1Institute of Hygiene, University Hospital I of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany.
Department of Clinical Microbiology, MVZ synlab Leverkusen GmbH, Köln-Merheim, Germany.
Antimicrob Resist Infect Control. 2018 Nov 26;7:145. doi: 10.1186/s13756-018-0436-8. eCollection 2018.
is a common nosocomial pathogen known for its high transmission potential. A high rate of carbapenem-susceptible (ACB)-complex in clinical specimens led to the implementation of a pathogen-based surveillance on a 32-bed surgical intensive care unit (SICU) in a German tertiary care centre.
Between April 2017 and March 2018, ACB-complex isolates with an epidemiological link to the SICU were further assessed. Identification to the species level was carried out using a multiplex PCR targeting the gene, followed by RAPD, PFGE (ApaI) and whole genome sequencing (WGS, core genome MLST, SeqSphere+ software, Ridom). Additional infection prevention and control (IPC) measures were introduced as follows: epidemiological investigations, hand hygiene training, additional terminal cleaning and disinfection incl. UV-light, screening for carbapenem-susceptible and environmental sampling. Hospital-acquired infections were classified according to the CDC definitions.
Fourty four patients were colonized/infected with one or two (different) carbapenem-susceptible ACB-complex isolates. Fourty three out of 48 isolates were classified as hospital-acquired (detection on or after 3rd day of admission). Nearly all isolates were identified as , only four as . Twelve patients developed infections. Genotyping revealed two pulsotype clusters, which were confirmed to be cgMLST clonal cluster type 1770 ( = 8 patients) and type 1769 ( = 12 patients) by WGS. All other isolates were distinct from each other. Nearly all transmission events of the two clonal clusters were confirmed by conventional epidemiology. Transmissions stopped after a period of several months. Environmental sampling revealed a relevant dissemination of , but only a few isolates corresponded to clinical strains. Introduction of the additional screening revealed a significantly earlier detection of carbapenem-susceptible during hospitalization.
A molecular and infection surveillance of ACB-complex based on identification to the species level, classic epidemiology and genotyping revealed simultaneously occurring independent transmission events and clusters of hospital-acquired . This underlines the importance of such an extensive surveillance methodology in IPC programmes also for carbapenem-susceptible .
是一种常见的医院病原体，以其高传播潜力而闻名。在德国一家三级护理中心的 32 张病床外科重症监护病房（SICU）中，由于临床标本中出现高比例的碳青霉烯类敏感（ACB）复杂菌，因此实施了基于病原体的监测。
在 2017 年 4 月至 2018 年 3 月期间，对与 SICU 有流行病学联系的 ACB 复杂菌分离株进行了进一步评估。通过针对基因的多重 PCR 进行种水平鉴定，随后进行 RAPD、PFGE（ApaI）和全基因组测序（WGS、核心基因组 MLST、SeqSphere+软件、Ridom）。引入了额外的感染预防和控制（IPC）措施，包括流行病学调查、手卫生培训、额外的终末清洁和消毒（包括紫外线）、对碳青霉烯类敏感菌的筛查和环境采样。医院获得性感染根据 CDC 定义进行分类。
44 名患者定植/感染了一个或两个（不同的）碳青霉烯类敏感 ACB 复杂菌。48 株分离株中有 43 株被归类为医院获得性（入院后第 3 天或之后检测到）。几乎所有分离株均被鉴定为，仅 4 株被鉴定为。12 名患者发生了感染。基因分型显示存在两个脉冲群簇，通过 WGS 证实它们是 cgMLST 克隆群类型 1770（=8 名患者）和 1769（=12 名患者）。其他所有分离株彼此之间均不同。通过传统流行病学证实了两个克隆群的几乎所有传播事件。经过数月的时间，传播停止。环境采样显示出与有关的传播，但只有少数分离株与临床菌株相对应。引入额外的筛查后，在住院期间更早地发现了碳青霉烯类敏感。
基于种水平鉴定、经典流行病学和基因分型的 ACB 复杂菌的分子和感染监测同时揭示了独立传播事件和医院获得性的集群。这强调了在感染预防和控制计划中，这种广泛的监测方法对于碳青霉烯类敏感也非常重要。
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