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Styczynski A, Amin MB, Hoque KI, Parveen S, Md Pervez AF, Zeba D, Akhter A, Pitchik H, Islam MA, Hossain MI, Saha SR, Gurley ES, Luby S. Perinatal colonization with extended-spectrum beta-lactamase-producing and carbapenem-resistant Gram-negative bacteria: a hospital-based cohort study. Antimicrob Resist Infect Control 2024; 13:13. [PMID: 38281974 PMCID: PMC10823664 DOI: 10.1186/s13756-024-01366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery. METHODS We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization. RESULTS We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10-1.40; CRB 2.46, 95% CI 1.39-4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08-1.59; newborn ESBL-PB 1.34, 95% CI 1.09-1.64; newborn CRB 1.73, 95% CI 1.20-2.47). CONCLUSIONS In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms.
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Affiliation(s)
- Ashley Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA.
| | - Mohammed Badrul Amin
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Kazi Injamamul Hoque
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Shahana Parveen
- Programme on Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Abu Faisal Md Pervez
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Dilruba Zeba
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Akhi Akhter
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Helen Pitchik
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Muhammed Iqbal Hossain
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sumita Rani Saha
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA
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Tsui CKM, Ben Abid F, Al Ismail K, McElheny CL, Al Maslamani M, Omrani AS, Doi Y. Genomic Epidemiology of Carbapenem-Resistant Klebsiella in Qatar: Emergence and Dissemination of Hypervirulent Klebsiella pneumoniae Sequence Type 383 Strains. Antimicrob Agents Chemother 2023; 67:e0003023. [PMID: 37310284 PMCID: PMC10353355 DOI: 10.1128/aac.00030-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
The emergence of carbapenem-resistant, hypervirulent Klebsiella pneumoniae is a new threat to health care. We studied the molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae isolates in Qatar using whole-genome sequence data. We also characterized the prevalence and genetic basis of hypervirulent phenotypes and established the virulence potential using a Galleria mellonella model. Of 100 Klebsiella isolates studied, NDM and OXA-48 were the most common carbapenemases. Core genome single-nucleotide polymorphism (SNP) analysis indicated the presence of diverse sequence types and clonal lineages; isolates belonging to Klebsiella quasipneumoniae subsp. quasipneumoniae sequence type 196 (ST196) and ST1416 may be disseminated among several health care centers. Ten K. pneumoniae isolates carried rmpA and/or truncated rmpA2, and 2 isolates belonged to KL2, indicating low prevalence of classical hypervirulent isolates. Isolates carrying both carbapenem resistance and hypervirulence genes were confined mainly to ST231 and ST383 isolates. One ST383 isolate was further investigated by MinION sequencing, and the assembled genome indicated that blaNDM was located on an IncHI1B-type plasmid (pFQ61_ST383_NDM-5) which coharbored several virulence factors, including the regulator of the mucoid phenotype (rmpA), the regulator of mucoid phenotype 2 (rmpA2), and aerobactin (iucABCD and iutA), likely resulting from recombination events. Comparative genomics indicated that this hybrid plasmid may be present in two additional Qatari ST383 isolates. Carbapenem-resistant, hypervirulent K. pneumoniae ST383 isolates pose an emerging threat to global health due to their simultaneous hypervirulence and multidrug resistance.
