Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.
College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji.
Front Cell Infect Microbiol. 2024 Sep 23;14:1429443. doi: 10.3389/fcimb.2024.1429443. eCollection 2024.
There are multiple ongoing outbreaks of carbapenem resistant (CR) infection in Fiji's hospitals. CR is able to colonize and persist on various hospital surfaces for extended periods. We conducted a study to understand the extent of hospital environmental contamination and phylogenetic links with clinical isolates.
Swabs were collected from high-touch surfaces at Colonial War Memorial Hospital (CWMH) September 2021 and December 2022; Lautoka Hospital (LTKH) August 2022; and Labasa Hospital (LBSH) November 2022. All bacterial isolates were identified, and antimicrobial susceptibility testing (AST) performed; isolates resistant to carbapenems and producing a carbapenemase underwent whole genome sequencing. Comparison was made to clinical isolates obtained from CWMH in 2016-2017 and 2019-2021 and from LTKH and LBSH from 2020-2021.
From the 180 environmental samples collected, ten (5.6%) CR were isolated; no other carbapenem-resistant gram-negative organisms were isolated. Seven (70%) of the CR were isolated from CWMH and three (30%) from LTKH; no CR were isolated from LBSH. Of the seven CWMH CR, two were sequence type 2 (ST2), three ST25, and two ST499. All LTKH isolates were ST499. The two environmental CR ST2 isolates were closely genetically linked to isolates obtained from patients in CWMH, LTKH, and LBSH 2020-2021. Similarly, the three environmental CR ST25 isolates were closely genetically linked to isolates obtained from patients admitted to CWMH in 2019-2021 and LBSH in 2020. The environmental CR ST499 isolates represented two distinct clones, with clone 1 comprising two genetically identical isolates from CWMH and clone 2 the three isolates from LTKH. Although no genetic linkages were observed when comparing environmental ST499 isolates to those from CWMH patients in 2020-2021, both clone 1 isolates were genetically identical to an isolate obtained from a patient admitted during the sampling period.
Our study highlights the contamination of high-touch surfaces within Fiji hospitals with CR, suggesting that these may serve as important sources for CR. Phylogenetic linkages to CR isolated from patients since 2019 underscores the persistence of this resistant pathogen in hospital settings and the ongoing risk for hospital-acquired infections.
斐济多家医院正在爆发耐碳青霉烯类抗生素（CR）感染。CR 能够在各种医院表面定植并持续存在很长时间。我们进行了一项研究，以了解医院环境污染的程度及其与临床分离株的系统发育联系。
2021 年 9 月和 2022 年 12 月，我们从殖民地战争纪念医院（CWMH）、2022 年 8 月从劳托卡医院（LTKH）和 2022 年 11 月从拉巴萨医院（LBSH）的高接触表面采集了拭子。对所有细菌分离株进行了鉴定和药敏试验（AST）；对耐碳青霉烯类抗生素并产生碳青霉烯酶的分离株进行了全基因组测序。并与 2016-2017 年和 2019-2021 年从 CWMH、2020-2021 年从 LTKH 和 LBSH 获得的临床分离株进行了比较。
从 180 份环境样本中分离出 10 株（5.6%）CR，未分离出其他耐碳青霉烯类抗生素的革兰氏阴性菌。7 株（70%）CR 分离自 CWMH，3 株（30%）分离自 LTKH，LBSH 未分离出 CR。在 CWMH 的 7 株 CR 中，2 株为 2 型（ST2），3 株为 ST25，2 株为 ST499。LTKH 的所有分离株均为 ST499。2 株环境 CR ST2 分离株与 2020-2021 年从 CWMH、LTKH 和 LBSH 患者中获得的分离株在遗传上密切相关。同样，3 株环境 CR ST25 分离株与 2019-2021 年从 CWMH 患者和 2020 年从 LBSH 患者获得的分离株在遗传上密切相关。环境 CR ST499 分离株代表了两个不同的克隆，其中克隆 1 由来自 CWMH 的两个遗传上相同的分离株组成，克隆 2 由来自 LTKH 的三个分离株组成。虽然在比较 2020-2021 年 CWMH 患者的环境 ST499 分离株时没有观察到遗传联系，但这两个克隆 1 分离株与在采样期间从一名患者中获得的分离株在遗传上完全相同。
我们的研究强调了斐济医院高接触表面耐碳青霉烯类抗生素的污染情况，表明这些表面可能是耐碳青霉烯类抗生素的重要来源。自 2019 年以来与从患者中分离出的耐碳青霉烯类抗生素的系统发育联系突出表明，这种耐药病原体在医院环境中持续存在，并且存在持续发生医院获得性感染的风险。
