Acquisition and Transmission of Carbapenemase-Producing (<i>bla</i>KPC-2) <i>Enterobacter cloacae</i> in a Highly Frequented Outpatient Clinic

Klein, Sabrina; Boutin, Sébastien; Späth, Isabel; Kimmich, Christoph; Brandt, Juliane; Müller‐Tidow, Carsten; Heeg, Klaus; Nurjadi, Dennis

doi:10.1093/cid/ciaa1734

Cited by 11 publications

(7 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For identification of such events, it is necessary to trace all contact points of patients to the healthcare system. For instance, transmission of CRGN via an outpatient clinic was reported ( Klein et al, 2021 ) and it is highly likely that a part of LT patients is under a shared medical supervision. Patients might have crossed at healthcare facilities, such as general practitioners, primary or secondary hospitals, or even nursing and rehabilitation facilities.…”

Section: Discussionmentioning

confidence: 99%

Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates

et al. 2021

View full text Add to dashboard Cite

Background: Carbapenem-resistant Gram-negative bacteria (CRGN) cause life-threatening infections due to limited antimicrobial treatment options. The occurrence of CRGN is often linked to hospitalization and antimicrobial treatment but remains incompletely understood. CRGN are common in patients with severe illness (e.g., liver transplantation patients). Using whole-genome sequencing (WGS), we aimed to elucidate the evolution of CRGN in this vulnerable cohort and to reconstruct potential transmission routes.Methods: From 351 patients evaluated for liver transplantation, 18 CRGN isolates (from 17 patients) were analyzed. Using WGS and bioinformatic analysis, genotypes and phylogenetic relationships were explored. Potential epidemiological links were assessed by analysis of patient charts.Results: Carbapenem-resistant (CR) Klebsiella pneumoniae (n=9) and CR Pseudomonas aeruginosa (n=7) were the predominating pathogens. In silico analysis revealed that 14/18 CRGN did not harbor carbapenemase-coding genes, whereas in 4/18 CRGN, carbapenemases (VIM-1, VIM-2, OXA-232, and OXA-72) were detected. Among all isolates, there was no evidence of plasmid transfer-mediated carbapenem resistance. A close phylogenetic relatedness was found for three K. pneumoniae isolates. Although no epidemiological context was comprehensible for the CRGN isolates, evidence was found that the isolates resulted of a transmission of a carbapenem-susceptible ancestor before individual radiation into CRGN.Conclusion: The integrative epidemiological study reveals a high diversity of CRGN in liver cirrhosis patients. Mutation of carbapenem-susceptible ancestors appears to be the dominant way of CR acquisition rather than in-hospital transmission of CRGN or carbapenemase-encoding genetic elements. This study underlines the need to avoid transmission of carbapenem-susceptible ancestors in vulnerable patient cohorts.

show abstract

Section: Discussionmentioning

confidence: 99%

Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates

et al. 2021

View full text Add to dashboard Cite

show abstract

“…DNA extraction, sequencing, and data analysis were performed on the Illumina MiSeq platform, as described elsewhere ( 5 ). Library preparation was conducted using the Illumina NEXTflex rapid DNA-seq library prep kit.…”

Section: Methodsmentioning

confidence: 99%

“… Enterobacter cloacae are commonly encountered as commensals of the gastrointestinal tract ( 4 ). However, in recent years, E. cloacae has gained attention and relevance as a nosocomial pathogen, frequently associated with hospital outbreaks ( 5 – 7 ). Nosocomial pathogens can spread via multiple routes within a hospital setting.…”

Section: Introductionmentioning

confidence: 99%

“…Nosocomial pathogens can spread via multiple routes within a hospital setting. Besides acquisition of infections and colonization via contaminated products or involving health care workers, the environmental reservoir has been linked to long-term transmission events and outbreaks in the hospital setting ( 5 , 8 – 11 ). In particular, water systems in health care facilities have been reported as a source of nosocomial infection, especially among immunocompromised patients in critical care units ( 10 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Colonised sink traps have shown to disperse bacteria and cause CPE colonisation or infection [ 23 – 25 ]. Also, toilet water has been found to be an environmental reservoir in several healthcare facilities from which various CPE species were transmitted [ 17 , 26 – 28 ], including in the burn unit of our own institution [ 29 ]. Wastewater collection pipes have been postulated as a possible route of spreading [ 23 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting

Hamerlinck,

Aerssens,

Boelens

et al. 2023

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

Background Accumulating evidence shows a role of the hospital wastewater system in the spread of multidrug-resistant organisms, such as carbapenemase producing Enterobacterales (CPE). Several sequential outbreaks of CPE on the geriatric ward of the Ghent University hospital have led to an outbreak investigation. Focusing on OXA-48 producing Citrobacter freundii, the most prevalent species, we aimed to track clonal relatedness using whole genome sequencing (WGS). By exploring transmission routes we wanted to improve understanding and (re)introduce targeted preventive measures. Methods Environmental screening (toilet water, sink and shower drains) was performed between 2017 and 2021. A retrospective selection was made of 53 Citrobacter freundii screening isolates (30 patients and 23 environmental samples). DNA from frozen bacterial isolates was extracted and prepped for shotgun WGS. Core genome multilocus sequence typing was performed with an in-house developed scheme using 3,004 loci. Results The CPE positivity rate of environmental screening samples was 19.0% (73/385). Highest percentages were found in the shower drain samples (38.2%) and the toilet water samples (25.0%). Sink drain samples showed least CPE positivity (3.3%). The WGS data revealed long-term co-existence of three patient sample derived C. freundii clusters. The biggest cluster (ST22) connects 12 patients and 8 environmental isolates taken between 2018 and 2021 spread across the ward. In an overlapping period, another cluster (ST170) links eight patients and four toilet water isolates connected to the same room. The third C. freundii cluster (ST421) connects two patients hospitalised in the same room but over a period of one and a half year. Additional sampling in 2022 revealed clonal isolates linked to the two largest clusters (ST22, ST170) in the wastewater collection pipes connecting the rooms. Conclusions Our findings suggest long-term circulation and transmission of carbapenemase producing C. freundii clones in hospital sanitary installations despite surveillance, daily cleaning and intermittent disinfection protocols. We propose a role for the wastewater drainage system in the spread within and between rooms and for the sanitary installations in the indirect transmission via bioaerosol plumes. To tackle this problem, a multidisciplinary approach is necessary including careful design and maintenance of the plumbing system.

show abstract

Acquisition and Transmission of Carbapenemase-Producing (blaKPC-2) Enterobacter cloacae in a Highly Frequented Outpatient Clinic

Cited by 11 publications

References 13 publications

Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates

Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting

Contact Info

Product

Resources

About