Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis.
Current migratory movements require new strategies for rapidly tracking the transmission of high-risk imported Mycobacterium tuberculosis strains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR Beijing M. tuberculosis strains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis.
Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
Laura
L
Pérez-Lago
Unidad de Gestión de Biotecnología, Complejo Hospitalario Torrecárdenas, Almería, Spain.
Miguel
M
Martínez-Lirola
Unidad de Gestión de Biotecnología, Complejo Hospitalario Torrecárdenas, Almería, Spain.
Sergio
S
García
Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
Marta
M
Herranz
Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, Russia.
Igor
I
Mokrousov
Instituto de Biomedicina de Valencia, IBV-CSIC, Valencia, Spain.|CIBER Epidemiología y Salud Pública, CIBERESP, Spain.
Iñaki
I
Comas
Sequencing Service of FISABIO Public Health, Valencia, Spain.
Llúcia
L
Martínez-Priego
Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
Emilio
E
Bouza
Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain dgviedma2@gmail.com.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
Darío
D
García-de-Viedma
D000995:Antitubercular Agents / Q000627:therapeutic use*; D001483:Base Sequence; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics* / Q000635:transmission; D005260:Female; D016680:Genome, Bacterial / Q000235:genetics*; D063426:Human Migration; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects*; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D017422:Sequence Analysis, DNA; D060386:Sex Workers; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission*
D000995:Antitubercular Agents
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