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Affiliation(s)
- Clement Kin-Ming Tsui
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Weill Cornell Medicine—Qatar, Doha, Qatar
| | - Fatma Ben Abid
- Weill Cornell Medicine—Qatar, Doha, Qatar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Khalil Al Ismail
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Christi Lee McElheny
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Muna Al Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali S. Omrani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Japan
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3
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Bah SY, Kujabi MA, Darboe S, Kebbeh N, Kebbeh BFK, Kanteh A, Bojang R, Lawn JE, Kampmann B, Sesay AK, de Silva TI, Brotherton H. Acquisition and carriage of genetically diverse multi-drug resistant gram-negative bacilli in hospitalised newborns in The Gambia. COMMUNICATIONS MEDICINE 2023; 3:79. [PMID: 37270610 PMCID: PMC10239441 DOI: 10.1038/s43856-023-00309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND This detailed genomic study characterised multi-drug resistant-Gram negative bacilli (MDR-GNB) carriage in neonates < 2 kg and paired mothers at a low-resource African hospital. METHODS This cross-sectional cohort study was conducted at the neonatal referral unit in The Gambia with weekly neonatal skin and peri-anal sampling and paired maternal recto-vaginal swabs. Prospective bacteriological culture used MacConkey agar with species identification by API20E and API20NE. All GNB isolates underwent whole genome sequencing on Illumina Miseq platform. Multi-Locus Sequence Typing and SNP-distance analysis identified strain type and relatedness. RESULTS 135 swabs from 34 neonates and 21 paired mothers, yielded 137 GNB isolates, of which 112 are high quality de novo assemblies. Neonatal MDR-GNB carriage prevalence is 41% (14/34) at admission with 85% (11/13) new acquisition by 7d. Multiple MDR and ESBL-GNB species are carried at different timepoints, most frequently K. pneumoniae and E. coli, with heterogeneous strain diversity and no evidence of clonality. 111 distinct antibiotic resistance genes are mostly beta lactamases (Bla-AMPH, Bla-PBP, CTX-M-15, Bla-TEM-105). 76% (16/21) and 62% (13/21) of mothers have recto-vaginal carriage of ≥1 MDR-GNB and ESBL-GNB respectively, mostly MDR-E. coli (76%, 16/21) and MDR-K. pneumoniae (24%, 5/21). Of 21 newborn-mother dyads, only one have genetically identical isolates (E. coli ST131 and K. pneumoniae ST3476). CONCLUSIONS Gambian hospitalised neonates exhibit high MDR and ESBL-GNB carriage prevalence with acquisition between birth and 7d with limited evidence supporting mother to neonate transmission. Genomic studies in similar settings are required to further understand transmission and inform targeted surveillance and infection prevention policies.
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Affiliation(s)
- Saikou Y Bah
- The Florey Institute of Host-Pathogen Interactions, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Mariama A Kujabi
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Saffiatou Darboe
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Ngange Kebbeh
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Bunja F K Kebbeh
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Abdoulie Kanteh
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | | | - Joy E Lawn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health London School of Hygiene & Tropical Medicine, London, UK
| | - Beate Kampmann
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Institut fur Internationale Gesundheit and Centre for Global Health, Charite Universitatsmedizin, Berlin, Germany
| | - Abdul K Sesay
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Thushan I de Silva
- The Florey Institute of Host-Pathogen Interactions, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Helen Brotherton
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia.
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health London School of Hygiene & Tropical Medicine, London, UK.
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Lewis JM, Mphasa M, Banda R, Beale MA, Heinz E, Mallewa J, Jewell C, Faragher B, Thomson NR, Feasey NA. Colonization dynamics of extended-spectrum beta-lactamase-producing Enterobacterales in the gut of Malawian adults. Nat Microbiol 2022; 7:1593-1604. [PMID: 36065064 PMCID: PMC9519460 DOI: 10.1038/s41564-022-01216-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/25/2022] [Indexed: 01/09/2023]
Abstract
Drug-resistant bacteria of the order Enterobacterales which produce extended-spectrum beta-lactamase enzymes (ESBL-Enterobacterales, ESBL-E) are global priority pathogens. Antimicrobial stewardship interventions proposed to curb their spread include shorter courses of antimicrobials to reduce selection pressure but individual-level acquisition and selection dynamics are poorly understood. We sampled stool of 425 adults (aged 16-76 years) in Blantyre, Malawi, over 6 months and used multistate modelling and whole-genome sequencing to understand colonization dynamics of ESBL-E. Models suggest a prolonged effect of antimicrobials such that truncating an antimicrobial course at 2 days has a limited effect in reducing colonization. Genomic analysis shows largely indistinguishable diversity of healthcare-associated and community-acquired isolates, hence some apparent acquisition of ESBL-E during hospitalization may instead represent selection from a patient's microbiota by antimicrobial exposure. Our approach could help guide stewardship protocols; interventions that aim to review and truncate courses of unneeded antimicrobials may be of limited use in preventing ESBL-E colonization.
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Affiliation(s)
- Joseph M Lewis
- Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi.
- Liverpool School of Tropical Medicine, Liverpool, UK.
- University of Liverpool, Liverpool, UK.
