RESUMO
In spring 2022, an increase in metallo-ß-lactamase-producing Pseudomonas aeruginosa (MBL-Pa) infections was detected in a hospital in Upper Austria. To identify the source of infection and to stop further transmissions, an epidemiological outbreak investigation including whole-genome sequencing (WGS)-based typing was conducted. The final case definition included cases admitted to the hospital between 2020 and 2023 with an MBL-Pa in one of the three genomic clusters identified. In addition, the investigation was extended to include historical cases from 2017. Core genome multilocus sequence typing was performed to assess the genetic relatedness between the isolates. Fifty-four clinical P. aeruginosa isolates and eight P. aeruginosa isolates from the hospital environment were obtained. All but nine isolates grouped into one of three genomic clusters (ST235/blaVIM-1, ST111/blaVIM-2, or ST621/blaIMP-13), which were considered to be distinct, prolonged outbreaks involving 47 out of 52 cases. The most likely source of infection for cluster 1 (ST111/blaVIM-2) and cluster 2 (ST235/blaVIM-1) was sinks in the intensive care unit (ICU) washroom. Cluster 3 clone (ST621/blaIMP-13) could have originated in the urology ward in 2020 and then spread to the ICU years later. However, the nosocomial origin of this clone could not be proven. In March 2023, following the implementation of control measures (gowning, patient isolation, screening, and daily disinfection), no further MLB-Pa was detected, and the outbreaks were considered to be over. As ICUs play an important role in the transmission of P. aeruginosa, emphasis should be placed on genomic surveillance, infection prevention, and control in such wards. IMPORTANCE: The significance of our work lies in the successful resolution of three prolonged outbreaks of MBL-Pa infections in a hospital in Upper Austria. Through a comprehensive epidemiological investigation coupled with WGS-based typing of P. aeruginosa isolates, the study identified three distinct genomic clusters responsible for prolonged outbreaks involving 47 cases. The investigation pinpointed sinks in the ICU washroom as the likely source of infection for two of the clusters. The study demonstrates the effectiveness of control measures such as hand hygiene, gowning, patient isolation, screening, and disinfection in stopping further transmission and bringing the outbreaks to a close. This underscores the critical role of genomic surveillance and control measures, particularly in high-risk settings like ICUs, in reducing nosocomial transmission of MBL-Pa infections.
RESUMO
BACKGROUND: The aim of the present study was to investigate the genetic relatedness and the antimicrobial resistance profiles of a collection of Austrian Streptococcus pneumoniae isolates from companion animals and horses. A total of 12 non-repetitive isolates presumptively identified as S. pneumoniae were obtained during routinely diagnostic activities between March 2009 and January 2017. RESULTS: Isolates were confirmed as S. pneumoniae by bile solubility and optochin susceptibility testing, matrix-assisted laser desorption-ionization-time of flight (MALDI-TOF) mass spectrometry and sequence analysis of a part recA and the 16S rRNA genes. Isolates were further characterized by pneumolysin polymerase chain reaction (PCR) and genotyped by multilocus sequence typing (MLST). Antimicrobial susceptibility testing was performed and resistance genes were detected by specific PCR assays. All isolates were serotyped. Four sequence types (ST) (ST36, ST3546, ST6934 and ST6937) and four serotypes (3, 19A, 19F and 23F) were detected. Two isolates from twelve displayed a multidrug-resistance pheno- and genotype. CONCLUSIONS: This study represents the first comprehensive investigation on characteristics of S. pneumoniae isolates recovered from Austrian companion animals and horses. The obtained results indicate that common human sero- (23F) and sequence type (ST36) implicated in causing invasive pneumococcal disease (IPD) may circulate in dogs. Isolates obtained from other examined animals seem to be host-adapted.
Assuntos
Cavalos/microbiologia , Animais de Estimação/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética , Animais , Antibacterianos/farmacologia , Áustria , Cães , Interações Hospedeiro-Patógeno , Humanos , Testes de Sensibilidade Microbiana , RNA Ribossômico 16S/genética , Recombinases Rec A/genética , Zoonoses/microbiologiaRESUMO
BACKGROUND: Contamination of surfaces by spores of Clostridium difficile is a major factor influencing the spread of healthcare-associated C. difficile infection. The aim of this study was to test the effect of an automated room disinfection system that provides an aerosol of 7.5 % hydrogen peroxide (H2O2) disinfectant, on spores of two different strains of C. difficile, and to evaluate the impact of biological soiling on the efficacy of H2O2 disinfection. MATERIAL AND METHOD: The strains used were a C. difficile PCR ribotype 027 and a C. difficile ATCC 9689. Spore suspensions of each strain were applied to ceramic tiles and exposed to aerosolized H2O2 at different locations in a test room. Biological soiling was simulated by bovine serum albumin and sheep erythrocytes. At set time points spores were recovered, plated onto Columbia 5 % sheep blood agar, and surviving bacteria were counted as colony-forming units (cfu). RESULTS: No viable spores of either strain were recovered after a 3 h exposure to gaseous H2O2. Spores located inside a drawer showed recovery of approximately 1E5 cfu/ml for C. difficile ribotype 027 after 1 h. In the presence of organic matter, a more than fivefold log reduction compared with not exposed controls could be observed for spores of either strain tested. CONCLUSION: Appropriate decontamination of surfaces exposed to spores of C. difficile is challenging for conventional cleaning methods. Aerosolized H2O2 delivered by automated room disinfection systems could possibly improve surface decontamination and thereby reduce transmission of healthcare-associated C. difficile infection. Also in the presence of organic matter H2O2 disinfection appears to be an effective adjunct for decontamination of environmental surfaces.
Assuntos
Clostridioides difficile/efeitos dos fármacos , Clostridioides difficile/crescimento & desenvolvimento , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Equipamentos e Provisões/microbiologia , Peróxido de Hidrogênio/farmacologia , Aerossóis/farmacologia , Ar , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/fisiologia , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/fisiologia , Esporos Bacterianos/efeitos dos fármacos , Esporos Bacterianos/crescimento & desenvolvimentoRESUMO
INTRODUCTION: Neisseria meningitidis is a leading cause of meningitis and sepsis worldwide. Thus, monitoring the epidemiology of invasive meningococcal disease (IMD) is an important public health measure. The National Reference Centre for Meningococci at the Austrian Agency for Health and Food Safety is operating the laboratory-based surveillance database. METHODS: IMD isolates from all over Austria are collected at the National Reference Centre for Meningococci, where the microorganism is characterised by serological and molecular methods, as well as by antimicrobial susceptibility testing. These laboratory-based surveillance data from 1995 to 2010 were analysed by time, place and person. Long-term and seasonal trends were analysed by log-linear regression, yielding an annual average percentage change (AAPC), and by cyclic regression models, applying either a simple linear or a negative binomial regression, including one sine and one cosine term. RESULTS: Over the past 16 years, IMD incidence ranged between 0.73 and 1.41/100,000 persons, with a decreasing trend in Serogroup B IMD incidence (AAPC: -2.1%; p = 0.0396) and an increasing trend in Serogroup C IMD incidence (AAPC: +4.3%; p = 0.043). In 2010, 80 cases of IMD were recorded, corresponding to an incidence of 0.95/100,000 population. Ten deaths were registered, which results in a case-fatality of 12.5% and a mortality incidence of 0.12/100,000 population. The predominant serogroup in Austria was serogroup B, followed by serogroups C, Y and W-135. DISCUSSION: Although the incidence of IMD in 2010 is below the average incidence rate over the last 15 years, serogroup C IMD in Austria is increasing. Within the previous 10 years two provinces initiated vaccination campaigns for a monovalent meningococcal conjugate vaccine, following the increasing trend of Sg C IMD incidence. An ongoing study on the impact of these vaccination campaigns on the IMD burden will yield further scientific evidence for supporting the introduction of this vaccine into the publicly funded childhood immunisation program.