背景:水生条件致病菌嗜水气单胞菌,已知在低营养氯化水中持续存在,会导致危及生命的感染.两个重症监护病房(ICU)经历了一系列的气单胞菌感染,室外温度峰值与反复出现的管道问题相吻合,由于严重的潜在合并症与广泛耐药(XDR)气单胞菌同时发生而导致死亡。
方法:我们使用全基因组测序(WGS)研究了该簇,以评估分离株的遗传相关性并确定抗菌素耐药性决定因素。在室外温度升高期间或之后立即从留在或邻近有管道问题的房间的患者中分离出三个亲水A.水槽和水龙头被擦拭以进行培养。
结果:所有嗜水气单胞菌临床分离株均表现出碳青霉烯耐药性,但与遗传无关。发现了与XDR相对应的多种抗性决定因素,包括共存的KPC-3和VIM-2,OXA-232和染色体CphA样碳青霉烯酶基因,导致重大治疗挑战。所有三名患者均接受了多种抗生素治疗,以克服各种碳青霉烯酶类别,并因潜在的合并症而过期。环境培养没有产生气单胞菌。
结论:虽然调查显示没有单一的污染源,它支持管道问题之间的可能联系,室外温度升高和医院气单胞菌感染的发生率。在这些废水来源的气单胞菌中检测到的碳青霉烯酶基因的多样性保证了在管道问题特别是热浪期间加强预防感染的预防措施。
结论:一组耐碳青霉烯类气单胞菌感染发生在户外温度升高和管道问题的重症监护病房。测序显示这些分离株是无关的,并且具有不同的抗性基因。高温和废水泄漏可能导致气单胞菌医院感染。
BACKGROUND: Aquatic opportunistic pathogen Aeromonas hydrophila, known to persist in low-nutrient chlorinated waters, can cause life-threatening infections. Two intensive care units experienced a cluster of Aeromonas infections following outdoor temperature spikes coinciding with recurrent plumbing issues, with fatalities due to severe underlying comorbidities co-occurring with extensively-drug resistant (XDR) Aeromonas.
METHODS: We investigated this cluster using whole genome sequencing to assess genetic relatedness of isolates and identify antimicrobial resistance determinants. Three A. hydrophila were isolated from patients staying in or adjacent to rooms with plumbing issues during or immediately after periods of elevated outdoor temperatures. Sinks and faucets were swabbed for culture.
RESULTS: All A. hydrophila clinical isolates exhibited carbapenem resistance but were not genetically related. Diverse resistance determinants corresponding to extensively-drug resistant were found, including co-occurring KPC-3 and VIM-2, OXA-232, and chromosomal CphA-like carbapenemase genes, contributing to major treatment challenges. All 3 patients were treated with multiple antibiotic regimens to overcome various carbapenemase classes and expired due to underlying comorbidities. Environmental culture yielded no Aeromonas.
CONCLUSIONS: While the investigation revealed no singular source of contamination, it supports a possible link between plumbing issues, elevated outdoor temperatures and incidence of nosocomial Aeromonas infections. The diversity of carbapenemase genes detected in these wastewater-derived Aeromonas warrants heightened infection prevention precautions during periods of plumbing problems especially with heat waves.