Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada.
Clin Infect Dis. 2021 Nov 2;73(9):e2521-e2528. doi: 10.1093/cid/ciaa788.
We previously identified Pseudomonas aeruginosa isolates with characteristics typical of chronic infection in some early infections in children with cystic fibrosis (CF), suggesting that these isolates may have been acquired from other patients. Our objective was to define the extent of P. aeruginosa strain-sharing in early CF infections and its impact on antibiotic eradication treatment failure rates.
We performed whole genome sequencing on isolates from early pediatric CF pulmonary infections and from the following comparator groups in the same hospital: chronic CF infection, sink drains, sterile site infections, and asymptomatic carriage. Univariate logistic regression was used to assess factors associated with treatment failure.
In this retrospective, observational study, 1029 isolates were sequenced. The CF clones strain B and clone C were present. In 70 CF patients with early infections, 14 shared strains infected 29 (41%) patients over 5 years; 16% (n = 14) of infections had mixed strains. In the 70 children, approximately one-third of shared-strain infections were likely due to patient-to-patient transmission. Mixed-strain infections were associated with strain-sharing (odds ratio, 8.50; 95% confidence interval, 2.2-33.4; P = .002). Strain-sharing was not associated with antibiotic eradication treatment failure; however, nosocomial strain transmission was associated with establishment of chronic infection in a CF sibling pair.
Although early P. aeruginosa CF infection is thought to reflect acquisition of diverse strains from community reservoirs, we identified frequent early CF strain-sharing that was associated with the presence of mixed strains and instances of possible patient-to-patient transmission.
我们之前在一些患有囊性纤维化 (CF) 的儿童的早期感染中发现了具有慢性感染特征的铜绿假单胞菌分离株，这表明这些分离株可能是从其他患者身上获得的。我们的目的是确定铜绿假单胞菌在早期 CF 感染中的菌株共享程度及其对抗生素清除治疗失败率的影响。
我们对来自早期儿科 CF 肺部感染的分离株以及来自同一医院的以下对照组的分离株进行了全基因组测序：慢性 CF 感染、水槽排水管、无菌部位感染和无症状携带。采用单变量逻辑回归评估与治疗失败相关的因素。
在这项回顾性观察研究中，对 1029 株分离株进行了测序。CF 克隆 B 和克隆 C 存在。在 70 例患有早期感染的 CF 患者中，14 株共享菌株在 5 年内感染了 29（41%）患者；16%（n=14）的感染存在混合菌株。在这 70 名儿童中，大约三分之一的共享菌株感染可能是由于患者之间的传播。混合菌株感染与菌株共享相关（比值比，8.50；95%置信区间，2.2-33.4；P=0.002）。菌株共享与抗生素清除治疗失败无关；然而，医院获得的菌株传播与 CF 同胞对中慢性感染的建立有关。
尽管早期铜绿假单胞菌 CF 感染被认为反映了从社区储库中获得的多种菌株，但我们发现了频繁的早期 CF 菌株共享，这与混合菌株的存在和可能的患者间传播有关。
