Pilot study of a combined genomic and epidemiologic surveillance program for hospital-acquired multidrug-resistant pathogens across multiple hospital networks in Australia

Infection Control and Hospital Epidemiology - Tập 42 Số 5 - Trang 573-581 - 2021
Norelle L. Sherry1,2,3, Robyn S. Lee3, Claire L. Gorrie3, Jason C. Kwong1,2,3, Rhonda L. Stuart4,5, Tony M. Korman4,5,6, Caroline Marshall7,8, Charlie Higgs2, Hiu Tat Chan9, Maryza Graham4,5,6, Paul D.R. Johnson1,10,8, Marcel J. Leroi11, Caroline M. Reed9,12, Michael J. Richards7,8, Monica A. Slavin13,14, Leon J. Worth13,14, Benjamin P. Howden1,2,3, M. Lindsay Grayson1,10,11,8
1Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
2Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia
3Microbiological Diagnostic Unit (MDU) Public Health Laboratory, Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia
4Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia
5Department of Medicine, Monash University, Clayton, Victoria, Australia
6Department of Microbiology, Monash Health, Clayton, Victoria, Australia
7Infection Prevention & Surveillance Service, Victorian Infectious Diseases Service, Melbourne Health, Parkville, Victoria, Australia
8Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
9Department of Microbiology, Melbourne Health, Parkville, Victoria, Australia
10Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
11Department of Microbiology, Austin Health, Heidelberg, Victoria, Australia.
12Department of Microbiology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
13Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
14National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia

Tóm tắt

AbstractObjectives:To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.Design:Pilot prospective multicenter surveillance study.Setting:The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.Methods:All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.Results:In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).Conclusions:Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.

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Infection Control and Hospital Epidemiology

Tập 42 Số 5

573-581

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