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Investigation on the transmission rate of carbapenemase-producing carbapenem-resistant Enterobacterales among exposed persons in a tertiary hospital using whole-genome sequencing

  • E. Chang
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • H.E. Chang
    Affiliations
    PHiCS Institute, Seoul, Republic of Korea
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  • I.S. Shin
    Affiliations
    PHiCS Institute, Seoul, Republic of Korea
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  • Y.R. Oh
    Affiliations
    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
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  • C.K. Kang
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
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  • P.G. Choe
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
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  • W.B. Park
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
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  • E.H. Choi
    Affiliations
    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea

    Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • M.D. Oh
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
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  • Author Footnotes
    † Joint senior authors.
    K.U. Park
    Correspondence
    Corresponding author. Address: Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
    Footnotes
    † Joint senior authors.
    Affiliations
    PHiCS Institute, Seoul, Republic of Korea

    Department of Laboratory Medicine, Seoul National University College of Medicine, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    † Joint senior authors.
    N.J. Kim
    Correspondence
    Corresponding author. Address: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
    Footnotes
    † Joint senior authors.
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    † Joint senior authors.
Published:March 17, 2022DOI:https://doi.org/10.1016/j.jhin.2022.03.005

      Summary

      Background

      To reduce transmission of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE), screening is recommended for patients sharing rooms with CP-CRE-detected patients and healthcare workers caring for them.

      Aim

      The aim of this study was to investigate the transmission rate of CP-CRE among exposed people in a tertiary hospital using whole-genome sequencing.

      Methods

      This study was conducted in a 1751-bed tertiary teaching hospital from January 2017 to December 2019. Index patients were defined as those with positive results in CP-CRE tests during hospitalization. When an index patient was detected in a shared room, we performed CRE screening tests for patients whose stay overlapped with an index patient's stay for at least one day. Where a second case was found, healthcare worker contacts were also screened. CP-CRE were confirmed, and the carbapenemase type identified, by PCR. Whole-genome sequencing was used to compare isolates from index and exposed patients.

      Results

      During the study period, 47 index patients were identified, and they had been in contact with 152 patients in shared rooms and 54 healthcare workers. None of the healthcare workers had CRE. Among the 152 exposed patients, four patients had the same type of carbapenemases as their CP-CRE index patients and all of them were KPC. Whole-genome sequencing revealed that three of these four pairs showed genotypic accordance between the index and the exposed.

      Conclusion

      The CP-CRE transmission rate among the exposed patients was calculated as 2.0% (= 3/152).

      Keywords

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