Investigators in the Center for Clinical and Translational Metagenomics in the BWH Department of Pathology have developed rapid genomic methods to analyze multi-drug resistant pathogens cultured from patients. Their paper, appearing in mBio, highlights the usefulness of prospective genomic surveillance for multi-drug resistant bacterial strains, particularly for carbapenem-resistant Enterobacterieaceae (CRE), which are gram-negative bacteria that are nearly resistant to the carbapenem class of antibiotics that are considered the “drug of last resort” for such infections, and are an urgent and growing international health concern.
To enhance current surveillance techniques for detecting CRE, the research team prospectively monitored strains cultured in BWH’s Clinical Microbiology lab for carbapenem resistance, and then performed genomic analyses. They identified the resistance genes and their genomic context, namely whether the genes were found on bacterial chromosomes or carried in transposons and/or plasmids. This contextual information allowed the team to develop a hospital-specific “mobilome,” capturing the diversity of mobile elements that spread drug resistance.
The authors further discovered that the majority of CRE strains entered the hospital from external sources, rather than arising and then spreading from within. The team has continued work with Infection Control to develop timely reporting for resistant strains, and is also working with the Pathology departments at MGH, Newton-Wellesley and Faulkner hospitals to support inter-institutional monitoring.
“Our study emphasizes the need for active monitoring of drug resistance across institutions,” said said Lynn Bry, MD, PhD, director of the center and senior study author. “The findings have ready application to aid ongoing surveillance efforts both within and across healthcare institutions.”