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Gravey F, Wilson S, Denisenko A, Lehoussel C, Fines-Guyon M, Le Hello S, Jeanne-Leroyer C. Highlighting extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak by routine genomic typing. Heliyon 2023; 9:e16131. [PMID: 37251855 PMCID: PMC10209395 DOI: 10.1016/j.heliyon.2023.e16131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Whole genome sequencing has become the gold standard for any microbiological investigations. Taking the opportunity to doing it prospectively and routinely allowed to detect undeclared outbreaks. Thanks to that, we investigated and ended a rare epidemic extended-spectrum beta-lactamase-producing Klebsiella pneumoniae ST584 strain on two intensive care units over a 4-month period.
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Affiliation(s)
- F. Gravey
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM DYNAMICURE UMR 1311, CHU Caen, Caen, France
- CHU Caen, Departement of Microbiology, F-14000, Caen, France
| | - S. Wilson
- CHU Caen, Departement of Hospital Hygiene and Infection Control, F-14000, Caen, France
| | - A. Denisenko
- CHU Caen, Departement of Surgical Intensive Care Unit, F-14000, Caen, France
| | - C. Lehoussel
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM DYNAMICURE UMR 1311, CHU Caen, Caen, France
| | | | - S. Le Hello
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM DYNAMICURE UMR 1311, CHU Caen, Caen, France
- CHU Caen, Departement of Microbiology, F-14000, Caen, France
- CHU Caen, Departement of Hospital Hygiene and Infection Control, F-14000, Caen, France
| | - C. Jeanne-Leroyer
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM DYNAMICURE UMR 1311, CHU Caen, Caen, France
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2
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Threshold-free genomic cluster detection to track transmission pathways in health-care settings: a genomic epidemiology analysis. THE LANCET MICROBE 2022; 3:e652-e662. [PMID: 35803292 PMCID: PMC9869340 DOI: 10.1016/s2666-5247(22)00115-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A crucial barrier to the routine application of whole-genome sequencing (WGS) for infection prevention is the insufficient criteria for determining whether a genomic linkage is consistent with transmission within the facility. We evaluated the use of single-nucleotide variant (SNV) thresholds, as well as a novel threshold-free approach, for inferring transmission linkages in a high-transmission setting. METHODS We did a retrospective genomic epidemiology analysis of samples previously collected in the context of an intervention study at a long-term acute care hospital in the USA. We performed WGS on 435 isolates of Klebsiella pneumoniae harbouring the blaKPC carbapenemase (KPC-Kp) collected from 256 patients through admission and surveillance culturing (once every 2 weeks) of almost every patient who was admitted to hospital over a 1-year period. FINDINGS Our analysis showed that the standard approach of using an SNV threshold to define transmission would lead to false-positive and false-negative inferences. False-positive inferences were driven by the frequent importation of closely related strains, which were presumably linked via transmission at connected health-care facilities. False-negative inferences stemmed from the diversity of colonising populations that were spread among patients, with multiple examples of hypermutator strain emergence within patients and, as a result, putative transmission links separated by large genetic distances. Motivated by limitations of an SNV threshold, we implemented a novel threshold-free transmission cluster inference approach, in which each of the acquired KPC-Kp isolates were linked back to the imported KPC-Kp isolate with which it shared the most variants. This approach yielded clusters that varied in levels of genetic diversity but where 105 (81%) of 129 unique strain acquisition events were associated with epidemiological links in the hospital. Of 100 patients who acquired KPC-Kp isolates that were included in a cluster, 47 could be linked to a single patient who was positive for KPC-Kp at admission, compared with 31 and 25 using 10 SNV and 20 SNV thresholds, respectively. Holistic examination of clusters highlighted extensive variation in the magnitude of onward transmission stemming from more than 100 importation events and revealed patterns in cluster propagation that could inform improvements to infection prevention strategies. INTERPRETATION Our results show how the integration of culture surveillance data into genomic analyses can overcome limitations of cluster detection based on SNV-thresholds and improve the ability to track pathways of pathogen transmission in health-care settings. FUNDING US Center for Disease Control and Prevention and University of Michigan.
