Voor in 't Holt Anne F, Severin Juliëtte A, Goessens Wil H F, Te Witt René, Vos Margreet C
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
PLoS One. 2015 Aug 28;10(8):e0136135. doi: 10.1371/journal.pone.0136135. eCollection 2015.
Infections with multidrug-resistant (MDR) microorganisms are an increasing threat to hospitalized patients. Although rapid typing of MDR microorganisms is required to apply targeted prevention measures, technical barriers often prevent this. We aimed to assess whether extended-spectrum beta-lactamase (ESBL)-producing Klebsiella species are transmitted between patients and whether routine, rapid typing is needed.
For 43 months, the clonality of all ESBL-producing Klebsiella isolates from patients admitted to Erasmus MC University Medical Center in Rotterdam, the Netherlands was assessed with Raman spectroscopy. A cluster was defined as n ≥ 2 patients who had identical isolates. Primary patients were the first patients in each cluster. Secondary patients were those identified with an isolate clonally related to the isolate of the primary patient.
Isolates from 132 patients were analyzed. We identified 17 clusters, with 17 primary and 56 secondary patients. Fifty-nine patients had a unique isolate. Patients (n = 15) in four out of the 17 clusters were epidemiologically related. Ten of these 15 patients developed an infection.
Clonal outbreaks of ESBL-producing Klebsiella species were detected in our hospital. Theoretically, after Raman spectroscopy had detected a cluster of n ≥ 2, six infections in secondary patients could have been prevented. These findings demonstrate that spread of ESBL-producing Klebsiella species occurs, even in a non-outbreak setting, and underscore the need for routine rapid typing of these MDR bacteria.
多重耐药（MDR）微生物感染对住院患者构成的威胁日益增加。尽管需要对MDR微生物进行快速分型以采取针对性的预防措施，但技术障碍常常阻碍这一过程。我们旨在评估产超广谱β-内酰胺酶（ESBL）的克雷伯菌属是否在患者之间传播，以及是否需要进行常规快速分型。
在43个月的时间里，我们使用拉曼光谱法对荷兰鹿特丹伊拉斯姆斯医学中心收治的患者中所有产ESBL的克雷伯菌分离株的克隆性进行了评估。一个聚类被定义为有≥2名患者具有相同分离株。原发患者是每个聚类中的首例患者。继发患者是那些分离株与原发患者的分离株存在克隆相关性的患者。
对132例患者的分离株进行了分析。我们识别出17个聚类，其中有17名原发患者和56名继发患者。59例患者具有独特的分离株。17个聚类中有4个聚类中的15例患者在流行病学上相关。这15例患者中有10例发生了感染。
我们医院检测到了产ESBL的克雷伯菌属的克隆性暴发。理论上，在拉曼光谱法检测到≥2个聚类后，继发患者中的6例感染本可得到预防。这些发现表明，即使在非暴发环境中产ESBL的克雷伯菌属也会传播，并强调了对这些MDR细菌进行常规快速分型的必要性。
