Brehony Carina, Domegan Lisa, Foley Margaret, Fitzpatrick Margaret, Cafferkey Jacqueline P, O'Connell Karina, Dinesh Binu, McNamara Eleanor, Duffy Fionnuala, Fitzpatrick Fidelma, Burns Karen
European Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.
Public Health Laboratory, Cherry Orchard, Health Service Executive, Dublin, Ireland.
Antimicrob Steward Healthc Epidemiol. 2021 Dec 8;1(1):e54. doi: 10.1017/ash.2021.206. eCollection 2021.
Molecular epidemiological description of an OXA-48 CPE outbreak affecting a tertiary-care hospital ward in Ireland over an extended period (2018-2019).
Microbiological testing and whole-genome sequencing (WGS) were performed on all 56 positive OXA-48 outbreak case isolates.
In total, 7 different species were identified: (n = 35, 62.5%), (n = 12, 21.4%), (n = 5, 8.9%), (n = 1, 1.8%), (n = 1, 1.8%), (n = 1, 1.8%), and (n = 1, 1.8%). ST78 was the most common genotype (n = 14, 25%). Two major pOXA-48 plasmid types were identified throughout the outbreak, 'types' 1 and 2, and 5 major clonal groupings were identified: ST78, ST108, ST1126, ST135, and ST66. Within each of the ST108, ST1126, ST135 and ST66 groups, the pOXA-48 harbored within each isolate were the same. Within ST78, 9 isolates contained the pOXA48 'type 2' plasmid and 5 contained the 'type 1' plasmid. Environmental specimens were taken from different outbreak ward locations: handwash basins, sink and shower drains, and taps. Of 394 environmental specimens, OXA-48 CPE was isolated from 26 (6.6%).
This prolonged outbreak of OXA-48 CPE was confined to one ward, but it exemplifies the complexity and difficulty in the control of these organisms. With multiple species and genotypes involved, they may be better described as 'plasmid outbreaks.' WGS provided insights into this diversity and potential transmission among cases, though its usefulness would be enhanced by analysis as close as possible to real time so that interventions can be implemented as soon as data are available.
对爱尔兰一家三级护理医院病房在较长时期（2018 - 2019年）内发生的产OXA - 48碳青霉烯酶肠杆菌科细菌（CPE）暴发进行分子流行病学描述。
对所有56株OXA - 48暴发病例分离株进行微生物检测和全基因组测序（WGS）。
共鉴定出7种不同的菌种：（n = 35，62.5%），（n = 12，21.4%），（n = 5，8.9%），（n = 1，1.8%），（n = 1，1.8%），（n = 1，1.8%），以及（n = 1，1.8%）。ST78是最常见的基因型（n = 14，25%）。在整个暴发过程中鉴定出两种主要的pOXA - 48质粒类型，即“类型”1和2，并且鉴定出5个主要的克隆群：ST78、ST108、ST1126、ST135和ST66。在ST108、ST1126、ST135和ST66每个克隆群内，每个分离株中携带的pOXA - 48是相同的。在ST78内，9株分离株含有pOXA48“类型2”质粒，5株含有“类型1”质粒。从暴发病房的不同位置采集环境标本：洗手盆、水槽和淋浴排水口以及水龙头。在394份环境标本中，从26份（6.6%）中分离出产OXA - 48 CPE。
此次产OXA - 48 CPE的长期暴发局限于一个病房，但它例证了控制这些微生物的复杂性和困难。由于涉及多种菌种和基因型，它们可能更宜被描述为“质粒暴发”。全基因组测序揭示了这种多样性以及病例之间的潜在传播，不过通过尽可能接近实时的分析来提高其有用性，以便一旦获得数据就能立即实施干预措施，其作用将得到增强。
