Nguyen Minh Ngoc, Gladstone Beryl Primrose, De Angelis Giulia, Biggel Michael, Xavier Basil Britto, Lammens Christine, Lin Qiang, Van Puyvelde Sandra, Goossens Herman, Kumar-Singh Samir, Glupczynski Youri, Carmeli Yehuda, Tacconelli Evelina, Malhotra-Kumar Surbhi
Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
Department of Internal Medicine I, Clinical Research Unit - German Centre for Infectious Diseases, Division of Infectious Disease, Tübingen University Hospital, Tübingen, Germany.
Genome Med. 2024 Dec 20;16(1):151. doi: 10.1186/s13073-024-01424-2.
The impact of community carriage on the influx of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) into hospitals remains understudied. In this prospective 2-year single-centre study, we investigate the community ESBL-E influx and trace the colonisation, nosocomial acquisition, transmission, and infection dynamics of ESBL-producing Escherichia coli (ESBL-Ec) in non-ICU wards at a tertiary care hospital.
This study reports primary and post hoc outcomes of the clinical trial NCT01208519 in which hospitalised patients were screened for rectal carriage of ESBL-E. ESBL-Ec isolates from ≈50% of carriers, including all patients who developed infections, were sequenced and genotyped. Endogenous infection was defined as infection by the same strain (< 10 SNPs distance) as colonizing strain.
Of 3703 screened patients, 456 (12.3%) were ESBL-positive-at-admission (PA-ESBL). Of the 2268 ESBL-negative-at-admission (NA-ESBL) patients with follow-up samples, 240 (10.6%) acquired ESBL-E (HA-ESBL), with an incidence density rate of 7.96 cases/1000 patient-day, notably higher in patients receiving antibiotics (P < 0.001). PA- and HA-ESBL patients developed significantly more ESBL-E infections than ESBL-free patients (P < 0.001). Sequenced ESBL-Ec showed high clonal diversity dominated by the multidrug-resistant and highly virulent ST131 clade, C2/H30-Rx. Among ESBL-Ec infections, 60% (18/30) were endogenous. Direct between-patients transmission clusters (n = 21) involved 23.9% (48/201) of patients and 23.0% (84/366) of ESBL-Ec isolates.
Our data show a high prevalence of nosocomial acquisition of ESBL-E in a non-ICU setting. The study provides genomic evidence that the endogenous reservoir is the main driver of ESBL-Ec infections underscoring the need for wide implementation of antibiotic stewardship programmes to reduce antibiotic pressure.
社区携带产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）对医院内此类细菌流入的影响仍未得到充分研究。在这项为期2年的前瞻性单中心研究中，我们调查了社区ESBL-E的流入情况，并追踪了一家三级护理医院非重症监护病房中产ESBL大肠杆菌（ESBL-Ec）的定植、医院获得、传播及感染动态。
本研究报告了临床试验NCT01208519的主要和事后结果，该试验对住院患者进行了直肠ESBL-E携带情况筛查。对约50%携带者的ESBL-Ec分离株进行测序和基因分型，包括所有发生感染的患者。内源性感染定义为感染与定植菌株相同的菌株（单核苷酸多态性距离<10）。
在3703例接受筛查的患者中，456例（12.3%）入院时ESBL呈阳性（PA-ESBL）。在2268例入院时ESBL呈阴性（NA-ESBL）且有随访样本的患者中，240例（10.6%）获得了ESBL-E（HA-ESBL），发病密度为7.96例/1000患者日，在接受抗生素治疗的患者中显著更高（P<0.001）。PA-ESBL和HA-ESBL患者发生ESBL-E感染的情况显著多于无ESBL患者（P<0.001）。测序的ESBL-Ec显示出高度的克隆多样性，以多重耐药且高毒力的ST131分支C2/H30-Rx为主。在ESBL-Ec感染中，60%（18/30）为内源性感染。患者之间的直接传播集群（n=21）涉及23.9%（48/201）的患者和23.0%（84/366）的ESBL-Ec分离株。
我们的数据显示在非重症监护环境中，医院获得ESBL-E的情况很普遍。该研究提供了基因组证据，表明内源性储存库是ESBL-Ec感染的主要驱动因素，强调了广泛实施抗生素管理计划以减轻抗生素压力的必要性。
