在一家囊性纤维化中心对脓肿分枝杆菌分离株进行基因组和流行病学调查，以确定潜在的传播途径。
Genomic and epidemiologic investigation of Mycobacterium abscessus isolates in a cystic fibrosis center to determine potential routes of transmission.
作者信息
Gross Jane E, Fullmer Jason, McCleland Gregory, Caceres Silvia M, Poch Katie R, Hasan Nabeeh A, Jia Fan, Epperson L Elaine, Lipner Ettie M, Vang Charmie K, Honda Jennifer R, Strand Matthew J, de Moura Vinicius Calado Nogueira, Daley Charles L, Strong Michael, Nick Jerry A
机构信息
Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA; Department of Medicine, National Jewish Health, Denver, CO, USA.
Department of Pediatrics, Dell Children's Medical Group, Austin, TX, USA.
出版信息
J Cyst Fibros. 2025 Aug 8. doi: 10.1016/j.jcf.2025.07.003.
BACKGROUND
Cystic Fibrosis (CF) Centers worldwide have reported healthcare-associated outbreaks of nontuberculous mycobacteria (NTM). We report a retrospective investigation of shared Mycobacterium abscessus strains among people with cystic fibrosis (pwCF) receiving care at Dell Children's/Ascension combined Pediatric and Adult CF Program (DCMC).
METHODS
Whole genome sequencing (WGS) was used to identify genetically similar isolates among 167 NTM isolates from 57 pwCF. Epidemiological investigation, respiratory and environmental isolate comparisons, and watershed mapping were performed.
RESULTS
WGS analysis revealed four M. abscessus clusters, two ssp. abscessus and two ssp. massiliense. One subject was infected with two distinct clustered M. abscessus (ssp. abscessus and ssp. massiliense). Epidemiologic investigation demonstrated opportunities for healthcare-associated transmission within all clusters. Two ssp. massiliense subject pairs had healthcare overlaps and high genomic relatedness, including one cohabitating sibling pair. M. abscessus recovered from DCMC revealed genetic similarity to a respiratory isolate from one patient who was never exposed to the hospital environment.
CONCLUSIONS
We identified shared M. abscessus strains via genomic analysis among pwCF at DCMC. None of the clustered patient isolates matched hospital environmental isolates at the genomic level. One hospital environmental isolate had genomic similarity to a respiratory isolate of M. abscessus, but the epidemiologic investigation revealed no evidence of subject exposure to the hospital setting. One ssp. massiliense subject pair had the same level of pangenome relatedness as the sibling pair and epidemiological investigation revealed overlap in the clinic, supporting healthcare-associated person-to-person transmission among the pair within a cluster. One pwCF had polyclonal clustered infections, suggesting multiple environmental sources of acquisition outside the healthcare environment.
背景
全球范围内的囊性纤维化（CF）中心报告了与医疗保健相关的非结核分枝杆菌（NTM）暴发情况。我们报告了一项对在戴尔儿童/阿森松联合儿科和成人CF项目（DCMC）接受治疗的囊性纤维化患者（pwCF）中共享脓肿分枝杆菌菌株的回顾性调查。
方法
采用全基因组测序（WGS）来鉴定来自57名pwCF的167株NTM分离株中基因相似的分离株。进行了流行病学调查、呼吸道和环境分离株比较以及流域绘图。
结果
WGS分析揭示了四个脓肿分枝杆菌簇，两个脓肿亚种和两个马赛亚种。一名受试者感染了两种不同的聚集性脓肿分枝杆菌（脓肿亚种和马赛亚种）。流行病学调查表明，所有簇内都存在与医疗保健相关的传播机会。两对马赛亚种受试者有医疗保健重叠且基因组相关性高，包括一对同居的兄弟姐妹。从DCMC分离出的脓肿分枝杆菌与从未接触过医院环境的一名患者的呼吸道分离株具有基因相似性。
结论
我们通过基因组分析在DCMC的pwCF中鉴定出了共享的脓肿分枝杆菌菌株。在基因组水平上，没有一个聚集性患者分离株与医院环境分离株匹配。一株医院环境分离株与脓肿分枝杆菌的呼吸道分离株具有基因组相似性，但流行病学调查没有发现受试者接触医院环境的证据。一对马赛亚种受试者的全基因组相关性水平与兄弟姐妹对相同，流行病学调查显示在诊所存在重叠，支持了簇内该对受试者之间与医疗保健相关的人际传播。一名pwCF有多克隆聚集性感染，提示在医疗保健环境之外存在多种环境感染源。
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