- Wellcome Sanger Institute, Hinxton, UK.
| | - Madalitso Mphasa
- Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Rachel Banda
- Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Eva Heinz
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jane Mallewa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Nicholas R Thomson
- Wellcome Sanger Institute, Hinxton, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas A Feasey
- Malawi-Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Chew KL, Octavia S, Lai D, Lin RTP, Teo JWP. Genomic Characterization of Klebsiella quasipneumoniae from Clinical Specimens in Singapore. Antimicrob Agents Chemother 2021; 65:e0041221. [PMID: 34060897 PMCID: PMC8284435 DOI: 10.1128/aac.00412-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022] Open
Abstract
A total of 1,281 specimens from 1,024 patients were screened. Phylogenetic analysis classified 44 of these isolates as Klebsiella quasipneumoniae subsp. similipneumoniae (44/1,281 [3.4%]) and the remaining three as K. quasipneumoniae subsp. quasipneumoniae. The most common specimen source was urine (21/47 [44.7%]) followed by blood (14/47 [29.8%]). K. quasipneumoniae isolates were nonclonal. Carbapenemase-encoding genes (blaNDM and blaOXA-181) were detected in only two isolates (2/47 [4.3%]). K. quasipneumoniae appears to cause a spectrum of infections similar to those of K. pneumoniae, although higher rates of susceptibility to many commonly tested antimicrobials and low prevalence of virulence genes were demonstrated.
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Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sophie Octavia
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Deborah Lai
- Department of Pathology, Singapore General Hospital, Singapore
| | - Raymond T. P. Lin
- Department of Laboratory Medicine, National University Hospital, Singapore
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Jeanette W. P. Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
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Dramowski A, Pillay S, Bekker A, Abrahams I, Cotton MF, Coffin SE, Whitelaw AC. Impact of 1% chlorhexidine gluconate bathing and emollient application on bacterial pathogen colonization dynamics in hospitalized preterm neonates - A pilot clinical trial. EClinicalMedicine 2021; 37:100946. [PMID: 34195575 PMCID: PMC8225683 DOI: 10.1016/j.eclinm.2021.100946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chlorhexidine gluconate (CHG) body washes and emollient application may modulate bacterial pathogen colonization and prevent neonatal hospital-acquired infections. METHODS This pilot, non-randomized, open-label trial, enrolled preterm neonates (1000-1500g; day 1-3 of life) at a tertiary hospital in Cape Town, South Africa. Participants were sequentially allocated to 4 trial arms (n=20 each): 1% aqueous CHG (CHG), 1% CHG plus emollient (CHG+EM), emollient only (EM) and standard of care (SOC: no antiseptic/emollient). Trial treatment/s were applied daily for 10 days (d) post-enrolment, documenting neonatal skin condition score. Anterior nose, neck, umbilical and perianal swabs for bacterial culture were collected at d1, d3, d10 and d16 post-enrolment, (±1 day), reporting pathogen acquisition rates and semi-quantitative bacterial colony counts. (ClinicalTrials.gov identifier: NCT03896893; trial status: closed). FINDINGS Eighty preterm neonates (mean gestational age 30 weeks [SD 2]) were enrolled between 4 March and 26 August 2019. The bacterial pathogen acquisition rate (comparing d1 and d16 swabs) varied from 33·9% [95%CI 22·9-47·0] at the umbilicus, 39·3% [95%CI 27·6-52·4] at the neck, to 71·4% [95%CI 58·5-81·7] at both the nose and perianal region. At d10, CHG babies had reduced bacterial density detected from neck, umbilicus, and perianal swabs compared to other groups (see Table 3). Following intervention cessation, colonization density was similar across all trial arms, but S. aureus colonization was more prevalent among EM and CHG+EM babies. Neonatal skin condition score improved in babies receiving emollient application (EM: -0·87 [95%CI 0·69-1·06] and CHG+EM: -0·73 [0·45-0·99]), compared to the SOC and CHG arms (Table 2); no CHG-related skin reactions occurred. INTERPRETATION Bacterial colonization density was significantly reduced in babies receiving 1% CHG washes but colonization levels rebounded rapidly post-intervention. Emollient application improved skin condition but was associated with higher rates of S. aureus colonization. FUNDING South African Medical Research Council; National Institutes of Health (TW010682).
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Key Words
- ACC, aerobic colony count
- AE, adverse event
- AMR, antimicrobial resistance
- ART, antiretroviral therapy
- BSI, bloodstream infection
- CFU, colony forming unit
- CHG, chlorhexidine gluconate
- CI, confidence interval
- EM, emollient
- ESBL, extended-spectrum B-lactamase
- HAI, healthcare-associated infection
- HIV, human immunodeficiency virus
- IPC, infection prevention and control
- KMC, kangaroo mother care
- LMIC, low-to-middle income countries
- NEC, necrotizing enterocolitis
- NICU, neonatal intensive care unit
- SD, standard deviation
- SOC, standard of care
- UIPC, Unit for Infection Prevention and Control
- UTI, urinary tract infection
- VLBW, very low birth weight
- bacterial colonization
- chlorhexidine gluconate
- d, day
- emollient
- hospital-acquired infection
- infection prevention
- nCPAP, nasal cannula positive airways pressure
- neonatal unit
- spp, species
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
- Corresponding author.
