与受污染的水槽和相关管道有关的产esbl的克雷伯氏菌在医院范围内爆发：爆发报告、风险因素分析和质粒制图。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-05-18 DOI:10.1016/j.jhin.2025.05.002

J. Edman-Wallér , J. Andersson , M. Nelson , L. Hallberg , L. Berglund , H. Mellström Dahlgren , O. Lindsjö , V. Müller , J. Stalfors

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引用次数: 0

摘要

目的：描述一个与水槽相关的克雷伯菌爆发，并确定获得爆发菌株的危险因素。方法：采用病例对照分析、环境水槽取样、短读全基因组测序和长读全基因组测序。结果：全基因组测序显示47例患者26个月的遗传聚类。暴发菌株（克雷伯氏菌，序列2型，含或不含blaCTX-M质粒）也在两个病房四个房间的水槽或邻近管道中被发现。在调整了年龄、性别和住院时间后，发现了感染或爆发菌株定植的四个重要危险因素：年龄(or每增加一年：1.03 (95% CI: 1.00-1.07)；住院时间(每增加一天的OR: 1.04 (95% CI: 1.02-1.08)；尿导管(OR: 7.65 (95% CI: 2.10-27.8；OR每增加一天：1.06 (95% CI: 1.01-1.12)；腹泻（OR: 3.10(1.03-9.35)）。长读质粒测序显示质粒从爆发菌株传播到其他序列类型的克雷伯氏菌的强烈迹象。采用了多方面的干预措施，包括交换水槽、过滤器、陷阱和管道、行为干预以及加强清洁和消毒。尽管采取了干预措施，但迄今尚未实现疫情控制。结论：建立在水槽管道生物膜上的克雷伯菌与长期暴发有关，且难以控制。年龄、住院时间、导尿管和腹泻是感染暴发菌株的危险因素。发生了无性传播和水平传播。

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A hospital-wide outbreak of extended-spectrum β-lactamase-producing Klebsiella oxytoca associated with contaminated sinks and associated plumbing: outbreak report, risk factor analysis and plasmid mapping

Aim

To describe a sink-related outbreak of Klebsiella oxytoca and determine risk factors for acquiring the outbreak strain.

Methods

Case–control analysis, environmental sampling from sinks, short-read whole-genome sequencing and long-read whole-genome sequencing of selected isolates.

Findings

Whole-genome sequencing revealed genetic clustering of 47 patient cases over 26 months. The outbreak strain (K. oxytoca, sequence type 2, with or without blaCTX-M containing plasmid) was also identified in sinks or adjacent plumbing in four rooms in two wards. After adjustment for age, sex, and length of stay, four significant risk factors for infection or colonization of the outbreak strain were found: age (odds ration (OR) per additional year: 1.03 (95% confidence interval (CI): 1.00–1.07); length of stay (OR per additional day: 1.04 (95% CI: 1.02–1.08); urinary catheter (OR: 7.65 (95% CI: 2.10–27.8; OR per additional day: 1.06 (95% CI: 1.01–1.12); and diarrhoea (OR: 3.10 (1.03–9.35). Long-read plasmid sequencing revealed strong indications of plasmid transmission from the outbreak strain to other sequence types of K. oxytoca. Multi-faceted interventions were employed, including exchange of sinks strainers, traps, and piping, behavioural interventions, and reinforced cleaning and disinfection. Outbreak control has thus far not been achieved despite interventions.

Conclusions

K. oxytoca established in sink plumbing biofilm was associated with a prolonged outbreak difficult to control. Age, length of stay, urinary catheter and diarrhoea were risk factors for acquiring the outbreak strain. Both clonal and horizontal transmission occurred.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.