R. Olivieri , E. Riccobono , S. Gonnelli , C. Basagni , M. Tumbarello , M.G. Cusi , G.M. Rossolini
{"title":"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","authors":"R. Olivieri , E. Riccobono , S. Gonnelli , C. Basagni , M. Tumbarello , M.G. Cusi , G.M. Rossolini","doi":"10.1016/j.jhin.2024.12.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aim</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Conclusion</h3><div>VIM-CPE has the potential to cause large and complex nosocomial outbreaks in hospital environments, underscoring the challenges to their control by IPC practices.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"157 ","pages":"Pages 10-18"},"PeriodicalIF":3.9000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Large, protracted, multi-species and multi-clonal spread of VIM-type metallo-β-lactamase-producing Enterobacterales in an Italian hospital\",\"authors\":\"R. Olivieri , E. Riccobono , S. Gonnelli , C. Basagni , M. Tumbarello , M.G. Cusi , G.M. Rossolini\",\"doi\":\"10.1016/j.jhin.2024.12.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Aim</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Conclusion</h3><div>VIM-CPE has the potential to cause large and complex nosocomial outbreaks in hospital environments, underscoring the challenges to their control by IPC practices.</div></div>\",\"PeriodicalId\":54806,\"journal\":{\"name\":\"Journal of Hospital Infection\",\"volume\":\"157 \",\"pages\":\"Pages 10-18\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-12-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hospital Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0195670124004055\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hospital Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0195670124004055","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Large, protracted, multi-species and multi-clonal spread of VIM-type metallo-β-lactamase-producing Enterobacterales in an Italian hospital
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.
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.
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