Tracing the transmission of carbapenem-resistant Enterobacterales at the patient: ward environmental nexus

Tracing the transmission of carbapenem-resistant Enterobacterales at the patient: ward environmental nexus

Abstract Introduction Colonisation and infection with Carbapenem-resistant Enterobacterales (CRE) in healthcare settings poses significant risks, especially for vulnerable patients. Genomic analysis can be used to trace transmission routes, supporting antimicrobial stewardship and informing infectio...

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Main Authors: Linzy Elton, Alan Williams, Shanom Ali, Jelena Heaphy, Vicky Pang, Liam Commins, Conor O’Brien, Özge Yetiş, Estelle Caine, Imogen Ward, Monika Muzslay, Samuel Yui, Kush Karia, Ellinor Shore, Sylvia Rofael, Damien J. F. Mack, Timothy D. McHugh, Emmanuel Q. Wey
Format: Article
Language:English
Published: BMC 2024-12-01
Series:Annals of Clinical Microbiology and Antimicrobials
Subjects:
Antimicrobial resistance
OXA48
NDM
Plasmids
Transmission
Environment
Online Access:https://doi.org/10.1186/s12941-024-00762-8
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Summary:Abstract Introduction Colonisation and infection with Carbapenem-resistant Enterobacterales (CRE) in healthcare settings poses significant risks, especially for vulnerable patients. Genomic analysis can be used to trace transmission routes, supporting antimicrobial stewardship and informing infection control strategies. Here we used genomic analysis to track the movement and transmission of CREs within clinical and environmental samples. Methods 25 isolates were cultured from clinical patient samples or swabs, that tested positive for OXA-48-like variants using the NG-Test® CARBA-5 test and whole genome sequenced (WGS) using Oxford Nanopore Technologies (ONT). 158 swabs and 52 wastewater samples were collected from the ward environment. 60 isolates (matching clinical isolate genera; Klebsiella, Enterobacter, Citrobacter and Escherichia) were isolated from the environmental samples using selective agar. Metagenomic sequencing was undertaken on 36 environmental wastewater and swab samples. Results 21/25 (84%) clinical isolates had > 1 bla OXA gene and 19/25 (76%) harboured > 1 bla NDM gene. Enterobacterales were most commonly isolated from environmental wastewater samples 27/52 (51.9%), then stick swabs 5/43 (11.6%) and sponge swabs 5/115 (4.3%). 11/60 (18%) environmental isolates harboured > 1 bla OXA gene and 1.9% (1/60) harboured bla NDM-1 . bla OXA genes were found in 2/36 (5.5%) metagenomic environmental samples. Conclusions Potential for putative patient-patient and patient-ward transmission was shown. Metagenomic sampling needs optimization to improve sensitivity.
ISSN:1476-0711

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