| Title: |
Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of blaKPC-carbapenemase-producing Enterobacterales in a hospital setting |
| Authors: |
Stoesser, N; George, R; Aiken, Z; Phan, HTT; Lipworth, S; Quan, TP; Mathers, AJ; De Maio, N; Seale, AC; Eyre, DW; Vaughan, A; Swann, J; Peto, TEA; Crook, DW; Cawthorne, J; Dodgson, A; Walker, AS |
| Contributors: |
Group, TRACE Investigators’ |
| Publisher Information: |
Oxford University Press |
| Publication Year: |
2024 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Background Healthcare-associated wastewater and asymptomatic patient reservoirs colonized by carbapenemase-producing Enterobacterales (CPE) contribute to nosocomial CPE dissemination, but the characteristics and dynamics of this remain unclear. Methods We systematically sampled wastewater sites (n = 4488 samples; 349 sites) and patients (n = 1247) across six wards over 6–12 months to understand blaKPC-associated CPE (KPC-E) diversity within these reservoirs and transmission in a healthcare setting. Up to five KPC-E-positive isolates per sample were sequenced (Illumina). Recombination-adjusted phylogenies were used to define genetically related strains; assembly and mapping-based approaches were used to characterize antimicrobial resistance genes, insertion sequences (ISs) and Tn4401 types/target site sequences. The accessory genome was evaluated in some of the largest clusters, and those crossing reservoirs. Results Wastewater site KPC-E-positivity was substantial [101/349 sites (28.9%); 228/5601 (4.1%) patients cultured]. Thirteen KPC-E species and 109 strains were identified using genomics, and 24% of wastewater and 26% of patient KPC-E-positive samples harboured one or more strains. Most diversity was explained by the individual niche, suggesting localized factors are important in selection and spread. Tn4401 + flanking target site sequence diversity was greater in wastewater sites (P KPC dissemination dynamics. Conclusions We identified substantial and diverse KPC-E colonization of wastewater sites and patients in this hospital setting. Reservoir and niche-specific factors (e.g. microbial interactions, selection pressures), and different strains and mobile genetic elements likely affect transmission dynamics. This should be considered in surveillance and control strategies. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://doi.org/10.1093/jacamr/dlae140 |
| DOI: |
10.1093/jacamr/dlae140 |
| Availability: |
https://doi.org/10.1093/jacamr/dlae140; https://ora.ox.ac.uk/objects/uuid:01192d00-dd7b-46ea-b236-823e883b8147 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.7E7C653C |
| Database: |
BASE |