Defining nosocomial transmission of Escherichia coli and antimicrobial resistance genes: a genomic surveillance study
Catherine Ludden, Francesc Coll, Theodore Gouliouris, Olivier Restif, Beth Blane, Grace A. Blackwell, Narender Kumar, Plamena Naydenova, Charles Crawley, Nicholas M Brown, Julian Parkhill, Sharon J. Peacock
Abstract
BACKGROUND: and associated plasmids in a hospital setting. METHODS: positive blood samples from the two adult haematology wards. FINDINGS: bloodstream infection, four with identical strains to those in their stool; two of these had documented nosocomial acquisition. INTERPRETATION: We provide evidence of bacterial transmission and endogenous infection during routine care by integrating genomic and epidemiological data and by determining a genetic cutoff informed by within-host diversity in the studied population. Our findings challenge single colony-based investigations, and the widely accepted notion of plasmid spread. FUNDING: UK Department of Health, Wellcome Trust, UK National Institute for Health Research.