在神经康复病房爆发的耐碳青霉烯肺炎克雷伯菌：基因组流行病学揭示了三级保健医院的复杂传播模式。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2025-01-14 DOI:10.1016/j.jgar.2025.01.001

Maria Grazia Silvotti , Erika Scaltriti , Luca Bolzoni , Beatrice Zerbi , Gabriella Tocci , Andrea Zappavigna , Gianfranco Lamberti , Federico Donati , Franco Federici , Stefano Pongolini , Giuliana Lo Cascio

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引用次数: 0

摘要

目的：医院中碳青霉烯耐药肠杆菌的感染是一种严重的威胁，但对产生肺炎克雷伯菌碳青霉烯酶（KPC-Kp）的肺炎克雷伯菌引起的康复病房暴发知之甚少。我们报告了意大利神经康复病房发生的KPC-Kp暴发，通过全基因组测序（WGS）分析了传播途径重建，以改善康复病房中KPC-Kp感染的管理。方法：对2022年2 - 10月医院监测收集的病例和分离株进行调查。碳青霉烯耐药性鉴定采用圆盘扩散和最小抑制浓度试验，碳青霉烯酶产生采用免疫层析横向流动试验。所有分离株均通过WGS进行基因分型，以突出可能的系统发育关系。用贝叶斯离散时间随机模型重构了KPC-Kp最可能的传输网络。结果：19例患者有KPC-Kp定殖。2株分离株为散发性STs (ST348和ST219)， 9/19和8/19分离株分别为ST307和ST716。在ST307分离株中，我们鉴定出两个基因组不同的聚类，分别为5例和2例。所有ST716分离株高度相似。基因分型和基于基因组数据的KPC-Kp传播网络重建确定了神经康复科的7次独立引入，而不是基因组调查前最初假设的一次暴发。七次引入中有三次产生了继发感染链，而其余四次仍然是单个病例。结论：临时人员短缺和微生物监测不足是疫情爆发的根本原因。采取相应措施，疫情结束。该研究强调了基因组流行病学在医院疾病暴发中的关键作用。

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Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital

Objectives

Infections by carbapenem-resistant Enterobacterales (CRE) in hospitals represent a severe threat but little is known on outbreaks in rehabilitation wards caused by Klebsiella pneumoniae producing Klebsiella pneumoniae Carbapenemase (KPC-Kp). We report an outbreak by KPC-Kp, in a neurorehabilitation unit in Italy, analysed through whole-genome sequencing (WGS) for transmission routes reconstruction to improve management of KPC-Kp infections in rehabilitation units.

Methods

We investigated cases and KPC-Kp isolates collected from February to October 2022 from hospital surveillance. Carbapenem resistance was identified with disk diffusion and minimum inhibitory concentration tests, carbapenemase production through immunochromatographic lateral flow assays. All isolates were genotyped through WGS to highlight possible phylogenetic relationships. The most likely transmission networks of KPC-Kp were reconstructed with Bayesian discrete-time stochastic models.

Results

Nineteen patients were colonized by KPC-Kp. Two isolates belonged to sporadic sequence types (STs; ST348 and ST219) whereas 9 of 19 and 8 of 19 isolates belonged to ST307 and ST716, respectively. Among the ST307 isolates, we identified two genomically distinct clusters of five and two cases. All ST716 isolates were highly similar. Genotyping and the reconstruction of transmission networks of KPC-Kp based on genomic data identified seven independent introductions into the neurorehabilitation unit rather than a single outbreak as initially hypothesized before genomic investigation. Three of the seven introductions generated chains of secondary infections, whereas the remaining four remained single cases.

Conclusions

The outbreak root-causes were identified in temporary staff shortage and insufficient microbiological surveillance. Measures were adopted accordingly and the outbreak ended. The study highlights the critical role of genomic epidemiology in hospital outbreaks. © 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.

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来源期刊

Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

8.70

自引率

2.20%

发文量

285

审稿时长

34 weeks

期刊介绍： The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.