Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales
| Autor: | Annaliese van Diemen, Claire L. Gorrie, Siobhan St. George, Susan A Ballard, Marion Easton, Torsten Seemann, Mark B. Schultz, Courtney R Lane, Donna R. M. Cameron, Michelle Sait, Allen C. Cheng, Anton Y. Peleg, Brett Sutton, Benjamin P Howden, Norelle L Sherry, Rhonda L. Stuart, Andrew J. Stewardson, Judith Brett, Anders Gonçalves da Silva, Deborah A Williamson, Jason C Kwong, Kerrie Stevens, Nicola Stephens, Denis Spelman, Mary Jo Waters, Finn Romanes |
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| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Victoria Population beta-Lactamases law.invention Antibiotic resistance Public health surveillance Bacterial Proteins law Environmental health Epidemiology medicine Infection control Humans Prospective Studies antimicrobial resistance education Online Only Articles education.field_of_study business.industry Public health Incidence (epidemiology) carbapenemase-producing Enterobacterales Enterobacteriaceae Infections Genomics infection control public health surveillance Major Articles and Commentaries Infectious Diseases Transmission (mechanics) AcademicSubjects/MED00290 business |
| Zdroj: | Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1537-6591 |
| Popis: | Background Multiresistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assessed the feasibility and impact of a statewide CPE surveillance and response program deployed across Victoria, Australia (population 6.5 million). Methods A prospective multimodal intervention including active screening, carrier isolation, centralized case investigation, and comparative pathogen genomics was implemented. We analyzed trends in CPE incidence and clinical presentation, risk factors, and local transmission over the program’s first 3 years (2016–2018). Results CPE case ascertainment increased over the study period to 1.42 cases/100 000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45–0.60 infections/100 000 population, P = .640). KPC-2 infection decreased from 0.29 infections/100 000 population prior to intervention to 0.03 infections/100 000 population in 2018 (P = .003). Comprehensive case investigation identified instances of overseas community acquisition. Median time between isolate referral and genomic and epidemiological assessment for local transmission was 11 days (IQR, 9–14). Prospective surveillance identified numerous small transmission networks (median, 2; range, 1–19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR, 4–13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response. Conclusions We demonstrate the value of centralized CPE control programs to increase case ascertainment, resolve risk factors, and identify local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally. A statewide multimodal intervention for the control of carbapenemase-producing Enterobacterales was associated with a significant increase in case ascertainment, with no rise in clinical infections. Timely prospective epidemiological and genomic surveillance identified numerous small local transmission networks permitting rapid response. |
| Databáze: | OpenAIRE |
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