PREreviews of “WGS-Enabled Surveillance Improves Detection Of Transmission Events Within A Large Tertiary Care Hospital Trust In London”

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WGS-Enabled Surveillance Improves Detection Of Transmission Events Within A Large Tertiary Care Hospital Trust In London

by Jonah Rodgus, Oskar Fraser-Krauss, Yalini Ravindra, Maria Getino, Ashleigh Myall, Chang Ho Yoon, Avishek Upadhya, Robert Peach, Sid Mookerjee, Alison Holmes, Elita Jauneikaite, Mauricio Barahona, and Frances Davies

Posted: March 30, 2026
Server: medRxiv
DOI: 10.64898/2026.03.24.26347804

Abstract

Infections caused by carbapenem-producing Enterobacterales (CPEs) are a persistent and growing threat in healthcare settings. Yet, current infection prevention and control (IPC) surveillance methods, which largely rely on the spatial and temporal proximity of patients, often misattribute or miss infection transmission events. Here, we develop and retrospectively evaluate an integrated methodology that combines analyses of ward-level patient movement data and whole-genome sequencing (WGS) data analyses, which provide measures of bacterial and plasmid similarity. Specifically, we evaluate this methodology across two datasets: a CPE outbreak of diverse carbapenem types (103 genomes, January 2021–March 2021) and an Imipenem-Hydrolysing β-lactamase-positive CPE outbreak (82 genomes, June 2016–October 2019), using standard clinical criteria and conservative genomic thresholds to quantify how often current IPC surveillance methods correctly identify genomically confirmed transmission events. Findings show that, across 3,423 patient contact–genome pairs, current IPC surveillance methods detected only 20.5% of genomically confirmed transmission events whilst maintaining 98.5% specificity, with missed events arising from temporal, spatial, and cross-species, mechanistic blindspots. In contrast, WGS-enabled IPC surveillance methods provided a 25–47-day earlier detection window and, in a linked economic evaluation, delivered annualised savings of up to £3.6 million, as well as a return on investment exceeding 2-fold in 7 of 8 cost scenarios. By operationalising high-throughput WGS data analysis with clinically relevant patient movement data, we evidence that it may be possible to disrupt and thereby mitigate the effects of AMR-driven CPE outbreaks, supporting investigations into the adoption of WGS-enabled IPC surveillance as a standard-of-care tool.

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PREreview by Rut Ruvalcaba Garcia

Authored by Rut Ruvalcaba Garcia

This study evaluates whether integrating whole-genome sequencing with patient movement data can improve the detection and characterization of outbreaks caused by carbapenem-producing Enterobacterales in hospital settings, compared to standard infection prevention and control surveillance. Using…

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PREreview by Jenelle Soo et al.

Authored by Jenelle Soo and 1 other author

Summary:

This study evaluates whether adding whole-genome sequencing (WGS) to routine infection prevention and control (IPC) surveillance improves the detection of carbapenem-producing Enterobacterales (CPE) transmission in a large hospital system in London. The authors combine patient movement…

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PREreviews of WGS-Enabled Surveillance Improves Detection Of Transmission Events Within A Large Tertiary Care Hospital Trust In London

2 PREreviews