Genomic surveillance, characterization and intervention of a polymicrobial multidrug-resistant outbreak in critical care.

摘要: Background. Infections caused by carbapenem-resistant Acinetobacter baumannii (CR-Ab) have become increasingly prevalent in clinical settings and often result significant morbidity mortality due to their multidrug resistance (MDR). Here we present an integrated whole-genome sequencing (WGS) response a persistent CR-Ab outbreak Brisbane hospital between 2016-2018.Methods. A. baumannii, Klebsiella pneumoniae, Serratia marcescens Pseudomonas aeruginosa isolates were sequenced using the Illumina platform primarily establish isolate relationships based on core-genome SNPs, MLST antimicrobial gene profiles. Representative selected for PacBio sequencing. Environmental metagenomic with was used detect persistence of strain hospital.Results. In suspected polymicrobial May August 2016, 28 (and 21 other MDR Gram-negative bacilli) collected from Intensive Care Unit Burns patients sent WGS 7 day turn-around time reporting. All sequence type (ST)1050 (Pasteur ST2) within 10 SNPs apart, indicative ongoing outbreak, distinct historical same hospital. Possible transmission routes identified basis K. pneumoniae SNP Continued surveillance 2016 2018 enabled cases be refuted, but resurgence mid-2018 prompted additional screening. plumbing as potential source. Replacement routine drain maintenance resulted rapid resolution secondary risk reduction no discernable since.Conclusion. We implemented comprehensive metagenomics investigation that resolved critical care setting.