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3
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Wareth G, Linde J, Hammer P, Pletz MW, Neubauer H, Sprague LD. WGS-Based Phenotyping and Molecular Characterization of the Resistome, Virulome and Plasmid Replicons in Klebsiella pneumoniae Isolates from Powdered Milk Produced in Germany. Microorganisms 2022; 10:microorganisms10030564. [PMID: 35336140 PMCID: PMC8956024 DOI: 10.3390/microorganisms10030564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
The emergence of Klebsiella pneumoniae (K. pneumoniae) in German healthcare is worrying. It is not well-investigated in the veterinary world and food chains. In the current study, antibiotic susceptibility profiles of 24 K. pneumoniae strains isolated from powdered milk samples produced in Germany were investigated by a microdilution test. Next-generation sequencing (NGS) was applied to identify genomic determinants for antimicrobial resistance (AMR), virulence-associated genes and plasmids replicons. All isolates were susceptible to the majority (14/18) of tested antibiotics. Resistance to colistin, fosfomycin, chloramphenicol and piperacillin was found. The ambler class A ß-lactamase, blaSHV variants were identified in all isolates, of which blaSHV-187 was most prevalent and found in 50% of isolates. Single-nucleotide-variants of oqxA and oqxB conferring resistance to phenicol/quinolone were found in all isolates, and the oqxB17 was the most prevalent found in 46% of isolates. 67% of isolates harbored fosA genes; however, only one was fosfomycin-resistant. Two isolates harbored genes conferring resistance to colistin, despite being susceptible. The majority of identified virulome genes were iron uptake siderophores. Two enterobactins (entB, fepC), six adherence-related genes belonging to E. coli common pilus (ECP) and one secretion system (ompA gene) were found in all isolates. In contrast, yersiniabactin was found in two isolates. One ST23 strain was susceptible to all tested antibiotics, and harbored determinants discriminatory for hypervirulent strains, e.g., aerobactin, salmochelin, yersiniabactin, enterobactin and regulator of mucoid phenotype A genes that are highly associated with hypervirulent K. pneumoniae. The IncF plasmid family was found in all strains, while almost half of the isolates harbored Col440I-type plasmids and nine isolates harbored various Inc-type plasmids. The presence of K. pneumoniae carrying different resistomes and major virulent specific virulomes in powdered milk samples is alarming. This could threaten public health, particularly of neonates and infants consuming dried milk.
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Affiliation(s)
- Gamal Wareth
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Naumburger Str. 96a, 07743 Jena, Germany; (J.L.); (H.N.); (L.D.S.)
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena University, 07743 Jena, Germany;
- Department of Bacteriology, Immunology and Mycology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt
- Correspondence:
| | - Jörg Linde
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Naumburger Str. 96a, 07743 Jena, Germany; (J.L.); (H.N.); (L.D.S.)
| | - Philipp Hammer
- Department of Microbiology and Biotechnology, Max Rubner-Institut, 24103 Kiel, Germany;
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena University, 07743 Jena, Germany;
- Research Campus Infectognostics, Philosophenweg 7, 07743 Jena, Germany
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Naumburger Str. 96a, 07743 Jena, Germany; (J.L.); (H.N.); (L.D.S.)
| | - Lisa D. Sprague
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Naumburger Str. 96a, 07743 Jena, Germany; (J.L.); (H.N.); (L.D.S.)
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4
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Greninger AL, Zerr DM. NGSocomial Infections: High-Resolution Views of Hospital-Acquired Infections Through Genomic Epidemiology. J Pediatric Infect Dis Soc 2021; 10:S88-S95. [PMID: 34951469 PMCID: PMC8755322 DOI: 10.1093/jpids/piab074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hospital outbreak investigations are high-stakes epidemiology. Contacts between staff and patients are numerous; environmental and community exposures are plentiful; and patients are highly vulnerable. Having the best data is paramount to understanding an outbreak in order to stop ongoing transmission and prevent future outbreaks. In the past 5 years, the high-resolution view of transmission offered by analyzing pathogen whole-genome sequencing (WGS) is increasingly part of hospital outbreak investigations. Concerns over speed and actionability, assay validation, liability, cost, and payment models lead to further opportunities for work in this area. Now accelerated by funding for COVID-19, the use of genomics in hospital outbreak investigations has firmly moved from the academic literature to more quotidian operations, with associated concerns involving regulatory affairs, data integration, and clinical interpretation. This review details past uses of WGS data in hospital-acquired infection outbreaks as well as future opportunities to increase its utility and growth in hospital infection prevention.
