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Genomic surveillance uncovers ongoing transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) and identifies actionable routes of transmissions in an endemic setting

Published online by Cambridge University Press:  23 May 2022

Sean Wei Xiang Ong
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore National Centre for Infectious Diseases, Singapore
Pooja Rao
Affiliation:
Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
Wei Xin Khong
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
Victor Yi Fa Ong
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
Prakki Sai Rama Sridatta
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore National Centre for Infectious Diseases, Singapore
Natascha May Thevasagayam
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore National Centre for Infectious Diseases, Singapore
Benjamin Choon Heng Ho
Affiliation:
Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
Brenda Sze Peng Ang
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore National Centre for Infectious Diseases, Singapore Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Partha Pratim De
Affiliation:
Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
Oon Tek Ng*
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore National Centre for Infectious Diseases, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Kalisvar Marimuthu*
Affiliation:
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore National Centre for Infectious Diseases, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore
*
Author for correspondence: Dr Kalisvar Marimuthu, E-mail: kalisvar_marimuthu@ttsh.com.sg. Or Dr Oon-Tek Ng, E-mail: oon_tek_ng@ttsh.com.sg
Author for correspondence: Dr Kalisvar Marimuthu, E-mail: kalisvar_marimuthu@ttsh.com.sg. Or Dr Oon-Tek Ng, E-mail: oon_tek_ng@ttsh.com.sg

Abstract

Objective:

In our center, previous infection prevention and control (IPC) resources were concentrated on multidrug-resistant organisms other than CRAB because the rate of CRAB was stable with no evidence of outbreaks. Triggered by an increase in the baseline rate of CRAB isolated in clinical cultures, we investigated horizontal transmission of CRAB to guide targeted IPC actions.

Methods:

We prospectively collected clinical data of patients with positive CRAB cultures. We identified genetic relatedness of CRAB isolates using whole-genome sequencing. Findings were regularly presented to the IPC committee, and follow-up actions were documented.

Results:

During the study period, 66 CRAB isolates were available for WGS. Including 12 clinical isolates and 10 environmental isolates from a previous study, a total of 88 samples were subjected to WGS, of which 83 were successfully sequenced and included in the phylogenetic analysis. We identified 5 clusters involving 44 patients. Genomic transmissions were explained by spatiotemporal overlap in 12 patients and by spatial overlap only in 12 patients. The focus of transmission was deduced to be the intensive care units. One cluster was related to a retrospective environmental isolate, suggesting the environment as a possible route of transmission. Discussion of these findings at multidisciplinary IPC meetings led to implementation of measures focusing on environmental hygiene, including hydrogen peroxide vapor disinfection in addition to terminal cleaning for rooms occupied by CRAB patients.

Conclusions:

We showed that WGS could be utilized as a “tool of persuasion” by demonstrating the presence of ongoing transmission of CRAB in an endemic setting, and by identifying actionable routes of transmission for directed IPC interventions.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

b

Authors of equal contribution.

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Genomic surveillance uncovers ongoing transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) and identifies actionable routes of transmissions in an endemic setting
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Genomic surveillance uncovers ongoing transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) and identifies actionable routes of transmissions in an endemic setting
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