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Cross-transmission is not the source of new Mycobacterium abscessus infections in a multi-centre cohort of cystic fibrosis patients

Doyle, RM; Rubio, M; Dixon, G; Hartley, J; Klein, N; Coll, P; Harris, KA; (2019) Cross-transmission is not the source of new Mycobacterium abscessus infections in a multi-centre cohort of cystic fibrosis patients. Clinical Infectious Diseases 10.1093/cid/ciz526. (In press). Green open access

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Abstract

BACKGROUND: 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 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 investigate whether WGS can reliably identify cross-transmission in M. abscessus. METHODS: We retrospectively sequenced the whole genomes of 145 M. abscessus isolates from 62 patients seen at four hospitals in two countries over 16 years. RESULTS: We have shown that a comparison of a fixed number of core single nucleotide variants (SNVs) alone cannot be used to infer cross-transmission in M. abscessus but does provide enough information to replace multiple existing molecular assays. We detected one 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. CONCLUSIONS: This novel analysis has demonstrated that the majority of patients in this study have not acquired M. abscessus through direct patient-patient transmission or a common reservoir. Tracking transmission using WGS will only realise its full potential with proper environmental screening as well as patient sampling.

Type: Article
Title: Cross-transmission is not the source of new Mycobacterium abscessus infections in a multi-centre cohort of cystic fibrosis patients
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/cid/ciz526
Publisher version: https://doi.org/10.1093/cid/ciz526
Language: English
Additional information: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).
Keywords: Nontuberculous mycobacteria, cystic fibrosis, phylogenomics, transmission, whole-genome sequencing
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10077194
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