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Affiliation(s)
- Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington, USA,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Corresponding Author: Alexander L. Greninger MD, PhD, MS, MPhil, 1616 Eastlake Ave East Suite 320, Seattle, WA 98102, USA. E-mail:
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington Medical Center, Seattle, Washington, USA,Division of Infectious Diseases, Seattle Children’s Hospital, Seattle, Washington, USA
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5
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Viehweger A, Blumenscheit C, Lippmann N, Wyres KL, Brandt C, Hans JB, Hölzer M, Irber L, Gatermann S, Lübbert C, Pletz MW, Holt KE, König B. Context-aware genomic surveillance reveals hidden transmission of a carbapenemase-producing Klebsiella pneumoniae. Microb Genom 2021; 7:000741. [PMID: 34913861 PMCID: PMC8767333 DOI: 10.1099/mgen.0.000741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Genomic surveillance can inform effective public health responses to pathogen outbreaks. However, integration of non-local data is rarely done. We investigate two large hospital outbreaks of a carbapenemase-carrying Klebsiella pneumoniae strain in Germany and show the value of contextual data. By screening about 10 000 genomes, over 400 000 metagenomes and two culture collections using in silico and in vitro methods, we identify a total of 415 closely related genomes reported in 28 studies. We identify the relationship between the two outbreaks through time-dated phylogeny, including their respective origin. One of the outbreaks presents extensive hidden transmission, with descendant isolates only identified in other studies. We then leverage the genome collection from this meta-analysis to identify genes under positive selection. We thereby identify an inner membrane transporter (ynjC) with a putative role in colistin resistance. Contextual data from other sources can thus enhance local genomic surveillance at multiple levels and should be integrated by default when available.
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Affiliation(s)
- Adrian Viehweger
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
- *Correspondence: Adrian Viehweger,
| | | | - Norman Lippmann
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
| | - Kelly L. Wyres
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Christian Brandt
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Jörg B. Hans
- National Reference Center for multidrug-resistant Gram-negative bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Hölzer
- Methodology and Research Infrastructure, MF1 Bioinformatics, Robert Koch Institute, Berlin, Germany
| | - Luiz Irber
- Department of Population Health and Reproduction, University of California, Davis, Davis, California, USA
| | - Sören Gatermann
- National Reference Center for multidrug-resistant Gram-negative bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Kathryn E. Holt
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Brigitte König
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
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6
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Tsioutis C, Eichel VM, Mutters NT. Transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae: the role of infection control. J Antimicrob Chemother 2021; 76:i4-i11. [PMID: 33534880 DOI: 10.1093/jac/dkaa492] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The worldwide spread of carbapenemase-producing Gram-negative bacteria (GNB) in healthcare settings is worrying. Of particular concern is the occurrence of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KP). In recent years, several guidelines and recommendations have focused on the control of carbapenem-resistant GNB. It remains, however, unknown to what extent individual infection control measures are effective. Our aim was to critically review the recent evidence regarding the effectiveness of measures to control KPC-KP spread in healthcare settings. METHODS Critical review of the literature aiming to evaluate, in accordance with published recommendations, all available studies reporting infection control (IC) measures to control KPC-KP published in the past 5 years. RESULTS Among 11 included studies, the majority consisted of outbreak reports, where application of measures was reported in the absence of control groups. Variability was observed related to the frequency of application of recommended measures for control of KPC-KP. Additional measures were recorded, such as environmental sampling and staff screening, whereas compliance with hand hygiene was measured in relatively few studies. Finally, mortality in patients harbouring KPC-KP was notable, reaching 42.9% of included patients. CONCLUSIONS Despite successful control of KPC-KP spread during outbreaks, the impact of individual IC measures is difficult to assess, as the quality of published evidence is low and controlled intervention studies are lacking. The distribution of studies, the number of reported cases and the high mortality rates, clearly show that KPC-KP remains a major healthcare problem worldwide.
