Ryan C Johnson1, Clay Deming1, Sean Conlan1, Caroline J Zellmer1, Angela V Michelin1, ShihQueen Lee-Lin1, Pamela J Thomas1, Morgan Park1, Rebecca A Weingarten1, John Less1, John P Dekker1, Karen M Frank1, Kimberlee A Musser1, John R McQuiston1, David K Henderson1, Anna F Lau1, Tara N Palmore1, Julia A Segre1. 1. From the National Human Genome Research Institute (R.C.J., C.D., S.C., S.L.-L., J.A.S.), National Institutes of Health (NIH) Clinical Center (C.J.Z., A.V.M., R.A.W., J.P.D., K.M.F., D.K.H., A.F.L., T.N.P.), and the Division of Facilities, Operations, and Maintenance (J.L.), NIH, Bethesda, and the NIH Intramural Sequencing Center, NIH, Rockville (P.J.T., M.P.) - all in Maryland; Wadsworth Center, New York State Department of Health, Albany (K.A.M.); and the Special Bacteriology Reference Laboratory, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta (J.R.M.). Dr. Park serves as an author on behalf of the NIH Intramural Sequencing Center Comparative Sequencing Program.
Abstract
BACKGROUND: Plumbing systems are an infrequent but known reservoir for opportunistic microbial pathogens that can infect hospitalized patients. In 2016, a cluster of clinical sphingomonas infections prompted an investigation. METHODS: We performed whole-genome DNA sequencing on clinical isolates of multidrug-resistant Sphingomonas koreensis identified from 2006 through 2016 at the National Institutes of Health (NIH) Clinical Center. We cultured S. koreensis from the sinks in patient rooms and performed both whole-genome and shotgun metagenomic sequencing to identify a reservoir within the infrastructure of the hospital. These isolates were compared with clinical and environmental S. koreensis isolates obtained from other institutions. RESULTS: The investigation showed that two isolates of S. koreensis obtained from the six patients identified in the 2016 cluster were unrelated, but four isolates shared more than 99.92% genetic similarity and were resistant to multiple antibiotic agents. Retrospective analysis of banked clinical isolates of sphingomonas from the NIH Clinical Center revealed the intermittent recovery of a clonal strain over the past decade. Unique single-nucleotide variants identified in strains of S. koreensis elucidated the existence of a reservoir in the hospital plumbing. Clinical S. koreensis isolates from other facilities were genetically distinct from the NIH isolates. Hospital remediation strategies were guided by results of microbiologic culturing and fine-scale genomic analyses. CONCLUSIONS: This genomic and epidemiologic investigation suggests that S. koreensis is an opportunistic human pathogen that both persisted in the NIH Clinical Center infrastructure across time and space and caused health care-associated infections. (Funded by the NIH Intramural Research Programs.).
BACKGROUND: Plumbing systems are an infrequent but known reservoir for opportunistic microbial pathogens that can infect hospitalized patients. In 2016, a cluster of clinical sphingomonas infections prompted an investigation. METHODS: We performed whole-genome DNA sequencing on clinical isolates of multidrug-resistant Sphingomonas koreensis identified from 2006 through 2016 at the National Institutes of Health (NIH) Clinical Center. We cultured S. koreensis from the sinks in patient rooms and performed both whole-genome and shotgun metagenomic sequencing to identify a reservoir within the infrastructure of the hospital. These isolates were compared with clinical and environmentalS. koreensis isolates obtained from other institutions. RESULTS: The investigation showed that two isolates of S. koreensis obtained from the six patients identified in the 2016 cluster were unrelated, but four isolates shared more than 99.92% genetic similarity and were resistant to multiple antibiotic agents. Retrospective analysis of banked clinical isolates of sphingomonas from the NIH Clinical Center revealed the intermittent recovery of a clonal strain over the past decade. Unique single-nucleotide variants identified in strains of S. koreensis elucidated the existence of a reservoir in the hospital plumbing. Clinical S. koreensis isolates from other facilities were genetically distinct from the NIH isolates. Hospital remediation strategies were guided by results of microbiologic culturing and fine-scale genomic analyses. CONCLUSIONS: This genomic and epidemiologic investigation suggests that S. koreensis is an opportunistic human pathogen that both persisted in the NIH Clinical Center infrastructure across time and space and caused health care-associated infections. (Funded by the NIH Intramural Research Programs.).
Authors: Jeffrey R Singer; Emily G Blosser; Carlene L Zindl; Daniel J Silberger; Sean Conlan; Vincent A Laufer; Daniel DiToro; Clay Deming; Ranjit Kumar; Casey D Morrow; Julia A Segre; Michael J Gray; David A Randolph; Casey T Weaver Journal: Nat Med Date: 2019-11-07 Impact factor: 53.440
Authors: Dimana Dimitrova; Juan Gea-Banacloche; Seth M Steinberg; Jennifer L Sadler; Stephanie N Hicks; Ellen Carroll; Jennifer S Wilder; Mark Parta; Lauren Skeffington; Thomas E Hughes; Jenny E Blau; Miranda M Broadney; Jeremy J Rose; Amy P Hsu; Rochelle Fletcher; Natalia S Nunes; Xiao-Yi Yan; William G Telford; Veena Kapoor; Jeffrey I Cohen; Alexandra F Freeman; Elizabeth Garabedian; Steven M Holland; Andrea Lisco; Harry L Malech; Luigi D Notarangelo; Irini Sereti; Nirali N Shah; Gulbu Uzel; Christa S Zerbe; Daniel H Fowler; Ronald E Gress; Christopher G Kanakry; Jennifer A Kanakry Journal: Biol Blood Marrow Transplant Date: 2019-09-04 Impact factor: 5.742
Authors: Brendan J Kelly; Selamawit Bekele; Sean Loughrey; Elizabeth Huang; Pam Tolomeo; Michael Z David; Ebbing Lautenbach; Jennifer H Han; Matthew J Ziegler Journal: Infect Control Hosp Epidemiol Date: 2021-08-24 Impact factor: 6.520
Authors: Sean Conlan; Anna F Lau; Clay Deming; Christine D Spalding; ShihQueen Lee-Lin; Pamela J Thomas; Morgan Park; John P Dekker; Karen M Frank; Tara N Palmore; Julia A Segre Journal: mBio Date: 2019-10-08 Impact factor: 7.867