Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.
Helmholtz Centre for Infection Research, Department of Molecular Bacteriology, Braunschweig, Germany.
J Hosp Infect. 2023 Oct;140:96-101. doi: 10.1016/j.jhin.2023.07.020. Epub 2023 Aug 9.
To contain intra-hospital transmission of third-generation cephalosporin-resistant Enterobacterales (3GCR-E), contact isolation precautions are recommended.
To quantify transmissions of 3GCR Escherichia coli and 3GCR Klebsiella pneumoniae within a hospital.
An automated outbreak detection system (AODS) was used to identify clusters (N≥2) of 3GCR Enterobacterales for the years 2016, 2018 and 2020. Clusters were defined by phenotypic agreement of microbiological results and spatial and temporal relationship. Core genome multi-locus sequence typing (cgMLST) was used to confirm whether the cluster isolates were transmitted between patients.
A total of 4343 3GCR E. coli and 1377 K. pneumoniae isolates were analysed. Among the 3GCR E. coli isolates, the AODS identified 304 isolates as cluster isolates, the median cluster size was two (range: 2-5). The cgMLST analysis revealed that a total of 23 (7.5%) 3GCR E. coli cluster isolates were transmission-associated, of which 20 isolates (87%) were detected in intensive care patients. Among the 3GCR K. pneumoniae isolates, the AODS identified 73 isolates as cluster isolates, the median cluster size was two (range: 2-4). CgMLST revealed that 35 (48%) 3GCR K. pneumoniae cluster isolates were transmission associated, of which 27 isolates (77%) were detected in intensive care patients.
For 3GCR K. pneumoniae, cgMLST confirmed the AODS results more frequently than for 3GCR E. coli. Therefore, contact isolation precautions for 3GCR K. pneumoniae may be appropriate on intensive care units, but only in certain circumstances, such as outbreaks, for Enterobacterales with lower transmissibility, such as E. coli.
为了控制第三代头孢菌素耐药肠杆菌科细菌（3GCR-E）在医院内的传播，建议采取接触隔离预防措施。
定量检测医院内 3GCR 大肠杆菌和 3GCR 肺炎克雷伯菌的传播情况。
使用自动爆发检测系统（AODS）来识别 2016 年、2018 年和 2020 年的 3GCR 肠杆菌科细菌的聚集（N≥2）。通过微生物学结果的表型一致性以及时空关系来定义聚集。核心基因组多位点序列分型（cgMLST）用于确认集群分离株是否在患者之间传播。
共分析了 4343 株 3GCR 大肠杆菌和 1377 株肺炎克雷伯菌。在 3GCR 大肠杆菌分离株中，AODS 确定了 304 株为集群分离株，集群的中位数大小为 2（范围：2-5）。cgMLST 分析显示，共有 23（7.5%）3GCR 大肠杆菌集群分离株与传播有关，其中 20 株（87%）在重症监护患者中检测到。在 3GCR 肺炎克雷伯菌分离株中，AODS 确定了 73 株为集群分离株，集群的中位数大小为 2（范围：2-4）。cgMLST 显示，35（48%）3GCR 肺炎克雷伯菌集群分离株与传播有关，其中 27 株（77%）在重症监护患者中检测到。
对于 3GCR 肺炎克雷伯菌，cgMLST 比 AODS 更频繁地证实结果。因此，接触隔离预防措施可能适用于重症监护病房的 3GCR 肺炎克雷伯菌，但仅在某些情况下，如暴发时，对于传播性较低的肠杆菌科细菌，如大肠杆菌，才适用。
