Iovleva Alina, Mustapha Mustapha M, Griffith Marissa P, Komarow Lauren, Luterbach Courtney, Evans Daniel R, Cober Eric, Richter Sandra S, Rydell Kirsten, Arias Cesar A, Jacob Jesse T, Salata Robert A, Satlin Michael J, Wong Darren, Bonomo Robert A, van Duin David, Cooper Vaughn S, Van Tyne Daria, Doi Yohei
Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
The Biostatistics Center, The George Washington University, Rockville, Maryland, USA.
mBio. 2022 Apr 26;13(2):e0275921. doi: 10.1128/mbio.02759-21. Epub 2022 Mar 21.
Carbapenem-resistant Acinetobacter baumannii (CR) is a major cause of health care-associated infections. CR is typically multidrug resistant, and infection is difficult to treat. Despite the urgent threat that CR poses, few systematic studies of CR clinical and molecular epidemiology have been conducted. The Study Network of Acinetobacter as a Carbapenem-Resistant Pathogen (SNAP) is designed to investigate the clinical characteristics and contemporary population structure of CR circulating in U.S. hospital systems using whole-genome sequencing (WGS). Analysis of the initial 120 SNAP patients from four U.S. centers revealed that CR remains a significant threat to hospitalized patients, affecting the most vulnerable patients and resulting in 24% all-cause 30-day mortality. The majority of currently circulating isolates belonged to ST2, a part of clonal complex 2 (CC2), which is the dominant drug-resistant lineage in the United States and Europe. We identified three distinct sublineages within CC2, which differed in their antibiotic resistance phenotypes and geographic distribution. Most concerning, colistin resistance (38%) and cefiderocol resistance (10%) were common within CC2 sublineage C (CC2C), where the majority of isolates belonged to ST2/ST281. Additionally, we identified ST499 as the most common non-CC2 lineage in our study. Our findings suggest a shift within the CR population in the United States during the past 10 years and emphasize the importance of real-time surveillance and molecular epidemiology in studying CR dissemination and clinical impact. Carbapenem-resistant Acinetobacter baumannii (CR) constitutes a major threat to public health. To elucidate the molecular and clinical epidemiology of CR in the United States, clinical CR isolates were collected along with data on patient characteristics and outcomes, and bacterial isolates underwent whole-genome sequencing and antibiotic susceptibility phenotyping. Key findings included emergence of new sublineages within the globally predominant clonal complex 2 (CC2), increased colistin and cefiderocol resistance within one of the CC2 sublineages, and emergence of ST499 as the dominant non-CC2 CR lineage in U.S. hospitals.
耐碳青霉烯类鲍曼不动杆菌（CR）是医疗保健相关感染的主要原因。CR通常对多种药物耐药，感染难以治疗。尽管CR构成了紧迫威胁，但针对CR临床和分子流行病学的系统性研究却很少。耐碳青霉烯类病原体不动杆菌研究网络（SNAP）旨在利用全基因组测序（WGS）调查在美国医院系统中传播的CR的临床特征和当代种群结构。对来自美国四个中心的最初120名SNAP患者的分析显示，CR仍然是住院患者的重大威胁，影响最脆弱的患者，并导致24%的全因30天死亡率。目前传播的大多数分离株属于ST2，是克隆复合体2（CC2）的一部分，CC2是美国和欧洲主要的耐药谱系。我们在CC2中鉴定出三个不同的亚谱系，它们在抗生素耐药表型和地理分布上存在差异。最令人担忧的是，在CC2亚谱系C（CC2C）中，黏菌素耐药（38%）和头孢地尔耐药（10%）很常见，其中大多数分离株属于ST2/ST281。此外，我们在研究中确定ST499是最常见的非CC2谱系。我们的研究结果表明，在过去10年中，美国CR种群发生了变化，并强调了实时监测和分子流行病学在研究CR传播和临床影响方面的重要性。耐碳青霉烯类鲍曼不动杆菌（CR）对公共卫生构成重大威胁。为了阐明美国CR的分子和临床流行病学，收集了临床CR分离株以及患者特征和结局数据，并对细菌分离株进行了全基因组测序和抗生素敏感性表型分析。主要发现包括在全球主要的克隆复合体2（CC2）中出现了新的亚谱系，CC
