UNASSIGNED:当前的微生物学方法缺乏准确识别多重耐药生物体(MDRO)传播的分辨率,然而,全基因组测序可以鉴定高度相关的患者分离株,为精确的感染控制干预提供机会.我们调查了前瞻性多中心基因组学工作流程对医院感染控制的可行性和潜在影响。
UNASSIGNED:我们在15个月内(2017年,2018年)对8家澳大利亚医院进行了前瞻性基因组学实施研究。从VanAVRE住院患者中收集所有临床和筛查分离株,MRSA,ESBL大肠杆菌(ESBL-Ec),或ESBL肺炎克雷伯菌(ESBL-Kp)。整合基因组和流行病学数据以评估MDRO传播。
未经批准:总共,包括1970名患者的2275个分离株,主要是ESBL-Ec(40·8%),其次是MRSA(35·6%),VNAVRE(15·2%),和ESBL-Kp(8·3%)。总的来说,医院和基因组流行病学显示,607名患者(30·8%)在医院获得了MDRO,包括大多数vanAVRE(266名患者,86·4%),ESBL-Ec比例较低(186例患者,23·0%),ESBL-Kp(42例,26·3%),和MRSA(113名患者,16·3%)。复杂的患者运动意味着大多数MDRO传输在没有基因组数据的情况下仍未被检测到。基因组学的实施产生了重大影响,识别意外的MDRO传输,促使新的感染控制干预措施,并促使vanAVRE成为应报告的状况。我们确定了实施的障碍,并建议了缓解策略。
UNASSIGNED:实施基于多中心基因组学的感染控制工作流程是可行的,并且可以识别出许多未被识别的MDRO传播。这为改善医院患者安全的干预措施提供了关键机会。
UNASSIGNED:墨尔本基因组学健康联盟(由维多利亚州政府支持,澳大利亚),国家卫生和医学研究委员会(澳大利亚)。
UNASSIGNED: Current microbiological methods lack the resolution to accurately identify multidrug-resistant organism (MDRO) transmission, however, whole genome sequencing can identify highly-related patient isolates providing opportunities for precision infection control interventions. We investigated the feasibility and potential impact of a prospective multi-centre genomics workflow for hospital infection control.
UNASSIGNED: We conducted a prospective genomics implementation study across eight Australian hospitals over 15 months (2017,2018), collecting all clinical and screening isolates from inpatients with vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec), or ESBL Klebsiella pneumoniae (ESBL-Kp). Genomic and epidemiologic data were integrated to assess MDRO transmission.
UNASSIGNED: In total, 2275 isolates were included from 1970 patients, predominantly ESBL-Ec (40·8%) followed by MRSA (35·6%), vanA VRE (15·2%), and ESBL-Kp (8·3%).Overall, hospital and genomic epidemiology showed 607 patients (30·8%) acquired their MDRO in hospital, including the majority of vanA VRE (266 patients, 86·4%), with lower proportions of ESBL-Ec (186 patients, 23·0%), ESBL-Kp (42 patients, 26·3%), and MRSA (113 patients, 16·3%). Complex patient movements meant the majority of MDRO transmissions would remain undetected without genomic data.The genomics implementation had major impacts, identifying unexpected MDRO transmissions prompting new infection control interventions, and contributing to vanA VRE becoming a notifiable condition. We identified barriers to implementation and recommend strategies for mitigation.
UNASSIGNED: Implementation of a multi-centre genomics-informed infection control workflow is feasible and identifies many unrecognised MDRO transmissions. This provides critical opportunities for interventions to improve patient safety in hospitals.
UNASSIGNED: Melbourne Genomics Health Alliance (supported by State Government of Victoria, Australia), and National Health and Medical Research Council (Australia).