Background

Hospital outbreaks of antimicrobial-resistant (AMR) bacteria should be detected and controlled as early as possible.

Aim

To develop a framework for automatic detection of AMR outbreaks in hospitals.

Methods

Japan Nosocomial Infections Surveillance (JANIS) is one of the largest national AMR surveillance systems in the world. For this study, all bacterial data in the JANIS database were extracted between 2011 and 2016. WHONET, a free software for the management of microbiology data, and SaTScan, a free cluster detection tool embedded in WHONET, were used to analyse 2015–2016 data of eligible hospitals. Manual evaluation and validation of 10 representative hospitals around Japan were then performed using 2011–2016 data.

Findings

Data from 1031 hospitals were studied; mid-sized (200–499 beds) hospitals accounted for 60%, followed by large hospitals (≥500 beds; 24%) and small hospitals (<200 beds; 16%). More clusters were detected in large hospitals. Most of the clusters included five or fewer patients. From the in-depth analysis of 10 hospitals, ∼80% of the detected clusters were unrecognized by infection control staff because the bacterial species involved were not included in the priority pathogen list for routine surveillance. In two hospitals, clusters of more susceptible isolates were detected before outbreaks of more resistant pathogens.

Conclusion

WHONET-SaTScan can automatically detect clusters of epidemiologically related patients based on isolate resistance profiles beyond lists of high-priority AMR pathogens. If clusters of more susceptible isolates can be detected, it may allow early intervention in infection control practices before outbreaks of more resistant pathogens occur.

中文翻译：

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在日本自动检测抗菌素耐药性暴发的情况。

背景

应该尽早发现并控制医院爆发的抗菌素耐药性（AMR）细菌。

目的

建立自动检测医院中AMR暴发的框架。

方法

日本医院感染监测（JANIS）是世界上最大的国家AMR监测系统之一。对于本研究，在2011年至2016年之间提取了JANIS数据库中的所有细菌数据。使用WHONET（用于管理微生物数据的免费软件）和SaTScan（嵌入在WHONET中的免费簇检测工具）来分析2015-2016年数据符合条件的医院。然后使用2011-2016年数据对日本10家代表性医院进行了人工评估和验证。

发现

研究了来自1031家医院的数据。中型（200-499张床）医院占60％，其次是大型医院（≥500张床； 24％）和小型医院（<200张床； 16％）。在大型医院中发现了更多的簇。大多数集群包括五个或更少的患者。从对10家医院的深入分析中，感染控制人员未识别出约80％的检测出的簇，因为所涉及的细菌种类未包括在常规监测的优先病原体列表中。在两家医院中，在爆发更具抗药性的病原体之前，发现了更多易感菌株。

结论

WHONET-SaTScan可以根据高优先级AMR病原体列表之外的分离株耐药性谱自动检测与流行病学相关的患者群。如果可以检测到更多易感菌群，则可以在发生更具抗药性的病原体爆发之前，尽早干预感染控制措施。