Genomic analysis of carbapenem resistant Acinetobacter baumannii outbreak in a burn intensive care unit of a tertiary-care hospital in Madrid, Spain.

IF 4.4 2区医学 Q1 INFECTIOUS DISEASES

Antimicrobial Resistance and Infection Control Pub Date : 2025-10-21 DOI:10.1186/s13756-025-01644-0

Alfredo Maldonado-Barrueco, Eduardo Rubio-Mora, Iván Bloise, Juana Cacho-Calvo, Lucía Hernández-Rivas, Elias Dahdouh, Julio García-Rodríguez, Montserrat Rodríguez-Aguirregabiria, Juan Carlos Ramos-Ramos, Verónica Pérez-Blanco, Jesús Mingorance, Fernando Lázaro-Perona

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引用次数: 0

Abstract

Background: Patients in burn intensive care units (BICUs) are at high risk of infections caused by multidrug-resistant pathogens, which can lead to hospital outbreaks.

Aim: To investigate an outbreak caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in a BICU at a tertiary care hospital in Madrid, Spain, using whole-genome sequencing (WGS) and antibiotic susceptibility testing.

Methods: CRAB isolates were obtained from rectal swabs collected during routine epidemiological screening of BICU patients, as well as clinical and environmental samples collected throughout the outbreak. The genomes of the isolates were sequenced using Ion Torrent™ and MinION™ technologies. Antibiotic susceptibility testing was conducted by microdilution using the MicroScan NF50 panel. Susceptibility to cefiderocol was tested using disk diffusion and broth microdilution (ComASP^®).

Findings: The outbreak occurred between October 2022 and August 2023, affecting 26 patients (median age: 56 years, IQR 34-70). Genomic analysis identified the isolates as belonging to ST2/ST451 (Pasteur/Oxford schemes), carrying bla_OXA-23 carbapenemase gene. Environmental sampling detected CRAB on 20 of 105 tested surfaces. The outbreak's genomic evolution included the emergence of hypermucoid isolates and bla_ADC-73 mutants with increased cefiderocol minimum inhibitory concentrations (MICs). Novel mutations and combinations in bla_ADC-73 were observed, likely selected under cefiderocol pressure. Antibiotic susceptibility testing using the microdilution method was more sensitive in detecting these mutations. The outbreak ultimately necessitated the closure of the BICU for disinfection with high-concentration H₂O₂.

Conclusions: WGS enabled detailed tracking of CRAB's genomic evolution during the outbreak, identifying mutations associated with increased cefiderocol MICs. This information supported effective infection control measures, highlighting the utility of WGS in managing hospital outbreaks.

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西班牙马德里一家三级医院烧伤重症监护室耐碳青霉烯鲍曼不动杆菌爆发的基因组分析

背景：烧伤重症监护病房（bicu）的患者是由耐多药病原体引起的感染的高危人群，这可能导致医院暴发。目的：利用全基因组测序（WGS）和抗生素药敏试验，调查西班牙马德里某三级医院BICU中耐碳青霉烯鲍曼不动杆菌（CRAB）的暴发情况。方法：从BICU患者常规流行病学筛查期间收集的直肠拭子以及疫情期间收集的临床和环境样本中分离出CRAB。使用Ion Torrent™和MinION™技术对分离物的基因组进行测序。采用MicroScan NF50检测板微量稀释进行抗生素药敏试验。采用圆盘扩散法和微量肉汤稀释法（ComASP®）检测头孢地罗的药敏性。发现：疫情发生于2022年10月至2023年8月，影响26例患者（中位年龄：56岁，IQR 34-70）。经基因组分析，分离株属于ST2/ST451 （Pasteur/Oxford方案），携带blaOXA-23碳青霉烯酶基因。环境抽样在105个测试表面中有20个检测到螃蟹。此次暴发的基因组进化包括出现高黏液样分离株和具有头孢地罗最低抑制浓度（mic）升高的blaADC-73突变体。观察到blaADC-73的新突变和组合，可能是在头孢地罗压力下选择的。抗生素药敏试验采用微量稀释法检测这些突变更为灵敏。疫情最终需要关闭BICU，用高浓度H2O2消毒。结论：WGS能够在疫情期间详细跟踪CRAB的基因组进化，确定与头孢地罗mic增加相关的突变。这一信息支持有效的感染控制措施，突出了WGS在管理医院疫情方面的作用。

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来源期刊

Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

9.70

自引率

3.60%

发文量

140

审稿时长

13 weeks

期刊介绍： Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.