施工期间(2017-2019年),儿科患者中黄曲霉感染增加,其中大多数人正在接受两性霉素B的预防.使用微卫星基因分型来表征爆发。总共包括153种临床和环境来源的黄曲霉分离株。临床分离株包括来自119例患者的140株。8名患者是爆发相关患者,而111名来自丹麦医院(1994-2023)的与爆发无关的患者。我们进一步包括四个对照菌株。9株黄曲霉分离株来自随后在暴发病房(2022-2023年)的空气采样。打字遵循Rudramurthy等人。(S.M.Rudramurthy,H.A.deValk,A.Chakrabarti,J.Meis,还有C.H.W.Klaassen,PLoSOne6:e16086,2011,https://doi.org/10.1371/journal。pone.0016086).采用最小生成树(MST)和主成分判别分析(DAPC)进行聚类分析。DAPC分析将所有153个分离株置于五个簇中。与其他簇相比,一个簇的微卫星标记模式明显不同。在MST中观察到相同的簇。这个集群包括所有爆发的分离株,空气样品分离,以及来自爆发医院的其他患者分离株,以前未公开与疫情有关。在爆发病房的两个技术立管中发现了最高的A.flavus空气流行率,然后被密封。后续空气样品对黄曲霉呈阴性。微卫星分型将爆发定义为医院爆发,并有助于确定医院内来源。六个月的随访空气采样没有黄曲霉。DAPC和MST很容易区分爆发相关/非相关分离株,因为在两个统计分析中都描述了爆发克隆的不同标记模式。因此,它可能是A.flavus的变体,具有在爆发医院环境中茁壮成长的利基能力。
目的:黄曲霉可引起免疫功能低下个体的严重感染和医院暴发。尽管缺乏同质性并不排除爆发,我们的研究强调了微卫星基因分型在潜在黄曲霉暴发中的价值.微卫星基因分型记录了具有内部来源的同基因医院暴发。这提供了“吸烟枪”,促使资源快速分配进行彻底的环境采样,其结果指导了立即和相关的清洁和源头控制措施。因此,我们建议,应保护易感患者免受感染,并在潜在的黄曲霉暴发调查中尽早进行基因分型.建议在可能散布空气孢子的任何地点进行检查和采样。这包括很少进入的区域,不能忽视与医院病房的空中通讯。
During construction work (2017-2019), an increase in Aspergillus flavus infections was noted among pediatric patients, the majority of whom were receiving amphotericin B prophylaxis. Microsatellite genotyping was used to characterize the outbreak. A total of 153 A. flavus isolates of clinical and environmental origin were included. Clinical isolates included 140 from 119 patients. Eight patients were outbreak-related patients, whereas 111 were outbreak-unrelated patients from Danish hospitals (1994-2023). We further included four control strains. Nine A. flavus isolates were from subsequent air sampling in the outbreak ward (2022-2023). Typing followed Rudramurthy et al.(S. M. Rudramurthy, H. A. de Valk, A. Chakrabarti, J. Meis, and C. H. W. Klaassen, PLoS One 6:e16086, 2011, https://doi.org/10.1371/journal.pone.0016086). Minimum spanning tree (MST) and discriminant analysis of principal components (DAPC) were used for cluster analysis. DAPC analysis placed all 153 isolates in five clusters. Microsatellite marker pattern was clearly distinct for one cluster compared to the others. The same cluster was observed in an MST. This cluster included all outbreak isolates, air-sample isolates, and additional patient isolates from the outbreak hospital, previously undisclosed as outbreak related. The highest air prevalence of A. flavus was found in two technical risers of the outbreak ward, which were then sealed. Follow-up air samples were negative for A. flavus. Microsatellite typing defined the outbreak as nosocomial and facilitated the identification of an in-hospital source. Six months of follow-up air sampling was without A. flavus. Outbreak-related/non-related isolates were easily distinguished with DAPC and MST, as the outbreak clone\'s distinct marker pattern was delineated in both statistical analyses. Thus, it could be a variant of A. flavus, with a niche ability to thrive in the outbreak-hospital environment.
OBJECTIVE: Aspergillus flavus can cause severe infections and hospital outbreaks in immunocompromised individuals. Although lack of isogeneity does not preclude an outbreak, our study underlines the value of microsatellite genotyping in the setting of potential A. flavus outbreaks. Microsatellite genotyping documented an isogenic hospital outbreak with an internal source. This provided the \"smoking gun\" that prompted the rapid allocation of resources for thorough environmental sampling, the results of which guided immediate and relevant cleaning and source control measures. Consequently, we advise that vulnerable patients should be protected from exposure and that genotyping be included early in potential A. flavus outbreak investigations. Inspection and sampling are recommended at any site where airborne spores might disperse from. This includes rarely accessed areas where air communication to the hospital ward cannot be disregarded.