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Bacteriology

Real-Time Genome Sequencing of Resistant Bacteria Provides Precision Infection Control in an Institutional Setting

Alexander Mellmann, Stefan Bletz, Thomas Böking, Frank Kipp, Karsten Becker, Anja Schultes, Karola Prior, Dag Harmsen
P. Bourbeau, Editor
Alexander Mellmann
aInstitute of Hygiene, University Hospital Muenster, Muenster, Germany
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Stefan Bletz
aInstitute of Hygiene, University Hospital Muenster, Muenster, Germany
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Thomas Böking
aInstitute of Hygiene, University Hospital Muenster, Muenster, Germany
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Frank Kipp
aInstitute of Hygiene, University Hospital Muenster, Muenster, Germany
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Karsten Becker
bInstitute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
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Anja Schultes
cDepartment of Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany
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Karola Prior
cDepartment of Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany
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Dag Harmsen
cDepartment of Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany
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P. Bourbeau
Roles: Editor
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DOI: 10.1128/JCM.00790-16
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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.

FOOTNOTES

    • Received 11 April 2016.
    • Returned for modification 8 May 2016.
    • Accepted 12 August 2016.
    • Accepted manuscript posted online 24 August 2016.
  • Supplemental material for this article may be found at http://dx.doi.org/10.1128/JCM.00790-16.

  • For a commentary on this article, see doi:10.1128/JCM.01714-16.

  • Copyright © 2016, American Society for Microbiology. All Rights Reserved.
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Real-Time Genome Sequencing of Resistant Bacteria Provides Precision Infection Control in an Institutional Setting
Alexander Mellmann, Stefan Bletz, Thomas Böking, Frank Kipp, Karsten Becker, Anja Schultes, Karola Prior, Dag Harmsen
Journal of Clinical Microbiology Nov 2016, 54 (12) 2874-2881; DOI: 10.1128/JCM.00790-16

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Real-Time Genome Sequencing of Resistant Bacteria Provides Precision Infection Control in an Institutional Setting
Alexander Mellmann, Stefan Bletz, Thomas Böking, Frank Kipp, Karsten Becker, Anja Schultes, Karola Prior, Dag Harmsen
Journal of Clinical Microbiology Nov 2016, 54 (12) 2874-2881; DOI: 10.1128/JCM.00790-16
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