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Whole-Genome Sequencing to Determine Origin of Multinational Outbreak of Sarocladium kiliense Bloodstream Infections
Authors:Kizee A. Etienne  Chandler C. Roe  Rachel M. Smith  Snigdha Vallabhaneni  Carolina Duarte  Patricia Escandón  Elizabeth Casta?eda  Beatriz L. Gómez  Catalina de Bedout  Luisa F. López  Valentina Salas  Luz Maria Hederra  Jorge Fernández  Paola Pidal  Juan Carlos Hormazabel  Fernando Otaíza-O’Ryan  Fredrik O. Vannberg  John Gillece  Darrin Lemmer  Elizabeth M. Driebe  David M. Engelthaler  Anastasia P. Litvintseva
Abstract:We used whole-genome sequence typing (WGST) to investigate an outbreak of Sarocladium kiliense bloodstream infections (BSI) associated with receipt of contaminated antinausea medication among oncology patients in Colombia and Chile during 2013–2014. Twenty-five outbreak isolates (18 from patients and 7 from medication vials) and 11 control isolates unrelated to this outbreak were subjected to WGST to elucidate a source of infection. All outbreak isolates were nearly indistinguishable (<5 single-nucleotide polymorphisms), and >21,000 single-nucleotide polymorphisms were identified from unrelated control isolates, suggesting a point source for this outbreak. S. kiliense has been previously implicated in healthcare-related infections; however, the lack of available typing methods has precluded the ability to substantiate point sources. WGST for outbreak investigation caused by eukaryotic pathogens without reference genomes or existing genotyping methods enables accurate source identification to guide implementation of appropriate control and prevention measures.
Keywords:fungal outbreaks   epidemiology   whole-genome sequencing   fungi   Latin America   bloodstream infections   Chile   Colombia
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