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148 Use of whole-genome sequencing to identify transmission of Pseudomonas aeruginosa between cystic fibrosis patients
Tools
Loman, Nicholas J., Manzoor, Susan, Quick, Joshua, Fothergill, J. L., Gossain, Savita, Kenna, D., Turton, J., Walshaw, M., Whitehouse, Joanna L., Pallen, Mark J., Winstanley, Craig, Hawkey, P. M. (Peter M.) and Nash, E. F. (2014) 148 Use of whole-genome sequencing to identify transmission of Pseudomonas aeruginosa between cystic fibrosis patients. In: 37th European Cystic Fibrosis Conference, 11-14 Jun 2014. Published in: Journal of Cystic Fibrosis, Volume 13 doi:10.1016/S1569-1993(14)60284-8 ISSN 1569-1993.
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Official URL: http://dx.doi.org/10.1016/S1569-1993(14)60284-8
Abstract
Background
Increasing numbers of individuals with cystic fibrosis are becoming infected with the multidrug-resistant non-tuberculous mycobacterium (NTM) Mycobacterium abscessus, which causes progressive lung damage and is extremely challenging to treat. How this organism is acquired is not currently known, but there is growing concern that person-to-person transmission could occur. We aimed to define the mechanisms of acquisition of M abscessus in individuals with cystic fibrosis.
Method
Whole genome sequencing and antimicrobial susceptibility testing were done on 168 consecutive isolates of M abscessus from 31 patients attending an adult cystic fibrosis centre in the UK between 2007 and 2011. In parallel, we undertook detailed environmental testing for NTM and defined potential opportunities for transmission between patients both in and out of hospital using epidemiological data and social network analysis.
Findings
Phylogenetic analysis revealed two clustered outbreaks of near-identical isolates of the M abscessus subspecies massiliense (from 11 patients), differing by less than ten base pairs. This variation represents less diversity than that seen within isolates from a single individual, strongly indicating between-patient transmission. All patients within these clusters had numerous opportunities for within-hospital transmission from other individuals, while comprehensive environmental sampling, initiated during the outbreak, failed to detect any potential point source of NTM infection. The clusters of M abscessus subspecies massiliense showed evidence of transmission of mutations acquired during infection of an individual to other patients. Thus, isolates with constitutive resistance to amikacin and clarithromycin were isolated from several individuals never previously exposed to long-term macrolides or aminoglycosides, further indicating cross-infection.
Interpretation
Whole genome sequencing has revealed frequent transmission of multidrug resistant NTM between patients with cystic fibrosis despite conventional cross-infection measures. Although the exact transmission route is yet to be established, our epidemiological analysis suggests that it could be indirect.
Item Type: | Conference Item (Paper) | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Microbiology & Infection Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Journal of Cystic Fibrosis | ||||
Publisher: | Elsevier Science BV | ||||
ISSN: | 1569-1993 | ||||
Official Date: | June 2014 | ||||
Dates: |
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Volume: | Volume 13 | ||||
Article Number: | Article number S84 | ||||
DOI: | 10.1016/S1569-1993(14)60284-8 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Conference Paper Type: | Paper | ||||
Title of Event: | 37th European Cystic Fibrosis Conference | ||||
Type of Event: | Conference | ||||
Date(s) of Event: | 11-14 Jun 2014 |
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