Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA.
Department of Medicine, Division of Epidemiology, Vanderbilt University, Nashville, Tennessee, USA.
J Clin Microbiol. 2023 Aug 23;61(8):e0025923. doi: 10.1128/jcm.00259-23. Epub 2023 Jul 13.
Carbapenem-resistant (CRE) are among the most concerning antibiotic resistance threats due to high rates of multidrug resistance, transmissibility in health care settings, and high mortality rates. We evaluated the potential for regional genomic surveillance to track the spread of -carrying CRE (KPC-CRE) by using isolate collections from health care facilities in three U.S. states. Clinical isolates were collected from Connecticut (2017 to 2018), Minnesota (2012 to 2018), and Tennessee (2016 to 2017) through the U.S. Centers for Disease Control and Prevention's Multi-site Gram-negative Surveillance Initiative (MuGSI) and additional surveillance. KPC-CRE isolates were whole-genome sequenced, yielding 255 isolates from 214 patients across 96 facilities. Case report data on patient comorbidities, facility exposures, and interfacility patient transfer were extracted. We observed that in Connecticut, most KPC-CRE isolates showed evidence of importation from outside the state, with limited local transmission. In Minnesota, cases were mainly from sporadic importation and transmission of -carrying Klebsiella pneumoniae ST258, and clonal expansion of -carrying Enterobacter hormaechei ST171, primarily at a single focal facility and its satellite facilities. In Tennessee, we observed transmission of diverse strains of -carrying Enterobacter and , with evidence that most derived from the local acquisition of plasmids circulating in an interconnected regional health care network. Thus, the underlying processes driving KPC-CRE burden can differ substantially across regions and can be discerned through regional genomic surveillance. This study provides proof of concept that integrating genomic data with information on interfacility patient transfers can provide insights into locations and drivers of regional KPC-CRE burden that can enable targeted interventions.
耐碳青霉烯类肠杆菌科细菌（CRE）是最令人担忧的抗生素耐药性威胁之一，因为它们具有很高的多药耐药性、在医疗环境中的传播性和高死亡率。我们评估了通过使用来自美国三个州的医疗保健设施的分离株收集来进行区域基因组监测以追踪携带 - 碳青霉烯酶（KPC-CRE）的 CRE 传播的潜力。通过美国疾病控制与预防中心的多地点革兰氏阴性菌监测倡议（MuGSI）和其他监测，从康涅狄格州（2017 年至 2018 年）、明尼苏达州（2012 年至 2018 年）和田纳西州（2016 年至 2017 年）收集临床分离株。对 KPC-CRE 分离株进行全基因组测序，从 96 个设施的 214 名患者中获得 255 个分离株。提取了有关患者合并症、设施暴露和跨设施患者转移的病例报告数据。我们观察到，在康涅狄格州，大多数 KPC-CRE 分离株显示出从州外输入的证据，本地传播有限。在明尼苏达州，病例主要来自零星的输入和传播，携带 - 碳青霉烯酶的肺炎克雷伯菌 ST258，以及 - 碳青霉烯酶的肠杆菌属 ST171 的克隆扩张，主要发生在一个单一的焦点设施及其卫星设施中。在田纳西州，我们观察到不同菌株的 - 碳青霉烯类肠杆菌和 的传播，有证据表明，大多数源自当地获得在相互关联的区域医疗保健网络中循环的质粒。因此，推动 KPC-CRE 负担的潜在过程在不同地区可能有很大差异，并且可以通过区域基因组监测来辨别。这项研究提供了一个概念验证，即整合基因组数据和跨设施患者转移信息可以提供有关区域 KPC-CRE 负担的位置和驱动因素的见解，从而可以进行有针对性的干预。
