Mellmann Alexander, Bletz Stefan, Böking Thomas, Kipp Frank, Becker Karsten, Schultes Anja, Prior Karola, Harmsen Dag
Institute of Hygiene, University Hospital Muenster, Muenster, Germany
Institute of Hygiene, University Hospital Muenster, Muenster, Germany.
J Clin Microbiol. 2016 Dec;54(12):2874-2881. doi: 10.1128/JCM.00790-16. Epub 2016 Aug 24.
The increasing prevalence of multidrug-resistant (MDR) bacteria is a serious global challenge. Here, we studied prospectively whether bacterial whole-genome sequencing (WGS) for real-time MDR surveillance is technical feasible, returns actionable results, and is cost-beneficial. WGS was applied to all MDR isolates of four species (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus faecium, MDR Escherichia coli, and MDR Pseudomonas aeruginosa) at the University Hospital Muenster, Muenster, Germany, a tertiary care hospital with 1,450 beds, during two 6-month intervals. Turnaround times (TAT) were measured, and total costs for sequencing per isolate were calculated. After cancelling prior policies of preemptive isolation of patients harboring certain Gram-negative MDR bacteria in risk areas, the second interval was conducted. During interval I, 645 bacterial isolates were sequenced. From culture, TATs ranged from 4.4 to 5.3 days, and costs were €202.49 per isolate. During interval II, 550 bacterial isolates were sequenced. Hospital-wide transmission rates of the two most common species (MRSA and MDR E. coli) were low during interval I (5.8% and 2.3%, respectively) and interval II (4.3% and 5.0%, respectively). Cancellation of isolation of patients infected with non-pan-resistant MDR E. coli in risk wards did not increase transmission. Comparing sequencing costs with avoided costs mostly due to fewer blocked beds during interval II, we saved in excess of €200,000. Real-time microbial WGS in our institution was feasible, produced precise actionable results, helped us to monitor transmission rates that remained low following a modification in isolation procedures, and ultimately saved costs.
多重耐药（MDR）细菌的日益流行是一项严峻的全球挑战。在此，我们前瞻性地研究了用于实时MDR监测的细菌全基因组测序（WGS）在技术上是否可行、能否产生可采取行动的结果以及是否具有成本效益。在德国明斯特大学医院（一家拥有1450张床位的三级护理医院），在两个6个月的时间段内，对四种细菌（耐甲氧西林金黄色葡萄球菌[MRSA]、耐万古霉素屎肠球菌、MDR大肠杆菌和MDR铜绿假单胞菌）的所有MDR分离株应用了WGS。测量了周转时间（TAT），并计算了每个分离株的测序总成本。在取消了先前在风险区域对携带某些革兰氏阴性MDR细菌患者进行抢先隔离的政策后，进行了第二个时间段的研究。在第一个时间段内，对645株细菌分离株进行了测序。从培养到测序，TAT范围为4.4至5.3天，每个分离株的成本为202.49欧元。在第二个时间段内，对550株细菌分离株进行了测序。在第一个时间段（分别为5.8%和2.3%）和第二个时间段（分别为4.3%和5.0%），两种最常见细菌（MRSA和MDR大肠杆菌）在全院的传播率较低。取消在风险病房对感染非泛耐药MDR大肠杆菌患者的隔离并未增加传播率。将测序成本与主要因第二个时间段内被占用床位减少而避免的成本进行比较，我们节省了超过20万欧元。我们机构的实时微生物WGS是可行的，产生了精确的可采取行动的结果，帮助我们监测在隔离程序修改后仍保持较低水平的传播率，并最终节省了成本。
