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Genomic Characterization of Carbapenem-Resistant Acinetobacter baumannii (CRAB) in Mechanically Ventilated COVID-19 Patients and Impact of Infection Control Measures on Reducing CRAB Circulation during the Second Wave of the SARS-CoV-2 Pandemic in Milan, Italy.
Mangioni, Davide; Fox, Valeria; Chatenoud, Liliane; Bolis, Matteo; Bottino, Nicola; Cariani, Lisa; Gentiloni Silverj, Flaminia; Matinato, Caterina; Monti, Gianpaola; Muscatello, Antonio; Teri, Antonio; Terranova, Leonardo; Piatti, Alessandra; Gori, Andrea; Grasselli, Giacomo; Stocchetti, Nino; Alteri, Claudia; Bandera, Alessandra.
Afiliación
  • Mangioni D; Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Fox V; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy.
  • Chatenoud L; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
  • Bolis M; Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
  • Bottino N; Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Cariani L; Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Gentiloni Silverj F; Microbiology Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Matinato C; Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Monti G; Microbiology Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Muscatello A; Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Teri A; Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Terranova L; Microbiology Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Piatti A; Department of Internal Medicine, Respiratory Unit and Adult Cystic Fibrosis Center, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Gori A; Medical Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Grasselli G; Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
  • Stocchetti N; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy.
  • Alteri C; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy.
  • Bandera A; Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
Microbiol Spectr ; : e0020923, 2023 Mar 28.
Article en En | MEDLINE | ID: mdl-36976013
COVID-19 has significantly affected hospital infection prevention and control (IPC) practices, especially in intensive care units (ICUs). This frequently caused dissemination of multidrug-resistant organisms (MDROs), including carbapenem-resistant Acinetobacter baumannii (CRAB). Here, we report the management of a CRAB outbreak in a large ICU COVID-19 hub Hospital in Italy, together with retrospective genotypic analysis by whole-genome sequencing (WGS). Bacterial strains obtained from severe COVID-19 mechanically ventilated patients diagnosed with CRAB infection or colonization between October 2020 and May 2021 were analyzed by WGS to assess antimicrobial resistance and virulence genes, along with mobile genetic elements. Phylogenetic analysis in combination with epidemiological data was used to identify putative transmission chains. CRAB infections and colonization were diagnosed in 14/40 (35%) and 26/40 (65%) cases, respectively, with isolation within 48 h from admission in 7 cases (17.5%). All CRAB strains belonged to Pasteur sequence type 2 (ST2) and 5 different Oxford STs and presented blaOXA-23 gene-carrying Tn2006 transposons. Phylogenetic analysis revealed the existence of four transmission chains inside and among ICUs, circulating mainly between November and January 2021. A tailored IPC strategy was composed of a 5-point bundle, including ICU modules' temporary conversion to CRAB-ICUs and dynamic reopening, with limited impact on ICU admission rate. After its implementation, no CRAB transmission chains were detected. Our study underlies the potentiality of integrating classical epidemiological studies with genomic investigation to identify transmission routes during outbreaks, which could represent a valuable tool to ensure IPC strategies and prevent the spread of MDROs. IMPORTANCE Infection prevention and control (IPC) practices are of paramount importance for preventing the spread of multidrug-resistant organisms (MDROs) in hospitals, especially in the intensive care unit (ICU). Whole-genome sequencing (WGS) is seen as a promising tool for IPC, but its employment is currently still limited. COVID-19 pandemics have posed dramatic challenges in IPC practices, causing worldwide several outbreaks of MDROs, including carbapenem-resistant Acinetobacter baumannii (CRAB). We present the management of a CRAB outbreak in a large ICU COVID-19 hub hospital in Italy using a tailored IPC strategy that allowed us to contain CRAB transmission while preventing ICU closure during a critical pandemic period. The analysis of clinical and epidemiological data coupled with retrospective genotypic analysis by WGS identified different putative transmission chains and confirmed the effectiveness of the IPC strategy implemented. This could be a promising approach for future IPC strategies.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Microbiol Spectr Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Microbiol Spectr Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos