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允许ICHNT快速感染控制反应，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的患者和环境中循环，以及它们如何变得耐药，以便我们可以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的感染控制团队将能够直接解决沉默CPE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，并且可以轻松地使它们适应未来新兴的AMR。

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.