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Affiliation(s)
- Constantinos Tsioutis
- European Committee on Infection Control, Basel, Switzerland.,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Vanessa M Eichel
- Heidelberg University Hospital, Centre of Infectious Diseases, Heidelberg, Germany
| | - Nico T Mutters
- European Committee on Infection Control, Basel, Switzerland.,Bonn University Hospital, Institute for Hygiene and Public Health, Venusberg-Campus 1, 53127, Bonn, Germany
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7
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Prescott K, Billam H, Yates C, Clarke M, Montgomery R, Staniforth K, Vaughan N, Boswell T, Mahida N. Outbreak of New Delhi Metallo-Beta-lactamase Carbapenemase Producing Enterobacterales on a bone marrow transplant unit: Role of the environment. Infect Prev Pract 2021; 3:100125. [PMID: 34368742 PMCID: PMC8336029 DOI: 10.1016/j.infpip.2021.100125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Carbapenemase Producing Enterobacterales (CPE) are a global health concern. Nosocomial outbreaks have been reported globally with patient-to-patient transmission felt to be the most frequent route of cross-transmission. AIM To describe the investigation and control of an outbreak of healthcare-associated New Delhi Metallo-beta-lactamase (NDM) CPE on a haematology ward, over 2 months. METHODS Four patients acquired CPE; all had gastrointestinal tract colonisation with two subsequently developing bacteraemias. The outbreak team performed a retrospective review, prospective case finding and environmental sampling using swabs, settle plates, air and water sampling. Immediate control measures were implemented including appropriate isolation of cases and additional ward cleaning with chlorine disinfectant, ultra-violet light decontamination and hydrogen peroxide. FINDINGS Following two cases of nosocomial acquired CPE prospective case finding identified two further cases. 4.6% of the initial environmental samples were positive for CPE including from waste water sites, the ward sluice and the ward kitchen. Three of the four CPE isolates were identical on pulse field gel electrophoresis (PFGE) typing. Detection of the CPE from the ward kitchen environmental samples suggests a possible role for cross transmission. CONCLUSION This is the first CPE outbreak report to highlight the role of a ward kitchen as a possible source of cross-transmission. In view of this we suggest ward kitchens are reviewed and investigated in nosocomial CPE outbreaks.
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Affiliation(s)
- Katherine Prescott
- Department of Microbiology, Nottingham University Hospitals NHS Trust, England, UK
| | - Harriet Billam
- Department of Microbiology, Nottingham University Hospitals NHS Trust, England, UK
| | - Carl Yates
- Infection Prevention & Control, Nottingham University Hospitals NHS Trust, England, UK
| | - Mitch Clarke
- Infection Prevention & Control, Nottingham University Hospitals NHS Trust, England, UK
| | - Ros Montgomery
- Infection Prevention & Control, Nottingham University Hospitals NHS Trust, England, UK
| | - Karren Staniforth
- Infection Prevention & Control, Nottingham University Hospitals NHS Trust, England, UK
| | - Natalie Vaughan
- Infection Prevention & Control, Nottingham University Hospitals NHS Trust, England, UK
| | - Tim Boswell
- Department of Microbiology, Nottingham University Hospitals NHS Trust, England, UK
| | - Nikunj Mahida
- Department of Microbiology, Nottingham University Hospitals NHS Trust, England, UK
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8
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Valiente-Mullor C, Beamud B, Ansari I, Francés-Cuesta C, García-González N, Mejía L, Ruiz-Hueso P, González-Candelas F. One is not enough: On the effects of reference genome for the mapping and subsequent analyses of short-reads. PLoS Comput Biol 2021; 17:e1008678. [PMID: 33503026 PMCID: PMC7870062 DOI: 10.1371/journal.pcbi.1008678] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 02/08/2021] [Accepted: 01/05/2021] [Indexed: 12/17/2022] Open
Abstract
Mapping of high-throughput sequencing (HTS) reads to a single arbitrary reference genome is a frequently used approach in microbial genomics. However, the choice of a reference may represent a source of errors that may affect subsequent analyses such as the detection of single nucleotide polymorphisms (SNPs) and phylogenetic inference. In this work, we evaluated the effect of reference choice on short-read sequence data from five clinically and epidemiologically relevant bacteria (Klebsiella pneumoniae, Legionella pneumophila, Neisseria gonorrhoeae, Pseudomonas aeruginosa and Serratia marcescens). Publicly available whole-genome assemblies encompassing the genomic diversity of these species were selected as reference sequences, and read alignment statistics, SNP calling, recombination rates, dN/dS ratios, and phylogenetic trees were evaluated depending on the mapping reference. The choice of different reference genomes proved to have an impact on almost all the parameters considered in the five species. In addition, these biases had potential epidemiological implications such as including/excluding isolates of particular clades and the estimation of genetic distances. These findings suggest that the single reference approach might introduce systematic errors during mapping that affect subsequent analyses, particularly for data sets with isolates from genetically diverse backgrounds. In any case, exploring the effects of different references on the final conclusions is highly recommended. Mapping consists in the alignment of reads (i.e., DNA fragments) obtained through high-throughput genome sequencing to a previously assembled reference sequence. It is a common practice in genomic studies to use a single reference for mapping, usually the ‘reference genome’ of a species—a high-quality assembly. However, the selection of an optimal reference is hindered by intrinsic intra-species genetic variability, particularly in bacteria. It is known that genetic differences between the reference genome and the read sequences may produce incorrect alignments during mapping. Eventually, these errors could lead to misidentification of variants and biased reconstruction of phylogenetic trees (which reflect ancestry between different bacterial lineages). To our knowledge, this is the first work to systematically examine the effect of different references for mapping on the inference of tree topology as well as the impact on recombination and natural selection inferences. Furthermore, the novelty of this work relies on a procedure that guarantees that we are evaluating only the effect of the reference. This effect has proved to be pervasive in the five bacterial species that we have studied and, in some cases, alterations in phylogenetic trees could lead to incorrect epidemiological inferences. Hence, the use of different reference genomes may be prescriptive to assess the potential biases of mapping.