| | - Sheylyn Pillay
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Ilhaam Abrahams
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Susan E. Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia and Department of Paediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Andrew C. Whitelaw
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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León-Sampedro R, DelaFuente J, Díaz-Agero C, Crellen T, Musicha P, Rodríguez-Beltrán J, de la Vega C, Hernández-García M, López-Fresneña N, Ruiz-Garbajosa P, Cantón R, Cooper BS, San Millán Á. Pervasive transmission of a carbapenem resistance plasmid in the gut microbiota of hospitalized patients. Nat Microbiol 2021; 6:606-616. [PMID: 33782584 PMCID: PMC7610705 DOI: 10.1038/s41564-021-00879-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 02/12/2021] [Indexed: 01/31/2023]
Abstract
Infections caused by carbapenemase-producing enterobacteria (CPE) are a major concern in clinical settings worldwide. Two fundamentally different processes shape the epidemiology of CPE in hospitals: the dissemination of CPE clones from patient to patient (between-patient transfer), and the transfer of carbapenemase-encoding plasmids between enterobacteria in the gut microbiota of individual patients (within-patient transfer). The relative contribution of each process to the overall dissemination of carbapenem resistance in hospitals remains poorly understood. Here, we used mechanistic models combining epidemiological data from more than 9,000 patients with whole genome sequence information from 250 enterobacteria clones to characterize the dissemination routes of a pOXA-48-like carbapenemase-encoding plasmid in a hospital setting over a 2-yr period. Our results revealed frequent between-patient transmission of high-risk pOXA-48-carrying clones, mostly of Klebsiella pneumoniae and sporadically Escherichia coli. The results also identified pOXA-48 dissemination hotspots within the hospital, such as specific wards and individual rooms within wards. Using high-resolution plasmid sequence analysis, we uncovered the pervasive within-patient transfer of pOXA-48, suggesting that horizontal plasmid transfer occurs in the gut of virtually every colonized patient. The complex and multifaceted epidemiological scenario exposed by this study provides insights for the development of intervention strategies to control the in-hospital spread of CPE.
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Affiliation(s)
- Ricardo León-Sampedro
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- Centro de Investigación Biológica en Red, Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier DelaFuente
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Cristina Díaz-Agero
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Thomas Crellen
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick Musicha
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jerónimo Rodríguez-Beltrán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- Centro de Investigación Biológica en Red, Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen de la Vega
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Marta Hernández-García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain
| | - Nieves López-Fresneña
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Patricia Ruiz-Garbajosa
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Álvaro San Millán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
- Centro de Investigación Biológica en Red, Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
- Centro Nacional de Biotecnología-CSIC, Madrid, Spain.
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Bacterial contamination of blood products for transfusion in the Democratic Republic of the Congo: temperature monitoring, qualitative and semi-quantitative culture. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:348-358. [PMID: 32931413 DOI: 10.2450/2020.0108-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bacterial contamination of blood for transfusion is rarely investigated in low-income countries. We determined the contamination rate of blood products in the Democratic Republic of the Congo. MATERIAL AND METHODS In this prospective observational study, blood products in one rural and two urban hospitals (paediatric and general) contained a satellite sampling bag by which blood was sampled for culture in a blood culture bottle (4 mL) and on an agar-coated slide to estimate colony forming units (CFU/mL). Bacteria were identified with biochemical tests and MALDI-TOF (Bruker). Exposure time >10 °C was assessed on a subset of blood products. RESULTS In total, 1.4% (41 of 2,959) of blood products were contaminated with 48 bacterial isolates. Skin (e.g., Staphylococcus spp.) and environmental (e.g., Bacillus spp.) bacteria predominated (97.8% of 45 isolates identified). Bacterial counts were ≤103 CFU/mL. Contamination rates for the urban paediatric, urban general and rural hospitals were 1.6%, 2.4% and 0.3%, respectively (p=0.004). None of the following variables was significantly associated with contamination: (i) donor type (voluntary 1.6%, family 1.2%, paid 3.9%); (ii) type of blood product (red cells 1.6%, whole blood 0.6%); (ii) season (dry season 2.4%, rainy season 1.8%); (iv) age of blood product (contaminated 8 days vs non-contaminated 6 days); and (v) exposure time >10 °C (median for contaminated and non-contaminated blood reached maximum test limit of 8 hours). DISCUSSION A bacterial contamination rate of 1.4% of whole blood and red cells is similar to results from high-income countries. Implementation of feasible risk-mitigation measures is needed.
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