Stadler Tanja, Meinel Dominik, Aguilar-Bultet Lisandra, Huisman Jana S, Schindler Ruth, Egli Adrian, Seth-Smith Helena M B, Eichenberger Lucas, Brodmann Peter, Hübner Philipp, Bagutti Claudia, Tschudin-Sutter Sarah
Department of Biosystems Science and Engineering, Eidgenössische Technische Hochschule (ETH) Zürich, Basel, Switzerland.
Swiss Institute of Bioinformatics, Lausanne, Switzerland.
BMJ Open. 2018 Feb 17;8(2):e021823. doi: 10.1136/bmjopen-2018-021823.
Extended-spectrum beta-lactamases (ESBL)-producing Enterobacteriaceae were first described in relation with hospital-acquired infections. In the 2000s, the epidemiology of ESBL-producing organisms changed as especially ESBL-producing was increasingly described as an important cause of community-acquired infections, supporting the hypothesis that in more recent years ESBL-producing Enterobacteriaceae have probably been imported into hospitals rather than vice versa. Transmission of ESBL-producing Enterobacteriaceae is complicated by ESBL genes being encoded on self-transmissible plasmids, which can be exchanged among the same and different bacterial species. The aim of this research project is to quantify hospital-wide transmission of ESBL-producing Enterobacteriaceae on both the level of bacterial species and the mobile genetic elements and to determine if hospital-acquired infections caused by ESBL producers are related to strains and mobile genetic elements predominantly circulating in the community or in the healthcare setting. This distinction is critical in prevention since the former emphasises the urgent need to establish or reinforce antibiotic stewardship programmes, and the latter would call for more rigorous infection control.
This protocol presents an observational study that will be performed at the University Hospital Basel and in the city of Basel, Switzerland. ESBL-producing Enterobacteriaceae will be collected from any specimens obtained by routine clinical practice or by active screening in both inpatient and outpatient settings, as well as from wastewater samples and foodstuffs, both collected monthly over a 12-month period for analyses by whole genome sequencing. Bacterial chromosomal, plasmid and ESBL-gene sequences will be compared within the cohort to determine genetic relatedness and migration between humans and their environment.
This study has been approved by the local ethics committee (Ethikkommission Nordwest-und Zentralschweiz) as a quality control project (Project-ID 2017-00100). The results of this study will be published in peer-reviewed medical journals, communicated to participants, the general public and all relevant stakeholders.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌最初是在医院获得性感染中被描述的。在21世纪，产ESBL细菌的流行病学发生了变化，尤其是产ESBL细菌越来越多地被描述为社区获得性感染的重要原因，这支持了近年来产ESBL的肠杆菌科细菌可能是被引入医院而非相反的假设。产ESBL肠杆菌科细菌的传播因ESBL基因编码在可自我传递的质粒上而变得复杂，这些质粒可在同种和不同细菌物种之间交换。本研究项目的目的是在细菌物种和移动遗传元件水平上量化产ESBL肠杆菌科细菌在全院范围内的传播，并确定由产ESBL细菌引起的医院获得性感染是否与主要在社区或医疗机构中传播的菌株和移动遗传元件有关。这种区分在预防中至关重要，因为前者强调迫切需要建立或加强抗生素管理计划，而后者则需要更严格的感染控制。
本方案提出了一项将在瑞士巴塞尔大学医院和巴塞尔市进行的观察性研究。产ESBL的肠杆菌科细菌将从常规临床实践或在住院和门诊环境中进行主动筛查获得的任何标本中收集，以及从废水样本和食品中收集，两者均在12个月期间每月收集一次，用于通过全基因组测序进行分析。将在队列中比较细菌染色体、质粒和ESBL基因序列，以确定遗传相关性以及人类与其环境之间的迁移情况。
本研究已作为质量控制项目（项目编号2017-00100）获得当地伦理委员会（瑞士西北部和中部伦理委员会）的批准。本研究结果将发表在同行评审的医学期刊上，并传达给参与者及公众和所有相关利益攸关方。
