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Endemicity and diversification of carbapenem-resistant Acinetobacter baumannii in an intensive care unit
被引:18
|作者:
Doughty, Emma L.
[1
,2
]
Liu, Haiyang
[2
,3
]
Moran, Robert A.
[1
,2
]
Hua, Xiaoting
[2
,3
]
Ba, Xiaoliang
[2
]
Guo, Feng
[2
,3
]
Chen, Xiangping
[2
,3
]
Zhang, Linghong
[2
,3
]
Holmes, Mark
[2
]
van Schaik, Willem
[1
,2
]
Mcnally, Alan
[1
,2
]
Yu, Yunsong
机构:
[1] Univ Birmingham, Inst Microbiol & Infect, Coll Med & Dent Sci, Birmingham, England
[2] Zhejiang Univ, Sir Run Run Shaw Hosp, Sch Med, Dept Infect Dis, Hangzhou 310016, Zhejiang, Peoples R China
[3] Univ Cambridge, Dept Vet Med, Cambridge, England
来源:
基金:
中国国家自然科学基金;
英国医学研究理事会;
关键词:
Carbapenem-resistant Acinetobacter baumannii;
Intensive care;
Genomic epidemiology;
Infection prevention and control;
Antimicrobial resistance;
Horizontal gene transfer;
RESISTANT ACINETOBACTER-BAUMANNII;
D O I:
10.1016/j.lanwpc.2023.100780
中图分类号:
R19 [保健组织与事业(卫生事业管理)];
学科分类号:
摘要:
Background Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major public health concern globally. Often studied in the context of hospital outbreaks, little is known about the persistence and evolutionary dynamics of endemic CRAB populations.Methods A three-month cross-sectional observational study was conducted in a 28-bed intensive care unit (ICU) in Hangzhou, China. A total of 5068 samples were collected from the hospital environment (n = 3985), patients (n = 964) and staff (n = 119). CRAB isolates were obtained from 10.5% of these samples (n = 532). All of these isolates, plus an additional 19 from clinical infections, were characterised through whole-genome sequencing.Findings The ICU CRAB population was dominated by OXA-23-producing global clone 2 isolates (99.3% of all isolates) that could be divided into 20 distinct clusters, defined through genome sequencing. CRAB was persistently present in the ICU, driven by regular introductions of distinct clusters. The hospital environment was heavily contaminated, with CRAB isolated from bed units on 183/335 (54.6%) sampling occasions but from patients on only 72/299 (24.1%) occasions. CRAB was spread to adjacent bed units and rooms, and following relocation of patients within the ICU. We also observed three horizontal gene transfer events between CRAB strains in the ICU, involving three different plasmids.Interpretation The epidemiology of CRAB in this setting contrasted with previously described clonal outbreaks in high-income countries, highlighting the importance of environmental CRAB reservoirs in ICU epidemiology and the unique challenges in containing the spread of CRAB in ICUs where this important multidrug-resistant pathogen is endemic.
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