调查一起嗜甲基杆菌属感染聚集性事件。
Investigation of a Cluster of Sphingomonas koreensis Infections.
机构信息
From the National Human Genome Research Institute (R.C.J., C.D., S.C., S.L.-L., J.A.S.), National Institutes of Health (NIH) Clinical Center (C.J.Z., A.V.M., R.A.W., J.P.D., K.M.F., D.K.H., A.F.L., T.N.P.), and the Division of Facilities, Operations, and Maintenance (J.L.), NIH, Bethesda, and the NIH Intramural Sequencing Center, NIH, Rockville (P.J.T., M.P.) - all in Maryland; Wadsworth Center, New York State Department of Health, Albany (K.A.M.); and the Special Bacteriology Reference Laboratory, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta (J.R.M.). Dr. Park serves as an author on behalf of the NIH Intramural Sequencing Center Comparative Sequencing Program.
出版信息
N Engl J Med. 2018 Dec 27;379(26):2529-2539. doi: 10.1056/NEJMoa1803238.
BACKGROUND
Plumbing systems are an infrequent but known reservoir for opportunistic microbial pathogens that can infect hospitalized patients. In 2016, a cluster of clinical sphingomonas infections prompted an investigation.
METHODS
We performed whole-genome DNA sequencing on clinical isolates of multidrug-resistant Sphingomonas koreensis identified from 2006 through 2016 at the National Institutes of Health (NIH) Clinical Center. We cultured S. koreensis from the sinks in patient rooms and performed both whole-genome and shotgun metagenomic sequencing to identify a reservoir within the infrastructure of the hospital. These isolates were compared with clinical and environmental S. koreensis isolates obtained from other institutions.
RESULTS
The investigation showed that two isolates of S. koreensis obtained from the six patients identified in the 2016 cluster were unrelated, but four isolates shared more than 99.92% genetic similarity and were resistant to multiple antibiotic agents. Retrospective analysis of banked clinical isolates of sphingomonas from the NIH Clinical Center revealed the intermittent recovery of a clonal strain over the past decade. Unique single-nucleotide variants identified in strains of S. koreensis elucidated the existence of a reservoir in the hospital plumbing. Clinical S. koreensis isolates from other facilities were genetically distinct from the NIH isolates. Hospital remediation strategies were guided by results of microbiologic culturing and fine-scale genomic analyses.
CONCLUSIONS
This genomic and epidemiologic investigation suggests that S. koreensis is an opportunistic human pathogen that both persisted in the NIH Clinical Center infrastructure across time and space and caused health care-associated infections. (Funded by the NIH Intramural Research Programs.).
背景
管道系统是机会性病原体的罕见但已知的储库，这些病原体可能感染住院患者。2016 年，一组临床鞘氨醇单胞菌感染促使进行了一项调查。
方法
我们对 2006 年至 2016 年期间在美国国立卫生研究院（NIH）临床中心从多药耐药性鞘氨醇单胞菌分离的临床分离株进行了全基因组 DNA 测序。我们从病房水槽中培养出鞘氨醇单胞菌，并进行全基因组和鸟枪法宏基因组测序，以确定医院基础设施中的储库。将这些分离株与从其他机构获得的临床和环境鞘氨醇单胞菌分离株进行比较。
结果
调查显示，从 2016 年群集中确定的六名患者中获得的两个鞘氨醇单胞菌分离株没有关联，但四个分离株具有超过 99.92%的遗传相似性，并且对多种抗生素药物具有耐药性。对 NIH 临床中心储存的鞘氨醇单胞菌临床分离株进行回顾性分析表明，过去十年中间歇性地恢复了一个克隆株。在鞘氨醇单胞菌分离株中发现的独特单核苷酸变体阐明了医院管道中存在储库。来自其他设施的临床鞘氨醇单胞菌分离株与 NIH 分离株在遗传上不同。微生物培养和精细基因组分析的结果指导了医院修复策略。
结论
这项基因组和流行病学调查表明，鞘氨醇单胞菌是一种机会性病原体，它在 NIH 临床中心的基础设施中随着时间和空间的推移而持续存在，并导致了与医疗保健相关的感染。（由 NIH 内部研究计划资助）。
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