Institute of Microbiology and Infection, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK.
Microb Genom. 2024 Nov;10(11). doi: 10.1099/mgen.0.001314.
Vulnerable patients in an intensive care unit (ICU) setting are at high risk of infection from bacteria including gut-colonising and species. Complex ICU procedures often depend on successful antimicrobial treatment, underscoring the importance of understanding the extent of patient colonisation by multi-drug-resistant organisms (MDROs) in large UK ICUs. Previous work on ICUs globally uncovered high rates of colonisation by transmission of MDROs, but the situation in UK ICUs is less understood. Here, we investigated the diversity and antibiotic resistance gene (ARG) carriage of bacteria present in one of the largest UK ICUs at the Queen Elizabeth Hospital Birmingham (QEHB), focusing primarily on as both a widespread commensal and a globally disseminated multi-drug-resistant pathogen. Samples were taken during highly restrictive coronavirus disease 2019 (COVID-19) control measures from May to December 2021. Whole-genome and metagenomic sequencing were used to detect and report strain-level colonisation of patients, focusing on sequence types (STs), their colonisation dynamics and antimicrobial resistance gene carriage. We found a lack of multi-drug resistance (MDR) in the QEHB. Only one carbapenemase-producing organism was isolated, a carrying . There was no evidence supporting the spread of this strain, and there was little evidence overall of nosocomial acquisition or circulation of colonising . Whilst 22 different STs were identified, only 1 strain of the pandemic ST131 lineage was isolated. This ST131 strain was non-MDR and was found to be a clade A strain, associated with low levels of antibiotic resistance. Overall, the QEHB ICU had very low levels of pandemic or MDR strains, a result that may be influenced in part by the strict COVID-19 control measures in place at the time. Employing some of these infection prevention and control measures where reasonable in all ICUs might therefore assist in maintaining low levels of nosocomial MDR.
重症监护病房（ICU）环境中的脆弱患者面临着来自包括肠道定植菌和物种在内的细菌感染的高风险。复杂的 ICU 程序通常依赖于成功的抗菌治疗，这突显了了解英国大型 ICU 中多药耐药菌（MDRO）患者定植程度的重要性。全球 ICU 的先前工作揭示了 MDRO 传播导致的定植率很高，但英国 ICU 的情况了解较少。在这里，我们调查了位于伯明翰伊丽莎白女王医院（QEHB）的英国最大的 ICU 之一的细菌多样性和抗生素耐药基因（ARG）携带情况，主要关注作为广泛共生菌和全球传播的多药耐药病原体的。在 2021 年 5 月至 12 月实施高度限制性的 2019 年冠状病毒病（COVID-19）控制措施期间采集了样本。使用全基因组和宏基因组测序来检测和报告患者的菌株级定植情况，重点关注序列类型（ST）、它们的定植动态和抗生素耐药基因携带情况。我们发现 QEHB 缺乏多药耐药性（MDR）。仅分离出一种产碳青霉烯酶的生物体，携带。没有证据支持该菌株的传播，总体上也没有证据表明定植的获得或传播。虽然鉴定了 22 种不同的 ST，但仅分离出一种流行的 ST131 谱系的菌株。这种 ST131 菌株是非 MDR 的，被发现是一种 A 谱系菌株，与低水平的抗生素耐药性相关。总体而言，QEHB ICU 中流行菌株或 MDR 菌株的水平非常低，这一结果可能部分受到当时实施的严格 COVID-19 控制措施的影响。在所有 ICU 中合理采用其中一些感染预防和控制措施可能有助于维持低水平的医院获得性 MDR。
