Young-Sharma Tracey, Lane Courtney R, James Rodney, Wilmot Mathilda, Autar Sanjeshni, Hui Kylie, Strobel Aneley Getahun, Lacey Jake A, Kumar Savneel, Datt Ashlyn, Lata Alvina, Cameron Donna, Sherry Norelle L, Genaro Sisilia, Ditukana Timaima, Nabose Ilisapeci, Goneyali Apaitia, Bennett Elizabeth, Kavoa Anisi, Prasad Shammi, Vakamocea Alipate, Suka Ana, Prasad Prinika, Hussein Farheen, Lin Chantel, Jenney Adam Wj, Buising Kirsty, Naidu Ravi, Howden Benjamin P
Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji.
WHO Collaborating Centre for Antimicrobial Resistance, The University of Melbourne at Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
Lancet Reg Health West Pac. 2024 Nov 20;53:101234. doi: 10.1016/j.lanwpc.2024.101234. eCollection 2024 Dec.
Fiji is a Pacific Island nation grappling with the increasing threat of antimicrobial resistance (AMR). While genomic technologies are increasingly utilised to understand the emergence and spread of AMR globally, its application to inform outbreak responses in low- and middle-income settings has not been reported.
Through an established capacity building program, suspected carbapenem-resistant organisms (CRO) identified at Colonial War Memorial Hospital in Fiji (Jan 2022-Oct 2023) underwent whole genome sequencing and analysis. Following a rapid increase in CROs, a joint outbreak investigation including detailed genomic epidemiology was undertaken. A multi-modal response was co-designed and implemented by hospital staff, and circulating strains monitored to assess impact.
Six large genomic clusters accounted for 73% (n = 223/304) of all sequenced CRO isolates. Four genomic clusters ( NDM-1, OXA-23/OXA-58 NDM-7, NDM-1) were investigated in detail, with affected wards differing between species. Following outbreak interventions, and clusters decreased rapidly, however transmission persisted. Repeated international importation of CROs into Fiji were suspected.
Carbapenem-resistant pathogens pose a major threat to the health system in Fiji. Genomics technologies are useful for understanding AMR and guiding successful response, in these settings. Strategies to ensure access to, and judicious use of the technology are justified.
This work was funded by the Australian Government through the Department of Foreign Affairs and Trade Centre for Health Security, Medical Research Future Fund and National Health and Medical Research Council.
斐济是一个太平洋岛国，正应对日益严重的抗菌药物耐药性（AMR）威胁。虽然基因组技术越来越多地用于了解全球AMR的出现和传播，但其在低收入和中等收入环境中为疫情应对提供信息的应用尚未见报道。
通过既定的能力建设计划，对2022年1月至2023年10月在斐济殖民战争纪念医院鉴定出的疑似耐碳青霉烯类病原体（CRO）进行全基因组测序和分析。在CRO数量迅速增加后，开展了包括详细基因组流行病学在内的联合疫情调查。医院工作人员共同设计并实施了多模式应对措施，并对传播菌株进行监测以评估影响。
六个大型基因组簇占所有测序CRO分离株的73%（n = 223/304）。对四个基因组簇（NDM-1、OXA-23/OXA-58 NDM-7、NDM-1）进行了详细调查，受影响的病房因物种而异。在采取疫情干预措施后，[此处原文缺失相关信息]簇迅速减少，但[此处原文缺失相关信息]传播仍持续存在。怀疑CRO多次从国际上输入斐济。
耐碳青霉烯类病原体对斐济的卫生系统构成重大威胁。在这些环境中，基因组技术有助于了解AMR并指导成功应对。确保获取并明智使用该技术的策略是合理的。
这项工作由澳大利亚政府通过外交和贸易部卫生安全中心、医学研究未来基金以及国家卫生和医学研究委员会提供资金。
