Real-Time Genome Sequencing of Resistant Bacteria Provides Precision Infection Control in an Institutional Setting

The increasing prevalence of multidrug-resistant (MDR) bacteria is a serious global challenge. Here, we studied prospectively whether bacterial whole-genome sequencing (WGS) for real-time MDR surveillance is technical feasible, returns actionable results, and is cost-beneficial. WGS was applied to a...

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Vydáno v:	Journal of clinical microbiology Ročník 54; číslo 12; s. 2874
Hlavní autoři:	Mellmann, Alexander, Bletz, Stefan, Böking, Thomas, Kipp, Frank, Becker, Karsten, Schultes, Anja, Prior, Karola, Harmsen, Dag
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.12.2016
Témata:	Anti-Bacterial Agents - pharmacology Cefotaxime - pharmacology Ciprofloxacin - pharmacology Cross Infection - microbiology Cross Infection - transmission Enterococcus faecium - drug effects Enterococcus faecium - genetics Enterococcus faecium - isolation & purification Escherichia coli - drug effects Escherichia coli - genetics Escherichia coli - isolation & purification Escherichia coli Infections - transmission Genome, Bacterial - genetics Gram-Positive Bacterial Infections - transmission High-Throughput Nucleotide Sequencing Humans Infection Control - methods Methicillin-Resistant Staphylococcus aureus - drug effects Methicillin-Resistant Staphylococcus aureus - genetics Methicillin-Resistant Staphylococcus aureus - isolation & purification Microbial Sensitivity Tests Piperacillin - pharmacology Prospective Studies Pseudomonas aeruginosa - drug effects Pseudomonas aeruginosa - genetics Pseudomonas aeruginosa - isolation & purification Pseudomonas Infections - transmission Sequence Analysis, DNA Staphylococcal Infections - transmission Vancomycin-Resistant Enterococci - drug effects Vancomycin-Resistant Enterococci - genetics Vancomycin-Resistant Enterococci - isolation & purification
ISSN:	1098-660X, 1098-660X
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Shrnutí:	The increasing prevalence of multidrug-resistant (MDR) bacteria is a serious global challenge. Here, we studied prospectively whether bacterial whole-genome sequencing (WGS) for real-time MDR surveillance is technical feasible, returns actionable results, and is cost-beneficial. WGS was applied to all MDR isolates of four species (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus faecium, MDR Escherichia coli, and MDR Pseudomonas aeruginosa) at the University Hospital Muenster, Muenster, Germany, a tertiary care hospital with 1,450 beds, during two 6-month intervals. Turnaround times (TAT) were measured, and total costs for sequencing per isolate were calculated. After cancelling prior policies of preemptive isolation of patients harboring certain Gram-negative MDR bacteria in risk areas, the second interval was conducted. During interval I, 645 bacterial isolates were sequenced. From culture, TATs ranged from 4.4 to 5.3 days, and costs were €202.49 per isolate. During interval II, 550 bacterial isolates were sequenced. Hospital-wide transmission rates of the two most common species (MRSA and MDR E. coli) were low during interval I (5.8% and 2.3%, respectively) and interval II (4.3% and 5.0%, respectively). Cancellation of isolation of patients infected with non-pan-resistant MDR E. coli in risk wards did not increase transmission. Comparing sequencing costs with avoided costs mostly due to fewer blocked beds during interval II, we saved in excess of €200,000. Real-time microbial WGS in our institution was feasible, produced precise actionable results, helped us to monitor transmission rates that remained low following a modification in isolation procedures, and ultimately saved costs.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1098-660X 1098-660X
DOI:	10.1128/jcm.00790-16