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
{"title":"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","authors":"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","doi":"10.1186/s13756-025-01644-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients in burn intensive care units (BICUs) are at high risk of infections caused by multidrug-resistant pathogens, which can lead to hospital outbreaks.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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<sup>®</sup>).</p><p><strong>Findings: </strong>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<sub>OXA-23</sub> 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<sub>ADC-73</sub> mutants with increased cefiderocol minimum inhibitory concentrations (MICs). Novel mutations and combinations in bla<sub>ADC-73</sub> 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 H<sub>2</sub>O<sub>2</sub>.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"124"},"PeriodicalIF":4.4000,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Genomic analysis of carbapenem resistant Acinetobacter baumannii outbreak in a burn intensive care unit of a tertiary-care hospital in Madrid, Spain.\",\"authors\":\"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\",\"doi\":\"10.1186/s13756-025-01644-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients in burn intensive care units (BICUs) are at high risk of infections caused by multidrug-resistant pathogens, which can lead to hospital outbreaks.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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<sup>®</sup>).</p><p><strong>Findings: </strong>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<sub>OXA-23</sub> 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<sub>ADC-73</sub> mutants with increased cefiderocol minimum inhibitory concentrations (MICs). Novel mutations and combinations in bla<sub>ADC-73</sub> 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 H<sub>2</sub>O<sub>2</sub>.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":7950,\"journal\":{\"name\":\"Antimicrobial Resistance and Infection Control\",\"volume\":\"14 1\",\"pages\":\"124\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-10-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial Resistance and Infection Control\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13756-025-01644-0\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial Resistance and Infection Control","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13756-025-01644-0","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Genomic analysis of carbapenem resistant Acinetobacter baumannii outbreak in a burn intensive care unit of a tertiary-care hospital in Madrid, Spain.
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 blaOXA-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 blaADC-73 mutants with increased cefiderocol minimum inhibitory concentrations (MICs). Novel mutations and combinations in blaADC-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.
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.
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