Cartography of opportunistic pathogens and antibiotic resistance genes in a tertiary hospital environment

Nat Med. 2020 Jun;26(6):941-951. doi: 10.1038/s41591-020-0894-4. Epub 2020 Jun 8.

Abstract

Although disinfection is key to infection control, the colonization patterns and resistomes of hospital-environment microbes remain underexplored. We report the first extensive genomic characterization of microbiomes, pathogens and antibiotic resistance cassettes in a tertiary-care hospital, from repeated sampling (up to 1.5 years apart) of 179 sites associated with 45 beds. Deep shotgun metagenomics unveiled distinct ecological niches of microbes and antibiotic resistance genes characterized by biofilm-forming and human-microbiome-influenced environments with corresponding patterns of spatiotemporal divergence. Quasi-metagenomics with nanopore sequencing provided thousands of high-contiguity genomes, phage and plasmid sequences (>60% novel), enabling characterization of resistome and mobilome diversity and dynamic architectures in hospital environments. Phylogenetics identified multidrug-resistant strains as being widely distributed and stably colonizing across sites. Comparisons with clinical isolates indicated that such microbes can persist in hospitals for extended periods (>8 years), to opportunistically infect patients. These findings highlight the importance of characterizing antibiotic resistance reservoirs in hospitals and establish the feasibility of systematic surveys to target resources for preventing infections.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Beds / microbiology
  • Biofilms
  • Cross Infection / drug therapy
  • Cross Infection / microbiology*
  • Cross Infection / transmission
  • Disinfection
  • Drug Resistance, Bacterial / genetics*
  • Drug Resistance, Multiple, Bacterial / genetics
  • Equipment Contamination
  • Equipment and Supplies, Hospital / microbiology*
  • Geographic Mapping
  • Humans
  • Infection Control*
  • Metagenomics
  • Microbiota / genetics*
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / transmission
  • Patients' Rooms
  • Singapore
  • Spatio-Temporal Analysis
  • Tertiary Care Centers