Large, protracted, multi-species and multi-clonal spread of VIM-type metallo-β-lactamase-producing Enterobacterales in an Italian hospital

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-12-18 DOI:10.1016/j.jhin.2024.12.003

R. Olivieri , E. Riccobono , S. Gonnelli , C. Basagni , M. Tumbarello , M.G. Cusi , G.M. Rossolini

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Abstract

Background

Carbapenem-resistant Enterobacterales, particularly those producing carbapenemase (CPE), pose a major threat to human health, being listed among critical-priority resistant pathogens by the World Health Organization.

Aim

To report on a large nosocomial spread of CPE of different species producing Verona integron-encoded metallo-β-lactamase (VIM)-type carbapenemases, and on the infection prevention and control measures that were adopted to combat the spread.

Methods

Conventional culture and molecular methods were used for detection and identification of VIM-positive CPE (VIM-CPE) causing infections or colonizing patients or present in environmental specimens. Whole-genome sequencing analysis of selected isolates was performed to investigate clonal relatedness. Basic (active surveillance, contact precautions, close contact screening, cohorting of patients, surface cleaning, hand hygiene) and advanced (weekly point-prevalence surveys for rectal colonization, additional training of healthcare workers, extraordinary ward sanitization, extraordinary maintenance interventions, and environmental microbiological screening, single-use equipment, ward relocation) infection prevention and control (IPC) measures were implemented to combat the spread.

Findings

Spread of VIM-CPE involving 151 patients (mostly colonizations) was documented in a single hospital ward from November 2021 to December 2023. The spread involved several different species of Enterobacterales, with clonal expansion documented in some cases. Implementation of basic and advanced IPC measures was temporarily successful at mitigating the spread, but multiple relapses were observed, suggesting the presence of an unidentified environmental reservoir.

Conclusion

VIM-CPE has the potential to cause large and complex nosocomial outbreaks in hospital environments, underscoring the challenges to their control by IPC practices.

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vim型产金属ß-内酰胺酶肠杆菌在意大利一家医院的大规模、长期、多物种和多克隆传播

背景：碳青霉烯耐药肠杆菌，特别是产生碳青霉烯酶（CPE）的肠杆菌，对人类健康构成重大威胁，被世界卫生组织列为重点耐药病原体之一。目的：本研究报道了一起产vim型碳青霉烯酶的不同菌种CPE在医院内的大规模传播，并对采取的感染防控措施进行了对比。方法：采用常规培养和分子方法对引起感染或定植患者或存在于环境标本中的vim阳性CPE （VIM-CPE）进行检测和鉴定。对所选菌株进行全基因组测序分析，研究其克隆亲缘性。实施了基本（主动监测、接触者预防措施、密切接触者筛查、病例分组、表面清洁、手部卫生）和高级（每周直肠定植点患病率调查、卫生保健工作者的额外培训、特别病房卫生、特别维持干预措施和环境微生物筛查、一次性设备、病房重新定位）感染预防和控制（IPC）措施，以对照传播。研究结果：从2021年11月至2023年12月，在一个医院病房中记录了151名患者（主要是定植）的VIM-CPE传播。传播涉及几种不同种类的肠杆菌，在某些情况下记录了克隆扩增。实施基本和先进的IPC措施暂时成功地缓解了传播，但观察到多次复发，表明存在未知的环境水库。结论：该研究强调了VIM-CPE在医院环境中引起大规模和复杂的医院暴发的潜力，并强调了通过IPC实践控制其可能遇到的挑战。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.