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Affiliation(s)
- Carlos Valiente-Mullor
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
| | - Beatriz Beamud
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
- * E-mail: (BB); (FG-C)
| | - Iván Ansari
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
| | - Carlos Francés-Cuesta
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
| | - Neris García-González
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
| | - Lorena Mejía
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Paula Ruiz-Hueso
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
| | - Fernando González-Candelas
- Joint Research Unit “Infection and Public Health” FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain
- CIBER in Epidemiology and Public Health, Valencia, Spain
- * E-mail: (BB); (FG-C)
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9
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Boncea EE, Expert P, Honeyford K, Kinderlerer A, Mitchell C, Cooke GS, Mercuri L, Costelloe CE. Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network. BMJ Qual Saf 2021; 30:457-466. [PMID: 33495288 PMCID: PMC8142451 DOI: 10.1136/bmjqs-2020-012124] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Background Intrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals. Objective This study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital-acquired infection (HAI). Methods A retrospective case–control study was conducted using data extracted from electronic health records and microbiology cultures of non-elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination. Results Of the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13). Conclusion Intrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment.
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Affiliation(s)
- Emanuela Estera Boncea
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Paul Expert
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.,Department of Mathematics, Imperial College London, London, UK.,Tokyo Tech World Research Hub Initiative, Tokyo Institute of Technology, Tokyo, Japan
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Anne Kinderlerer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Colin Mitchell
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Graham S Cooke
- Infectious Diseases Section, Imperial College London, London, UK
| | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Céire E Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
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10
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Brolund A, Lagerqvist N, Byfors S, Struelens MJ, Monnet DL, Albiger B, Kohlenberg A. Worsening epidemiological situation of carbapenemase-producing Enterobacteriaceae in Europe, assessment by national experts from 37 countries, July 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 30862330 PMCID: PMC6402177 DOI: 10.2807/1560-7917.es.2019.24.9.1900123] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A survey on the epidemiological situation, surveillance and containment activities for carbapenemase-producing Enterobacteriaceae (CPE) was conducted in European countries in 2018. All 37 participating countries reported CPE cases. Since 2015, the epidemiological stage of CPE expansion has increased in 11 countries. Reference laboratory capability, dedicated surveillance and a specific national containment plan are in existence in 33, 27 and 14 countries, respectively. Enhanced control efforts are needed for CPE containment in Europe.
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Affiliation(s)
- Alma Brolund
- These authors contributed equally to this work.,Public Health Agency of Sweden, Solna, Sweden
| | - Nina Lagerqvist
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.,These authors contributed equally to this work.,Public Health Agency of Sweden, Solna, Sweden
| | - Sara Byfors
- Public Health Agency of Sweden, Solna, Sweden
| | - Marc J Struelens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Barbara Albiger
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Anke Kohlenberg
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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11
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Chia PY, Sengupta S, Kukreja A, S L Ponnampalavanar S, Ng OT, Marimuthu K. The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms. Antimicrob Resist Infect Control 2020; 9:29. [PMID: 32046775 PMCID: PMC7014667 DOI: 10.1186/s13756-020-0685-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Sharmila Sengupta
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore
| | | | | | - Oon Tek Ng
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore. .,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Rd, Singapore.
