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首页> 外文期刊>Frontiers in Public Health >Phylogenetic Analysis of Multi-Drug Resistant Klebsiella pneumoniae Strains From Duodenoscope Biofilm: Microbiological Surveillance and Reprocessing Improvements for Infection Prevention
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Phylogenetic Analysis of Multi-Drug Resistant Klebsiella pneumoniae Strains From Duodenoscope Biofilm: Microbiological Surveillance and Reprocessing Improvements for Infection Prevention

机译：多药物抗性肺炎肺炎肺炎肺炎肺炎的系统发育分析来自Duodenopecopecocope的肺炎：微生物监测和再加工改善对预防的影响

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Duodenoscopes have been described as potential vehicles of patient-to-patient transmission of multi-drug resistant organisms. Carbapenem-resistant Enterobacteriaceae duodenoscope related infections have been described by the Center for Disease Control and the US Food and Drug Administration consequently to outbreaks occurring in the United States. These evidences suggested that improved microbiological surveillance and endoscope design optimization could represent valid tools to improve infection control. At this aim, in this study an example of duodenoscope microbiological surveillance and reprocessing improvement analyzing strains component of bacterial biofilm by phylogenetic analysis has been proposed. From September 2016 to December 2017, duodenoscope instruments were subjected to microbial surveillance by post-reprocessing cultures of liquid collected by internal channels of instruments after injection and aspiration cycles and membrane filtration. During surveillance seventeen Klebsiella pneumoniae , of which 10/17 (58.8%) MDR and KPC strains were collected from duodenoscope instruments plus one MDR Klebsiella pneumoniae strain from the rectal swab performed before ERCP procedure in an inpatient. The surveillance allowed evidencing potential failure of reprocessing procedure and performing consequent reprocessing improvements including the contaminated instruments quarantine until their negativity. Phylogenetic analysis of whole genome sequence of duodenoscope strains plus inpatients MDR strains, showed intermixing between duodenoscopes and inpatients, as evidenced by minimum spanning tree and time-scale Maximum Clade Credibility tree. In minimum spanning tree, three groups have been evidenced. Group I including Klebsiella pneumoniae strains, isolated from inpatients before microbiological surveillance adoption; group II including intermixed Klebsiella pneumoniae strains isolated from inpatients and Klebsiella pneumoniae strains isolated from duedonoscopes and group III including Klebsiella pneumoniae strains exclusively from duedonoscope instruments. In the Maximum Credibility Tree, a statistically supported cluster including two Klebsiella pneumoniae strains from duedonoscope instruments and one strains isolated from an inpatient was showed. From the first microbiologic surveillance performed on September 2016 and after the reprocessing improvement adoption, none MDR or susceptible Klebsiella pneumoniae strain was isolated in the following surveillance periods. In conclusion, these results should encourage hospital board to perform microbiological surveillance of duodenoscopes as well as of patients, by rectal swabs culture, and rapid molecular testing for antimicrobial resistance before any endoscopic invasive procedure.
机译：Duodenoscepes已被描述为多毒性生物的患者患者患者患者的潜在车辆。耐药肠道睾丸型肠杆菌病患者有效的感染已被疾病控制和美国食品和药物管理局所描述的，因此在美国发生的爆发。这些证据表明，改善的微生物监测和内窥镜设计优化可以代表改善感染控制的有效工具。在此目的，在本研究中，提出了一种通过系统发育分析的细菌生物膜的微生物微生物监测和再加工改善分析的例子。从2016年9月到2017年12月，通过注射和吸入循环后内部通道收集的液体后再处理培养，对Duodencope仪器进行微生物监测。在Surveillance中，其中10/17（58.8％）MDR和KPC菌株从Duodencope Instruments加上一名MDR Klebsiella肺炎，在住院病，在进行中，从直肠拭子，从直肠拭子中进行，其中一个MDR Klebsiella肺炎菌株。监测允许证明重新处理程序的潜在失败，并进行后续再加工改进，包括受污染的工具检疫，直到其消极性。剂量介质菌株的全基因组序列的系统发育分析加入患者MDR菌株，在多指仪和住院患者之间搅拌，如最小跨度树和时间尺度最大疏水板可信度树所证明。在最小的生成树中，已经证明了三组。我群在微生物监测之前，患有Klebsiella肺炎肺炎菌株，离住院患者分离;第II组包括从住院患者和肺炎群岛和Klebsiella肺炎群菌株中分离的混合的Klebsiella肺炎菌株，包括来自DuedoNoscopes的肺炎群岛肺炎群岛肺炎群岛。在最大可信度树中，统计上支持的群体包括来自DuedOnoscope仪器的两个Klebsiella肺炎群菌株和从住院病的一个菌株。从2016年9月进行的第一个微生物监测以及再处理改进采用后，在以下监测期中，无MDR或易感的Klebsiella肺炎菌株。总之，这些结果应该鼓励医院委员会对患者进行微生物监测，并通过直肠拭子培养，以及在任何内窥镜侵袭性手术前的抗微生物抗性的快速分子测试。

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