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http://conacyt.repositorioinstitucional.mx/jspui/handle/1000/446| Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp) positive patients − a genomic exposé of cross-colonization hazards in a long-term acute care hospital (LTACH) | |
| Karen Lolans Rachel D Yelin Robert A Weinstein Evan S Snitkin Shawn Emily Hawken Mary K Hayden Michael Y Lin | |
| Novel Coronavirus | |
| Acceso Abierto | |
| Atribución-NoComercial-SinDerivadas | |
| 10.1101/2020.02.07.20020669 | |
| Objective: Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) has been demonstrated to protect uncolonized patients from acquiring MDROs in healthcare settings. A neglected aspect of cohorting is the potential for cross-transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits. We searched for evidence of cross-transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute care hospital (LTACH), and evaluated the impact of secondary acquisitions on resistance potential. Design: Genomic epidemiological investigation Setting: A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp-positive patients. Methods: Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross-transmission between cohorted patients. Results: Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient’s isolate than to their own admission isolate. In 14 of these 19 cases there was strong genomic evidence for cross-transmission (<10 SNVs) and the majority of these patients occupied shared cohort floors (12 cases) or rooms (5 cases) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates. Conclusions: Acquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and motivate future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by CDC U54 CK00016 04S2 and CDC U54 CK000481.S.E.H was supported by the University of Michigan NIH Training Program in Translational Research T32-GM113900 and the University of Michigan Rackham pre-doctoral fellowship. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Sequence data are available under BioProject PRJNA603790. | |
| Cold Spring Harbor Laboratory Press | |
| 2020 | |
| Preimpreso | |
| https://www.medrxiv.org/content/10.1101/2020.02.07.20020669v1 | |
| Inglés | |
| VIRUS RESPIRATORIOS | |
| Aparece en las colecciones: | Artículos científicos |
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