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12
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Bilozor A, Balode A, Chakhunashvili G, Chumachenko T, Egorova S, Ivanova M, Kaftyreva L, Kõljalg S, Kõressaar T, Lysenko O, Miciuleviciene J, Mändar R, Lis DO, Wesolowska MP, Ratnik K, Remm M, Rudzko J, Rööp T, Saule M, Sepp E, Shyshporonok J, Titov L, Tsereteli D, Naaber P. Application of Molecular Methods for Carbapenemase Detection. Front Microbiol 2019; 10:1755. [PMID: 31428068 PMCID: PMC6687770 DOI: 10.3389/fmicb.2019.01755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
This study has evaluated the correlation between different carbapenemases detection methods on carbapenem non-susceptible Klebsiella pneumoniae strains from Northern and Eastern Europe; 31 institutions in 9 countries participated in the research project, namely Finland, Estonia, Latvia, Lithuania, Russia, St. Petersburg, Poland, Belarus, Ukraine, and Georgia. During the research program, a total of 5,001 clinical K. pneumoniae isolates were screened for any carbapenem non-susceptibility by the disk diffusion method, Vitek 2 or Phoenix system following the EUCAST guideline on detection of resistance mechanisms, version 1.0. Strains isolated from outpatients and hospitalized patients from April 2015 to June 2015 were included. All types of samples (blood, pus, urine, etc.) excluding fecal screening or fecal colonization samples have been represented. In total, 171 carbapenemase screening-positive K. pneumoniae isolates (3.42%) were found and characterized. Several methods were used for detection of carbapenemases production, including Luminex assay (PCR and hybridization), whole genome sequencing, MALDI-TOF based Imipenem degradation assay, and immunochromatography testing. Minimal inhibitory concentration determination for Meropenem by agar-based gradient method was also used. Finally, 83 K. pneumoniae strains were carbapenemase negative by all confirmation methods (49.4% of all screening-positive ones), 74 – positive by three methods (44.0%), 8 – positive by two methods (4.8%) and 3 – positive by only one method (1.8%). The sensitivity of the tests was 96.3% for Whole genome sequencing and MALDI-TOF assay (both three undetected cases), and 95.1% for Luminex-Carba (4 undetected cases). The most commonly detected carbapenemases were NDM (n = 54) and OXA-48 (n = 26), followed by KPC-2, VIM-5, and OXA-72 (one case of each). Our results showed that different types of carbapenemases can be detected in the countries involved in the project. The sensitivity of our methods for carbapenemase detection (including screening as a first step and further confirmation tests) was >95%, but we would recommend using different methods to increase the sensitivity of detection and make it more precise.
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Affiliation(s)
- Anastasia Bilozor
- Department of Microbiology, Central Laboratory, East-Tallinn Central Hospital, Tallinn, Estonia.,Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Arta Balode
- Department of Biology and Microbiology, Riga Stradins University, Riga, Latvia
| | - Giorgi Chakhunashvili
- Department of Communicable Disease, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tetyana Chumachenko
- Department of Epidemiology, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Svetlana Egorova
- Department of Enteric Infections, St-Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Marina Ivanova
- Department of Microbiology, Central Laboratory, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Liidia Kaftyreva
- Department of Enteric Infections, St-Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Siiri Kõljalg
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Triinu Kõressaar
- Department of Bioinformatics, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Olga Lysenko
- Department of Bacteriological Laboratory, Kyiv City Clinical Hospital, Kyiv, Ukraine
| | | | - Reet Mändar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Danuta O Lis
- Department of Biohazards and Immunoallergology, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
| | | | | | - Maido Remm
- Department of Bioinformatics, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | | | - Tiiu Rööp
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Mara Saule
- Department of Biology and Microbiology, Riga Stradins University, Riga, Latvia
| | - Epp Sepp
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Julia Shyshporonok
- Department of Clinical and Experimental Microbiology, Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Leonid Titov
- Department of Clinical and Experimental Microbiology, Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - David Tsereteli
- Department of Communicable Disease, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Paul Naaber
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.,SYNLAB Estonia, Tallinn, Estonia
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13
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Persisting intrahospital transmission of multidrug-resistant Klebsiella pneumoniae and challenges for infection control. Infect Control Hosp Epidemiol 2019; 40:904-909. [PMID: 31184564 DOI: 10.1017/ice.2019.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past several decades, the incidence of Klebsiella pneumoniae harboring resistance mechanisms against multiple antibiotic agents has increased on a global scale. We discuss reasons for ongoing transmission of multidrug-resistant K. pneumoniae in healthcare settings, which has resulted in the successful spread and establishment of this pathogen. It is now one of the most important causes of healthcare-associated infections worldwide.
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14
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Escherichia coli Harboring mcr-1 in a Cluster of Liver Transplant Recipients: Detection through Active Surveillance and Whole-Genome Sequencing. Antimicrob Agents Chemother 2019; 63:AAC.02680-18. [PMID: 30962343 DOI: 10.1128/aac.02680-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
mcr-1, a plasmid-associated gene for colistin resistance, was first described in China in 2015, but its spread in the United States is unknown. We report detection of mcr-1-carrying Escherichia coli ST117 in a cluster of three liver transplant recipients.
