Sustained outbreak of blaVIM-1 harbouring pathogens in an Italian tertiary hospital: Genomic insights into persistence and spreading

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance Pub Date : 2025-06-19 DOI:10.1016/j.jgar.2025.06.007

Francesca Saluzzo , Federico Di Marco , Virginia Batignani , Kiarash Moghaddasi , Franca Averara , Silvia Bracco , Gabriele Del Castillo , Claudio Farina , Daniela Maria Cirillo

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Abstract

Objectives

We investigated an outbreak of bla_VIM harbouring pathogens lasting over a year, affecting patients in an intensive care unit (ICU) in a tertiary hospital in Bergamo, Italy. To identify transmission routes of pathogens, we combined classical epidemiological investigation with the molecular identification of the mobile genetic elements (MGEs), integrons, and resistance cassettes that could have played a role in the outbreak persistence.

Methods

Short and long reads sequencing were performed. Transmission, resistome, and virulome analysis were conducted, as well as the identification of plasmids and integrons harbouring bla_VIM-1.

Results

Forty-four bla_VIM harbouring isolates, including Enterobacterales and Pseudomonadaceae, were identified from patients and environmental samples. The strains exhibited diverse resistomes and virulomes, with high mortality rates among infected patients. The performed assembly analysis did not support the hypothesis of interspecies plasmid transmission, but, nonetheless, genomic analysis revealed a consistent presence of a class 1 integron (IntI1) in all the analysed strains. The identification of the same IntI1 in clinical and environmental samples suggests a potential reservoir for resistant strains in the hospital environment.

Conclusions

These findings emphasize the need for comprehensive infection control measures, including genomic-based surveillance, to address MGEs’ horizontal spreading and persistence in the healthcare setting. © 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.

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意大利一家三级医院持续爆发携带病原体的blaVIM-1：对持久性和传播的基因组见解

背景：我们调查了意大利贝加莫一家三级医院重症监护病房（ICU）患者持续一年多的携带病原体的blaVIM暴发。为了确定病原体的传播途径，我们将经典流行病学调查与可能在疫情持续中发挥作用的移动遗传元件（MGEs）、整合子和抗性磁带的分子鉴定相结合。方法：进行短、长reads测序。进行了传播、抗性组和病毒组分析，并鉴定了携带blaVIM-1的质粒和整合子。结果：从患者和环境样本中分离出44株blaVIM，包括肠杆菌科和假单胞菌科。这些菌株表现出不同的抵抗体和病毒体，感染患者的死亡率很高。装配分析不支持种间质粒传播的假设，但基因组分析显示所有菌株中一致存在1类整合子（IntI1）。在临床和环境样本中发现相同的IntI1表明医院环境中存在耐药菌株的潜在储存库。结论：这些发现强调需要采取全面的感染控制措施，包括基于基因组的监测，以解决MGEs在医疗保健环境中的水平传播和持续存在。

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来源期刊

Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

8.70

自引率

2.20%

发文量

285

审稿时长

34 weeks

期刊介绍： The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.