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德国产 ESBL 大肠杆菌来源归因方法比较。

Comparison of approaches for source attribution of ESBL-producing Escherichia coli in Germany.

机构信息

Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany.

Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany.

出版信息

PLoS One. 2022 Jul 15;17(7):e0271317. doi: 10.1371/journal.pone.0271317. eCollection 2022.

Abstract

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia (E.) coli have been widely described as the cause of treatment failures in humans around the world. The origin of human infections with these microorganisms is discussed controversially and in most cases hard to identify. Since they pose a relevant risk to human health, it becomes crucial to understand their sources and the transmission pathways. In this study, we analyzed data from different studies in Germany and grouped ESBL-producing E. coli from different sources and human cases into subtypes based on their phenotypic and genotypic characteristics (ESBL-genotype, E. coli phylogenetic group and phenotypic antimicrobial resistance pattern). Then, a source attribution model was developed in order to attribute the human cases to the considered sources. The sources were from different animal species (cattle, pig, chicken, dog and horse) and also from patients with nosocomial infections. The human isolates were gathered from community cases which showed to be colonized with ESBL-producing E. coli. We used the attribution model first with only the animal sources (Approach A) and then additionally with the nosocomial infections (Approach B). We observed that all sources contributed to the human cases, nevertheless, isolates from nosocomial infections were more related to those from human cases than any of the other sources. We identified subtypes that were only detected in the considered animal species and others that were observed only in the human population. Some subtypes from the human cases could not be allocated to any of the sources from this study and were attributed to an unknown source. Our study emphasizes the importance of human-to-human transmission of ESBL-producing E. coli and the different role that pets, livestock and healthcare facilities may play in the transmission of these resistant bacteria. The developed source attribution model can be further used to monitor future trends. A One Health approach is necessary to develop source attribution models further to integrate also wildlife, environmental as well as food sources in addition to human and animal data.

摘要

产超广谱β-内酰胺酶(ESBL)的大肠杆菌已被广泛描述为导致世界各地人类治疗失败的原因。这些微生物引起的人类感染的起源存在争议,在大多数情况下难以确定。由于它们对人类健康构成相关风险,因此了解其来源和传播途径至关重要。在这项研究中,我们分析了来自德国不同研究的数据,并根据表型和基因型特征(ESBL 基因型、大肠杆菌进化群和表型抗菌药物耐药模式)将来自不同来源和人类病例的产 ESBL 大肠杆菌分为亚型。然后,开发了一种源归因模型,以便将人类病例归因于考虑中的来源。这些来源来自不同的动物物种(牛、猪、鸡、狗和马),也来自医院感染的患者。人类分离株是从社区病例中收集的,这些病例表现为产 ESBL 的大肠杆菌定植。我们首先仅使用动物来源(方法 A),然后再加上医院感染(方法 B)使用归因模型。我们观察到所有来源都导致了人类病例,但医院感染的分离株与人类病例的分离株比任何其他来源的分离株更相关。我们确定了仅在考虑的动物物种中检测到的亚型,以及仅在人类群体中观察到的其他亚型。一些来自人类病例的亚型无法分配到本研究中的任何来源,归因于未知来源。我们的研究强调了人与人之间传播产 ESBL 的大肠杆菌的重要性,以及宠物、牲畜和医疗机构在传播这些耐药细菌方面可能发挥的不同作用。开发的源归因模型可进一步用于监测未来的趋势。需要采取一种“同一健康”方法,进一步开发源归因模型,以整合野生动物、环境以及食物来源,除了人类和动物数据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/062f/9286285/0aa398120998/pone.0271317.g001.jpg

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