Robyn S Lee1, Benjamin P Howden1,2,3, M Lindsay Grayson3,4,5,6, Norelle L Sherry1,2,3, Claire L Gorrie1, Jason C Kwong1,2,3, Rhonda L Stuart7,8, Tony M Korman7,8,9, Caroline Marshall10,4, Charlie Higgs2, Hiu Tat Chan11, Maryza Graham7,8,9, Paul D R Johnson3,4,5, Marcel J Leroi6, Caroline Reed11,12, Michael J Richards10,4, Monica A Slavin13,14, Leon J Worth13,14. 1. Microbiological Diagnostic Unit (MDU) Public Health Laboratory, Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia. 2. Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia. 3. Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia. 4. Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia. 5. Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia. 6. Department of Microbiology, Austin Health, Heidelberg, Victoria, Australia. 7. Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia. 8. Department of Medicine, Monash University, Clayton, Victoria, Australia. 9. Department of Microbiology, Monash Health, Clayton, Victoria, Australia. 10. Infection Prevention & Surveillance Service, Victorian Infectious Diseases Service, Melbourne Health, Parkville, Victoria, Australia. 11. Department of Microbiology, Melbourne Health, Parkville, Victoria, Australia. 12. Department of Microbiology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia. 13. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia. 14. National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
OBJECTIVES: To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission. DESIGN: Pilot prospective multicenter surveillance study. SETTING: The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals. METHODS: All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data. RESULTS: In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients). CONCLUSIONS: Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
OBJECTIVES: To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission. DESIGN: Pilot prospective multicenter surveillance study. SETTING: The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals. METHODS: All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data. RESULTS: In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients). CONCLUSIONS: Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
Authors: Alexander J Sundermann; Jieshi Chen; Praveen Kumar; Ashley M Ayres; Shu Ting Cho; Chinelo Ezeonwuka; Marissa P Griffith; James K Miller; Mustapha M Mustapha; A William Pasculle; Melissa I Saul; Kathleen A Shutt; Vatsala Srinivasa; Kady Waggle; Daniel J Snyder; Vaughn S Cooper; Daria Van Tyne; Graham M Snyder; Jane W Marsh; Artur Dubrawski; Mark S Roberts; Lee H Harrison Journal: Clin Infect Dis Date: 2022-08-31 Impact factor: 20.999
Authors: Claire L Gorrie; Mirjana Mirčeta; Ryan R Wick; Louise M Judd; Margaret M C Lam; Ryota Gomi; Iain J Abbott; Nicholas R Thomson; Richard A Strugnell; Nigel F Pratt; Jill S Garlick; Kerrie M Watson; Peter C Hunter; David V Pilcher; Steve A McGloughlin; Denis W Spelman; Kelly L Wyres; Adam W J Jenney; Kathryn E Holt Journal: Nat Commun Date: 2022-05-31 Impact factor: 17.694
Authors: Charlie Higgs; Norelle L Sherry; Torsten Seemann; Kristy Horan; Hasini Walpola; Paul Kinsella; Katherine Bond; Deborah A Williamson; Caroline Marshall; Jason C Kwong; M Lindsay Grayson; Timothy P Stinear; Claire L Gorrie; Benjamin P Howden Journal: Nat Commun Date: 2022-01-26 Impact factor: 14.919
Authors: Norelle L Sherry; Claire L Gorrie; Jason C Kwong; Charlie Higgs; Rhonda L Stuart; Caroline Marshall; Susan A Ballard; Michelle Sait; Tony M Korman; Monica A Slavin; Robyn S Lee; Maryza Graham; Marcel Leroi; Leon J Worth; Hiu Tat Chan; Torsten Seemann; M Lindsay Grayson; Benjamin P Howden Journal: Lancet Reg Health West Pac Date: 2022-04-12
Authors: Kelly L Wyres; Jane Hawkey; Mirianne Mirčeta; Louise M Judd; Ryan R Wick; Claire L Gorrie; Nigel F Pratt; Jill S Garlick; Kerrie M Watson; David V Pilcher; Steve A McGloughlin; Iain J Abbott; Nenad Macesic; Denis W Spelman; Adam W J Jenney; Kathryn E Holt Journal: BMC Infect Dis Date: 2021-07-14 Impact factor: 3.090