Moretti Marco, Vanstokstraeten Robin, Crombé Florence, Barbé Kurt, Wybo Ingrid, Allard Sabine D, Jonckheer Joop, De Geyter Deborah
Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Internal Medicine and Infectious Diseases, Brussels, Belgium.
Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Microbiology and Infection Control, Brussels, Belgium.
Am J Infect Control. 2024 Dec;52(12):1425-1431. doi: 10.1016/j.ajic.2024.08.022. Epub 2024 Aug 31.
Verona integron-encoded metallo-β-lactamase-producing Pseudomonas aeruginosa (VIM-PA) outbreaks are frequently linked to contaminated sink-drains in the intensive care unit (ICU). This study aims to investigate a VIM-PA outbreak occurring at 4 ICUs in a Belgian university center.
Between 01/01/2019 and 30/07/2023, data were retrospectively retrieved. Whole-genome sequencing of VIM-PA was carried out for available isolates and the core genome multilocus sequencing typing (cgMLST) was used to confirm clonality. New case incidence was estimated by analyzing the weekly data of at-risk and VIM-PA-colonized patients, fitting a regression model.
Fifty-one patients were colonized, among them, 32 (63%) were infected by VIM-PA, which contributed to 7 deaths. The outbreak investigation showed that 19 (47%) of the examined sink-drains grew at least once a VIM-PA. Two major clusters were observed by cgMLST: ST111 (59 clones with 40 clinical isolates), and ST17 (8 clones with 6 clinical isolates). The estimated incidence rate of new cases was significantly higher in one unit.
A 5-year prolonged outbreak at the UZ Brussel ICUs was caused by only 2 VIM-PA clones, both linked to sink-drains, with minimal mutations occurring throughout the years. Statistical modeling found different incidence rates between units. Tailored interventions were hence prioritized.
产维罗纳整合子编码金属β-内酰胺酶的铜绿假单胞菌（VIM-PA）暴发频繁与重症监护病房（ICU）受污染的水槽排水口有关。本研究旨在调查比利时一所大学中心4个ICU发生的VIM-PA暴发情况。
回顾性检索2019年1月1日至2023年7月30日期间的数据。对可用分离株进行VIM-PA全基因组测序，并使用核心基因组多位点测序分型（cgMLST）来确认克隆性。通过分析高危患者和VIM-PA定植患者的每周数据，拟合回归模型来估计新病例发病率。
51例患者被定植，其中32例（63%）感染了VIM-PA，导致7人死亡。暴发调查显示，19个（47%）检查的水槽排水口中至少有一次培养出VIM-PA。通过cgMLST观察到两个主要聚类：ST111（59个克隆，40个临床分离株）和ST17（8个克隆，6个临床分离株）。一个科室的新病例估计发病率显著更高。
布鲁塞尔大学医院ICU长达5年的暴发仅由2个VIM-PA克隆引起，两者均与水槽排水口有关，多年来发生的突变极少。统计建模发现各科室之间发病率不同。因此优先采取针对性干预措施。