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Mintzer V, Moran-Gilad J, Simon-Tuval T. Operational models and criteria for incorporating microbial whole genome sequencing in hospital microbiology - A systematic literature review. Clin Microbiol Infect 2019; 25:1086-1095. [PMID: 31039443 DOI: 10.1016/j.cmi.2019.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Microbial whole genome sequencing (WGS) has many advantages over standard microbiological methods. However, it is not yet widely implemented in routine hospital diagnostics due to notable challenges. OBJECTIVES The aim was to extract managerial, financial and clinical criteria supporting the decision to implement WGS in routine diagnostic microbiology, across different operational models of implementation in the hospital setting. METHODS This was a systematic review of literature identified through PubMed and Web of Science. English literature studies discussing the applications of microbial WGS without limitation on publication date were eligible. A narrative approach for categorization and synthesis of the sources identified was adopted. RESULTS A total of 98 sources were included. Four main alternative operational models for incorporating WGS in clinical microbiology laboratories were identified: full in-house sequencing and analysis, full outsourcing of sequencing and analysis and two hybrid models combining in-house/outsourcing of the sequencing and analysis components. Six main criteria (and multiple related sub-criteria) for WGS implementation emerged from our review and included cost (e.g. the availability of resources for capital and operational investment); manpower (e.g. the ability to provide training programmes or recruit trained personnel), laboratory infrastructure (e.g. the availability of supplies and consumables or sequencing platforms), bioinformatics requirements (e.g. the availability of valid analysis tools); computational infrastructure (e.g. the availability of storage space or data safety arrangements); and quality control (e.g. the existence of standardized procedures). CONCLUSIONS The decision to incorporate WGS in routine diagnostics involves multiple, sometimes competing, criteria and sub-criteria. Mapping these criteria systematically is an essential stage in developing policies for adoption of this technology, e.g. using a multicriteria decision tool. Future research that will prioritize criteria and sub-criteria that were identified in our review in the context of operational models will inform decision-making at clinical and managerial levels with respect to effective implementation of WGS for routine use. Beyond WGS, similar decision-making challenges are expected with respect to future integration of clinical metagenomics.
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Affiliation(s)
- V Mintzer
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel; Leumit Health Services, Israel
| | - J Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel; ESCMID Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - T Simon-Tuval
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
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16
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Contamination of chicken meat with extended-spectrum beta-lactamase producing- Klebsiella pneumoniae and Escherichia coli during scalding and defeathering of broiler carcasses. Food Microbiol 2019; 77:185-191. [DOI: 10.1016/j.fm.2018.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 01/04/2023]
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17
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Spencer MD, Winglee K, Passaretti C, Earl AM, Manson AL, Mulder HP, Sautter RL, Fodor AA. Whole Genome Sequencing detects Inter-Facility Transmission of Carbapenem-resistant Klebsiella pneumoniae. J Infect 2018; 78:187-199. [PMID: 30503842 PMCID: PMC6408229 DOI: 10.1016/j.jinf.2018.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/03/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To identify transmission patterns of Carbapenem-resistant Klebsiella pneumoniae infection during an outbreak at a large, tertiary care hospital and to detect whether the outbreak organisms spread to other facilities in the integrated healthcare network. METHODS We analyzed 71 K. pneumoniae whole genome sequences collected from clinical specimens before, during and after the outbreak and reviewed corresponding patient medical records. Sequence and patient data were used to model probable transmissions and assess factors associated with the outbreak. RESULTS We identified close genetic relationships among carbapenem-resistant K. pneumoniae isolates sampled during the study period. Transmission tree analysis combined with patient records uncovered extended periods of silent colonization in many study patients and transmission routes that were likely the result of asymptomatic patients transitioning between facilities. CONCLUSIONS Detecting how and where Carbapenem-resistant K. pneumoniae infections spread is challenging in an environment of rising prevalence, asymptomatic carriage and mobility of patients. Whole genome sequencing improved the precision of investigating inter-facility transmissions. Our results emphasize that containment of Carbapenem-resistant K. pneumoniae infections requires coordinated efforts between healthcare networks and settings of care that acknowledge and mitigate transmission risk conferred by undetected carriage and by patient transfers between facilities.
