Cross-transmission Is Not the Source of New Mycobacterium abscessus Infections in a Multicenter Cohort of Cystic Fibrosis Patients
Doyle, Ronan M. (National Institute for Health Research)
Rubio, Marc (Universitat Autònoma de Barcelona. Departament de Genètica i de Microbiologia)
Dixon, Garth (National Institute for Health Research)
Hartley, John (National Institute for Health Research)
Klein, Nigel (University College London)
Coll Figa, Pedro (Universitat Autònoma de Barcelona. Departament de Genètica i de Microbiologia)
Harris, Kathryn A. (National Institute for Health Research)

Data:	2019
Resum:	Mycobacterium abscessus is an extensively drug-resistant pathogen that causes pulmonary disease, particularly in cystic fibrosis (CF) patients. Identifying direct patient-to-patient transmission of M. abscessus is critically important in directing an infection control policy for the management of risk in CF patients. A variety of clinical labs have used molecular epidemiology to investigate transmission. However, there is still conflicting evidence as to how M. abscessus is acquired and whether cross-transmission occurs. Recently, labs have applied whole-genome sequencing (WGS) to investigate this further and, in this study, we investigated whether WGS can reliably identify cross-transmission in M. abscessus. We retrospectively sequenced the whole genomes of 145 M. abscessus isolates from 62 patients, seen at 4 hospitals in 2 countries over 16 years. We have shown that a comparison of a fixed number of core single nucleotide variants alone cannot be used to infer cross-transmission in M. abscessus but does provide enough information to replace multiple existing molecular assays. We detected 1 episode of possible direct patient-to-patient transmission in a sibling pair. We found that patients acquired unique M. abscessus strains even after spending considerable time on the same wards with other M. abscessus- positive patients. This novel analysis has demonstrated that the majority of patients in this study have not acquired M. abscessus through direct patient-to-patient transmission or a common reservoir. Tracking transmission using WGS will only realize its full potential with proper environmental screening, as well as patient sampling. Whole-genome sequencing should replace the current molecular typing used routinely in clinical microbiology laboratories. The patient-to-patient spread of Mycobacterium abscessus is not common. Environmental screening may provide a better understanding of the acquisition of M. abscessus infections.
Nota:	M.R. va rebre un ajut del National Institute for Health Research (European Molecular Biology Organization ShortTerm Fellowship 7307).
Nota:	R.M.D. va rebre un ajut del European Association of National Metrology Institutes (grant number 15HLT07).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Nontuberculous mycobacteria ; Whole-genome sequencing ; Transmission ; Cystic fibrosis ; Phylogenomics
Publicat a:	Clinical Infectious Diseases, Vol. 70, Issue 9 (May 2019) , p. 1855-1864, ISSN 1537-6591

DOI: 10.1093/cid/ciz526
PMID: 31225586

10 p, 10.2 MB

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