Real-time genome sequencing of resistant bacteria provides precision infection control in an institutional setting

Mellmann A., Bletz S., Böking T., Kipp F., Becker K., Schultes A., Prior K., Harmsen D.

Research article (journal) | Peer reviewed

Abstract

The increasing prevalence of multidrug-resistant (MDR) bacteria is a serious global challenge. Here, we studied prospectively whether bacterial whole-genome sequencing (WGS) for real-time MDR surveillance is technical feasible, returns actionable results, and is cost-beneficial. WGS was applied to all MDR isolates of four species (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus faecium, MDR Escherichia coli, and MDR Pseudomonas aeruginosa) at the University Hospital Muenster, Muenster, Germany, a tertiary care hospital with 1,450 beds, during two 6-month intervals. Turnaround times (TAT) were measured, and total costs for sequencing per isolate were calculated. After cancelling prior policies of preemptive isolation of patients harboring certain Gram-negative MDR bacteria in risk areas, the second interval was conducted. During interval I, 645 bacterial isolates were sequenced. From culture, TATs ranged from 4.4 to 5.3 days, and costs were €202.49 per isolate. During interval II, 550 bacterial isolates were sequenced. Hospital-wide transmission rates of the two most common species (MRSA and MDR E. Coli) were low during interval I (5.8% and 2.3%, respectively) and interval II (4.3% and 5.0%, respectively). Cancellation of isolation of patients infected with non-pan-resistant MDR E. Coli in risk wards did not increase transmission. Comparing sequencing costs with avoided costs mostly due to fewer blocked beds during interval II, we saved in excess of €200,000. Real-time microbial WGS in our institution was feasible, produced precise actionable results, helped us to monitor transmission rates that remained low following a modification in isolation procedures, and ultimately saved costs.

Details about the publication

JournalJournal of Clinical Microbiology (J Clin Microbiol)
Volume54
Issue12
Page range2874-2881
StatusPublished
Release year2016
Language in which the publication is writtenEnglish
DOI10.1128/JCM.01714-16
Link to the full texthttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84997719769&origin=inward

Authors from the University of Münster

Becker, Karsten
Institute of Medical Microbiology
Bletz, Stefan
Institute of Hygiene
Mellmann, Alexander
Institute of Hygiene
Prior, Karola
Department of Periodontology