在非暴发情况下，使用全基因组测序调查大型急性医院中医护人员、患者和环境中耐甲氧西林金黄色葡萄球菌的传播。
Meticillin-susceptible Staphylococcus aureus transmission among healthcare workers, patients and the environment in a large acute hospital under non-outbreak conditions investigated using whole-genome sequencing.
机构信息
Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland.
Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland; Department of Infection Control and Prevention, Beaumont Hospital, Dublin, Ireland.
出版信息
J Hosp Infect. 2022 Sep;127:15-25. doi: 10.1016/j.jhin.2022.05.004. Epub 2022 May 18.
BACKGROUND
The role of meticillin-susceptible Staphylococcus aureus (MSSA) colonization of healthcare workers (HCWs), patients and the hospital environment in MSSA transmission events (TEs) is poorly understood.
AIMS
The role of meticillin-resistant Staphylococcus aureus (MRSA) was investigated recently under non-outbreak conditions in a large hospital with a history of endemic MRSA over 2 years using whole-genome sequencing (WGS). Numerous potential MRSA TEs were identified. The present study investigated MSSA TEs from the same sources during the same 2-year hospital study.
METHODS
HCW (N=326) and patient (N=388) volunteers on nine wards were tested for nasal and oral MSSA colonization over 2 years. Near-patient environment (N=1164), high-frequency touch sites (N=810) and air (N=445) samples were screened for MSSA. Representative MSSA and clinical isolates were sequenced and analysed by core genome multi-locus sequence typing. Closely related isolates (≤24 allelic differences) were segregated into related isolate groups (RIGs). Potential TEs involving MSSA in RIGs from HCWs, patients and patient infections were identified in combination with epidemiological data.
FINDINGS
In total, 635 MSSA were recovered: clinical isolates (N=82), HCWs (N=170), patients (N=120), and environmental isolates (N=263). Twenty-four clonal complexes (CCs) were identified among 406/635 MSSA sequenced, of which 183/406 segregated into 59 RIGs. Numerous potential HCW-to-patient, HCW-to-HCW and patient-to-patient TEs were identified, predominantly among CC5-MSSA, CC30-MSSA and CC45-MSSA. HCW, patient, clinical and environmental isolates were identified in 33, 24, six and 32 RIGs, respectively, with 19/32 of these containing MSSA related to HCW and/or patient isolates.
CONCLUSIONS
WGS detected numerous potential hospital MSSA TEs involving HCWs, patients and environmental contamination under non-outbreak conditions.
背景
医护人员（HCW）、患者和医院环境中耐甲氧西林金黄色葡萄球菌（MSSA）定植在 MSSA 传播事件（TE）中的作用知之甚少。
目的
在一家 2 年多来一直存在地方性耐甲氧西林金黄色葡萄球菌（MRSA）的大型医院中，最近在非暴发情况下使用全基因组测序（WGS）对耐甲氧西林金黄色葡萄球菌（MRSA）的作用进行了研究。发现了许多潜在的耐甲氧西林金黄色葡萄球菌 TE。本研究在同一 2 年医院研究期间调查了来自同一来源的 MSSA TE。
方法
9 个病房的 326 名 HCW 和 388 名患者志愿者在 2 年内接受了鼻腔和口腔 MSSA 定植检测。对近患者环境（N=1164）、高频接触点（N=810）和空气（N=445）样本进行 MSSA 筛查。对代表性 MSSA 和临床分离株进行测序，并通过核心基因组多位点序列分型进行分析。≤24 个等位基因差异的密切相关分离株被分为相关分离株组（RIG）。通过结合流行病学数据，确定 RIG 中涉及 HCW、患者和患者感染的 MSSA 潜在 TE。
结果
共回收了 635 株 MSSA：临床分离株（N=82）、HCW（N=170）、患者（N=120）和环境分离株（N=263）。在 406 株 MSSA 测序中，鉴定出 24 个克隆复合体（CC），其中 183 株分离株分为 59 个 RIG。确定了许多潜在的 HCW 到患者、HCW 到 HCW 和患者到患者的 TE，主要是在 CC5-MSSA、CC30-MSSA 和 CC45-MSSA 中。在 33、24、6 和 32 个 RIG 中分别鉴定出 HCW、患者、临床和环境分离株，其中 19/32 个 RIG 含有与 HCW 和/或患者分离株相关的 MSSA。
结论
WGS 在非暴发情况下检测到了许多潜在的医院 MSSA TE，涉及 HCW、患者和环境污染。
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