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Title:	Analysis of a long-term outbreak of XDR Pseudomonas aeruginosa: a molecular epidemiological study
Author:	Willmann, Matthias; Bezdan, Daniela; Zapata Ortiz, Luis, 1985-; Susak, Hana; Vogel, Wichard; Schröppel, Klaus; Liese, Jan; Weidenmaier, Christopher; Autenrieth, Ingo B.; Ossowski, Stephan; Peter, Silke
Abstract:	OBJECTIVES: Here we report on a long-term outbreak from 2009 to 2012 with an XDR Pseudomonas aeruginosa on two wards at a university hospital in southern Germany. METHODS: Whole-genome sequencing was performed on the outbreak isolates and a core genome was constructed for molecular epidemiological analysis. We applied a time-place-sequence algorithm to improve estimation of transmission probabilities. RESULTS: By using conventional infection control methods we identified 49 P. aeruginosa strains, including eight environmental isolates that belonged to ST308 (by MLST) and carried the metallo-β-lactamase IMP-8. Phylogenetic analysis on the basis of a non-recombinant core genome that contained 22 outbreak-specific SNPs revealed a pattern of four dominant clades with a strong phylogeographic structure and allowed us to determine the potential temporal origin of the outbreak to July 2008, 1 year before the index case was diagnosed. Superspreaders at the root of clades exhibited a high number of probable and predicted transmissions, indicating their exceptional position in the outbreak. CONCLUSIONS: Our results suggest that the initial expansion of dominant sublineages was driven by a few superspreaders, while environmental contamination seemed to sustain the outbreak for a long period despite regular environmental control measures.
Abstract:	This work was supported by a grant from ‘la Caixa’ to L.Z.
Subject(s):	-Bacteris -Epidemiologia -IMP carbapenemase -Outbreak investigation -Transmission analysis -Whole-genome sequencing
Rights:	© Oxford University Press. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Journal of antimicrobial chemotherapy following peer review. The definitive publisher-authenticated version Willmann M, Bezdan D, Zapata L, Susak H, Vogel W, Schröppel K et al. Analysis of a long-term outbreak of XDR Pseudomonas aeruginosa: a molecular epidemiological study. Journal of antimicrobial chemotherapy. 2015; 70(5): 1322-1330. DOI 10.1093/jac/dku546 is available online at: http://jac.oxfordjournals.org/content/70/5/1322.long
Document type:	Article Article - Accepted version
Published by:	Oxford University Press
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