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Affiliation(s)
- Melanie D Spencer
- Center for Outcomes Research and Evaluation, Atrium Health, Research Office Building, 1540 Garden Terrace, Charlotte, NC 28203, USA.
| | - Kathryn Winglee
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9331 Robert D. Snyder Road, Charlotte NC 28223, USA.
| | - Catherine Passaretti
- Departments of Internal Medicine and Infectious Disease, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA.
| | - Ashlee M Earl
- Broad Institute of Harvard and Massachusetts Institute of Technology, 415 Main Street, Cambridge, MA 02142, USA.
| | - Abigail L Manson
- Broad Institute of Harvard and Massachusetts Institute of Technology, 415 Main Street, Cambridge, MA 02142, USA.
| | - Holly P Mulder
- Center for Outcomes Research and Evaluation, Atrium Health, Research Office Building, 1540 Garden Terrace, Charlotte, NC 28203, USA.
| | - Robert L Sautter
- Carolinas Pathology Group, P.O. Box 30637, Charlotte, NC 28230, USA.
| | - Anthony A Fodor
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9331 Robert D. Snyder Road, Charlotte NC 28223, USA.
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18
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Becker L, Kaase M, Pfeifer Y, Fuchs S, Reuss A, von Laer A, Sin MA, Korte-Berwanger M, Gatermann S, Werner G. Genome-based analysis of Carbapenemase-producing Klebsiella pneumoniae isolates from German hospital patients, 2008-2014. Antimicrob Resist Infect Control 2018; 7:62. [PMID: 29744043 PMCID: PMC5930415 DOI: 10.1186/s13756-018-0352-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background By using whole genome sequence data we aimed at describing a population snapshot of carbapenemase-producing K. pneumoniae isolated from hospitalized patients in Germany between 2008 and 2014. Methods We selected a representative subset of 107 carbapenemase-producing K. pneumoniae clinical isolates possessing the four most prevalent carbapenemase types in Germany (KPC-2, KPC-3, OXA-48, NDM-1). Isolates were processed via illumina NGS. Data were analysed using different SNP-based mapping and de-novo assembly approaches. Relevant information was extracted from NGS data (antibiotic resistance determinants, wzi gene/cps type, virulence genes). NGS data from the present study were also compared with 238 genome data from two previous international studies on K. pneumoniae. Results NGS-based analyses revealed a preferred prevalence of KPC-2-producing ST258 and KPC-3-producing ST512 isolates. OXA-48, being the most prevalent carbapenemase type in Germany, was associated with various K. pneumoniae strain types; most of them possessing IncL/M plasmid replicons suggesting a preferred dissemination of blaOXA-48 via this well-known plasmid type. Clusters ST15, ST147, ST258, and ST512 demonstrated an intermingled subset structure consisting of German and other European K. pneumoniae isolates. ST23 being the most frequent MLST type in Asia was found only once in Germany. This latter isolate contained an almost complete set of virulence genes and a K1 capsule suggesting occurrence of a hypervirulent ST23 strain producing OXA-48 in Germany. Conclusions Our study results suggest prevalence of "classical" K. pneumonaie strain types associated with widely distributed carbapenemase genes such as ST258/KPC-2 or ST512/KPC-3 also in Germany. The finding of a supposed hypervirulent and OXA-48-producing ST23 K. pneumoniae isolates outside Asia is highly worrisome and requires intense molecular surveillance.
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Affiliation(s)
| | - Martin Kaase
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
- Present address: Department of Infection Control and Infectious Diseases, University Medical Centre Goettingen, Goettingen, Germany
| | | | | | | | | | | | - Miriam Korte-Berwanger
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
- Fachgruppe Infektiologie und Hygiene, Landeszentrum Gesundheit North-Rhine Westphalia, Gesundheitscampus 10, Bochum, Germany
| | - Sören Gatermann
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
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Pterostilbene, a Potential MCR-1 Inhibitor That Enhances the Efficacy of Polymyxin B. Antimicrob Agents Chemother 2018; 62:AAC.02146-17. [PMID: 29339386 DOI: 10.1128/aac.02146-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/04/2018] [Indexed: 12/11/2022] Open
Abstract
We characterized the synergistic effect produced between pterostilbene and polymyxin B (fractional inhibitory concentration [FIC] index = 0.156 or 0.188) against MCR-producing Escherichia coli strains of both human and animal origins. The time-killing assays showed that either pterostilbene or polymyxin B failed to eradicate the mcr-1- and NDM-positive E. coli strain ZJ487, but the combination eliminated the strain by 1 h postinoculation. The survival rate of mice after intraperitoneal infections was significantly enhanced from 0% to 60% in the group in which combination therapy was applied.
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