基于宏基因组测序技术的ICU环境耐药菌传播特征

Transmission characteristics of drug-resistant bacteria in ICU environment based on metagenomic sequencing technology

    摘要
  • 摘要:
    目的 探讨宏基因组二代测序(mNGS)在三个重症监护室(ICU)环境耐药菌监测中的应用价值，揭示耐药菌传播特征，为优化感染控制提供依据。
    方法 选取某三级甲等综合性医院外科重症监护室(SICU)、急诊重症监护室(EICU)和脑科重症监护室(NICU)的物表及空气样本，结合常规细菌培养与mNGS技术，分析微生物群落、耐药基因和毒力因子分布，并通过系统发育树和冗余分析(RDA)探究传播路径。
    结果 培养结果显示，3个ICU物表均检出耐药菌，主要为携带OXA-23型碳青霉烯酶的不动杆菌、携带KPC型碳青霉烯酶的肠杆菌目细菌和假单胞菌。空气样本仅NICU检出耐药菌，主要为利奈唑胺耐药葡萄球菌。mNGS揭示环境中存在复杂细菌群落，其中NICU物表样本多样性最高，并检出与全球流行一致的IC2型鲍曼不动杆菌。RDA显示，不同ICU的物表与空气样本群落差异显著。耐药基因和毒力基因分析显示，SICU物表样本携带多种β-内酰胺酶基因及铁摄取相关毒力基因，NICU样本则富集鲍曼不动杆菌菌毛合成相关毒力基因；空气样本中仅NICU检出携带blaOXA、blaKPC和blaSHV的耐药菌。
    结论 mNGS可精准识别ICU环境耐药菌的分布特征及潜在传播关联，与常规培养形成互补。其应用有助于建立ICU环境耐药菌的主动监测体系，提高院感防控的精准性和时效性。

     

    Abstract:
    OBJECTIVE To explore the application value of metagenomic next-generation sequencing (mNGS) in monitoring drug-resistant bacteria in environment of 3 intensive care units(ICUs), reveal the transmission characteristics of drug-resistant bacteria and provide a basis for optimizing infection control.
    METHODS Object surface and air samples were selected from the surgical intensive care unit (SICU), emergency intensive care unit (EICU) and neurology intensive care unit (NICU) of a three-A general hospital. Combined with conventional culture and mNGS technology, the distribution of microbial communities, resistance genes and virulence factors were analyzed, and the transmission pathways were explored through phylogenetic tree and redundancy analysis (RDA).
    RESULTS The culture results showed that drug-resistant bacteria were detected on the object surfaces of 3 ICUs, mainly including Acinetobacter spp. carrying OXA-23 carbapenemase, Enterobacteriaceae carrying KPC carbapenemase and Pseudomonas spp.. Only NICU detected drug-resistant bacteria in the air samples, mainly linezolid-resistant Staphylococcus spp.. mNGS revealed the presence of complex bacterial communities in the environment, with object surface samples in NICU exhibiting the highest diversity and detecting IC2 type Acinetobacter baumannii consistent with global prevalence. RDA showed significant differences in the object surface and air sample communities across different ICUs. Analysis of resistance genes and virulence genes showed that object surface samples in SICU carried multiple β-lactamase genes and iron uptake related virulence genes, while samples in NICU were enriched with virulence genes related to the synthesis of A. baumannii pili. Only NICU detected drug-resistant bacteria carrying blaOXA, blaKPC and blaSHV in the air sample.
    CONCLUSIONS mNGS can accurately identify the distribution characteristics of drug resistance strains from ICU environment and their association with potential transmission, which is complementary to the conventional culture method. Its application helps establish an active monitoring system for drug-resistant bacteria in ICU environment, and improve the accuracy and timeliness of hospital-associated infection prevention and control.

     

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