Microbiological Diagnostic Unit (MDU) Public Health Laboratory, Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia.
Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia.
Infect Control Hosp Epidemiol. 2021 May;42(5):573-581. doi: 10.1017/ice.2020.1253. Epub 2020 Nov 26.
To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.
Pilot prospective multicenter surveillance study.
The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.
All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.
In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).
Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
开展一项针对医院获得性多药耐药菌（MDRO）的基因组和流行病学联合监测的试点研究，以预测患者之间的传播，并估计 MDRO 传播的本地负担。
试点前瞻性多中心监测研究。
该研究在澳大利亚墨尔本的 8 所大学医院（共 2800 张床位）进行，包括 4 所急性护理医院、1 所专门癌症护理医院和 3 所亚急性护理医院。
从 2017 年 4 月 24 日至 6 月 18 日期间，所有住院患者的临床和筛查分离株均被采集用于检测 6 种 MDRO：vanA VRE、MRSA、ESBL 大肠埃希菌（ESBL-Ec）和肺炎克雷伯菌（ESBL-Kp），以及耐碳青霉烯类铜绿假单胞菌（CRPa）和鲍曼不动杆菌（CRAb）。分离株由医院实验室按常规进行分析和报告，在中央实验室进行全基因组测序，并使用开源生物信息学工具进行分析。使用基因组学和流行病学数据综合评估 MDRO 负担和传播情况。
共从 358 名患者中采集了 408 株分离株；47.5%为筛查分离株。最常见的是 ESBL-Ec（52.5%），其次是 MRSA（21.6%）、vanA VRE（15.7%）和 ESBL-Kp（7.6%）。大多数 MDRO（88.3%）是从近期有医疗保健接触史的患者中分离出来的。基因组学和流行病学相结合确定，至少有 27.1%的 MDRO 是在医院获得的；如果没有基因组学，这些传播事件中的大多数都不会被发现。vanA VRE 的传播比例最高（88.4%的患者）。
来自多个机构的基因组学和流行病学数据可以进行前瞻性结合，从而深入了解 MDRO 的负担和分布情况，包括医院内传播情况。这种分析使感染控制团队能够更有效地针对干预措施。
