Division for Public Health, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria.
Institute of Pathology, Upper Austrian Health Holding GmbH, Pyhrn-Eisenwurzen Clinical Centre Kirchdorf Steyr, Steyr, Austria.
Microbiol Spectr. 2024 Oct 3;12(10):e0074024. doi: 10.1128/spectrum.00740-24. Epub 2024 Aug 20.
In spring 2022, an increase in metallo-β-lactamase-producing (MBL-Pa) infections was detected in a hospital in Upper Austria. To identify the source of infection and to stop further transmissions, an epidemiological outbreak investigation including whole-genome sequencing (WGS)-based typing was conducted. The final case definition included cases admitted to the hospital between 2020 and 2023 with an MBL-Pa in one of the three genomic clusters identified. In addition, the investigation was extended to include historical cases from 2017. Core genome multilocus sequence typing was performed to assess the genetic relatedness between the isolates. Fifty-four clinical isolates and eight isolates from the hospital environment were obtained. All but nine isolates grouped into one of three genomic clusters (ST235/, ST111/, or ST621/), which were considered to be distinct, prolonged outbreaks involving 47 out of 52 cases. The most likely source of infection for cluster 1 (ST111/) and cluster 2 (ST235/) was sinks in the intensive care unit (ICU) washroom. Cluster 3 clone (ST621/) could have originated in the urology ward in 2020 and then spread to the ICU years later. However, the nosocomial origin of this clone could not be proven. In March 2023, following the implementation of control measures (gowning, patient isolation, screening, and daily disinfection), no further MLB-Pa was detected, and the outbreaks were considered to be over. As ICUs play an important role in the transmission of , emphasis should be placed on genomic surveillance, infection prevention, and control in such wards.
The significance of our work lies in the successful resolution of three prolonged outbreaks of MBL-Pa infections in a hospital in Upper Austria. Through a comprehensive epidemiological investigation coupled with WGS-based typing of isolates, the study identified three distinct genomic clusters responsible for prolonged outbreaks involving 47 cases. The investigation pinpointed sinks in the ICU washroom as the likely source of infection for two of the clusters. The study demonstrates the effectiveness of control measures such as hand hygiene, gowning, patient isolation, screening, and disinfection in stopping further transmission and bringing the outbreaks to a close. This underscores the critical role of genomic surveillance and control measures, particularly in high-risk settings like ICUs, in reducing nosocomial transmission of MBL-Pa infections.
本研究成功解决了上奥地利一家医院发生的三起产金属β-内酰胺酶（MBL-Pa）感染的持续暴发。
对 2020 年至 2023 年期间住院且检出三种基因组簇之一的 MBL-Pa 的患者进行基于全基因组测序（WGS）的流行病学暴发调查，包括确定感染源和阻止进一步传播。最终的病例定义包括在 2017 年发生的历史病例。对分离株进行核心基因组多位点序列分型，以评估分离株之间的遗传相关性。获得了 54 株临床分离株和 8 株医院环境分离株。除 9 株外，所有分离株均分为三个基因组簇（ST235/、ST111/或 ST621/），这些簇被认为是不同的，持续时间较长的暴发涉及 52 例中的 47 例。集群 1（ST111/）和集群 2（ST235/）的最可能感染源是 ICU 洗漱间的水槽。集群 3 克隆（ST621/）可能于 2020 年起源于泌尿科病房，数年后传播至 ICU。然而，无法证明该克隆的医院感染来源。2023 年 3 月，在实施控制措施（穿长袍、患者隔离、筛查和日常消毒）后，未再检出 MBL-Pa，暴发被认为已结束。由于 ICU 在 传播中起着重要作用，因此应重视此类病房的基因组监测、感染预防和控制。
本研究成功解决了上奥地利一家医院三起产金属β-内酰胺酶（MBL-Pa）感染的持续暴发，通过综合的流行病学调查和基于 WGS 的分离株分型，确定了三个不同的基因组簇，导致了涉及 47 例的持续暴发。调查确定 ICU 洗漱间的水槽是两个集群的可能感染源。该研究证明了手卫生、穿长袍、患者隔离、筛查和消毒等控制措施在阻止进一步传播和结束暴发方面的有效性。这突显了基因组监测和控制措施在减少医院内 MBL-Pa 感染传播方面的关键作用，尤其是在 ICU 等高危环境中。
