Outbreak of multidrug-resistant CTX-M-15-producing Enterobacter cloacae in a neonatal intensive care unit

Oteo, Jesús; Cercenado, Emilia; Vindel, Ana; Bautista, Verónica; Fernández-Romero, Sara; Sáez, David; Padilla, Belén; Zamora, Elena; Campos, José

doi:10.1099/jmm.0.053017-0

Cited by 22 publications

(16 citation statements)

References 12 publications

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“…Occurrence of the qnrB and aac(6 )-Ib-cr genes in enterobacterial isolates producing OXA-48 or ESBLs, including some of the CTX-M-15-producing E. cloacae isolates causing the outbreak in a neonatal unit in Spain, was previously noticed [12].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, one of the clone 2 isolates was apparently transferred from another hospital located in a nearby region of Spain, so in addition to intrahospital dissemination, interhospital spread is contributing to the emergence of CTX-M-15-producing E. cloacae in HUCA. Additional outbreaks of E. cloacae producing CTX-M-15 have occurred in a newborn ICU in Spain as well as in a children's hospital in Finland [12,13].…”

Section: Discussionmentioning

confidence: 99%

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Dissemination of multiresistant Enterobacter cloacae isolates producing OXA-48 and CTX-M-15 in a Spanish hospital

Fernández

Montero

Martinez

et al. 2015

International Journal of Antimicrobial Agents

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Twenty-one multiresistant Enterobacter cloacae isolates producing OXA-48 (n = 10), CTX-M-15 (n = 7) or both (n = 4) ␤-lactamases were detected in a Spanish hospital during a 1-year period (June 2013 to June 2014). The isolates were also resistant to non-␤-lactam antimicrobials, further complicating the therapeutic options. Genotyping of the isolates identified two major clones (ST74 and ST66) that caused prolonged outbreaks in different buildings of the hospital as well as some sporadic isolates (ST78, ST45 and ST295). Isolates belonging to clone 1 (n = 7) were carbapenem-resistant and carried the bla OXA-48 gene on a conjugative IncL/M plasmid of ca. 65 kb. Clone 2 isolates (n = 11) were resistant to cefepime and harboured the bla CTX-M-15 gene on an ca. 150-kb, non-conjugative plasmid of the IncF group, co-harbouring the qnrB and aac(6 )-Ib-cr genes encoding quinolone resistance. Four clone 2 isolates were also resistant to carbapenems owing to the co-production of OXA-48. Most of the isolates were recovered from critically ill patients and were admitted to intensive care units; a single patient was transferred from another Spanish hospital. Intrahospital and interhospital dissemination of multiresistant E. cloacae isolates is of major clinical concern as it could lead to endemic nosocomial situations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dissemination of multiresistant Enterobacter cloacae isolates producing OXA-48 and CTX-M-15 in a Spanish hospital

Fernández

Montero

Martinez

et al. 2015

International Journal of Antimicrobial Agents

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“…Bei drei der hier referierten Ausbrüche durch Klebsiella pneumoniae handelte es sich um ein CTX-M-15 bildendes Isolat [28][29][30]. Solche β-Laktamasen mit erweitertem Wirkspektrum werden in den letzten Jahren zunehmend bei Enterobacteriaceae, insbesondere auch bei E. coli im ambulanten Setting (Harnwegsinfektionen) gefunden [53,54].…”

Section: Ausbruchsuntersuchung Und Maßnahmen Zur Ausbruchskontrolleunclassified

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

Kraus-Haas

Mielke

Simon

2015

Bundesgesundheitsbl.

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Häufungen von Infektionen mit einem (vermeintlich) einheitlichen Erreger in neonatologischen Intensivpflegestationen (NICUs) sind unerwünschte Ereignisse, durch die die Sicherheit der Patienten und ein günstiger Ausgang der Intensivtherapie gefährdet wird [1]. Mitunter sterben die Kinder an unmittelbaren Komplikationen bzw. langfristigen Folgen dieser "Late-onset"-Infektionen oder ihre psychomotorischen und mentalen Entwicklungsoptionen werden durch diese Ereignisse nachhaltig beeinträchtigt [2]. Ausbrüche bedingen zudem erhebliche Mehrbelastungen des Behandlungsteams (zu dem wir auch das Hygienefachpersonal zählen) [3] und können zur vorüber-gehenden oder dauerhaften Schließung einer Abteilung führen [4][5][6][7][8]. Aufgrund der besonderen Infektionsgefährdung der Patienten, der strukturell-organisatorischen Besonderheiten der Intensivtherapie in NICUs, des initial sehr uncharakteristischen klinischen Bildes und aufgrund des speziellen Erregerspektrums (z. B. Serratia marcescens) müssen Ausbrüche auf NICUs separat von anderen Ausbrüchen betrachtet werden [1].Die

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“…As they were previously-shown, that orthopedic surgical site infections are often associated with substantial morbidity and exorbitant costs, and are challenging to treat, especially in case of multi-resistant pathogens or presence of implants (Martinez-Pastor et al, 2010). Additionally, many studies in Intensive care units have established risk factors for the acquisition of infection due to ESBL producing E. coli and even to other bacterial species (Oteo et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and molecular typing of extended-spectrum -lactamases in Escherichia coli, Enterobacter cloacae and Citrobacter freundii isolates from Laghouat Hospital, Algeria

Lagha¹,

Hassaïne²,

Robin³

et al. 2016

Afr. J. Microbiol. Res.

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The antibiotic resistance of enterobacteriacae knows a worldwide worrying evolution with an increase of the extended-spectrum β-lactamases. The present study was to determine the prevalence and molecular typing of extended-spectrum β-lactamases (ESBLs) in clinical isolates of Escherichia coli, Enterobacter cloacae, and Citrobacter freundii, isolated between January 2010 and December 2012, at the Laghouat "Ahemida Ben Adjila" hospital, Algeria. Antimicrobial susceptibility testing was determined by disk diffusion on Mueller Hinton agar. Genetic transfers were performed by conjugation and plasmid DNA was extracted by the alcalin-lysis method. The characterization of ESBL genes were examined using PCR amplification and DNA sequencing and the clonal relatedness was investigated by ERIC-PCR. During the study period, twenty-one (8.23%) isolates were found to produce ESBLs, distributed as follows: 13 isolates of E. coli (61.9%), 6 isolates of E. cloacae (28.57%) and 2 isolates of C. freundii with 9.52 %. The CTX-M-15 ESBL were predominant (95.24%), followed by TEM-4 (14.28%) and SHV-12 (4.76%). ERIC-PCR analysis showed that the isolates are genetically unrelated and conjugation experiments showed that bla CTX-M-15 gene was transferred on a conjugative plasmid of high molecular weight (≈130 kb). This study indicated a high prevalence of CTX-M-15 enzymes among E. coli, E. cloacae and C. freundii in Laghouat hospital, Algeria.

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Outbreak of multidrug-resistant CTX-M-15-producing Enterobacter cloacae in a neonatal intensive care unit

Cited by 22 publications

References 12 publications

Dissemination of multiresistant Enterobacter cloacae isolates producing OXA-48 and CTX-M-15 in a Spanish hospital

Dissemination of multiresistant Enterobacter cloacae isolates producing OXA-48 and CTX-M-15 in a Spanish hospital

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

Prevalence and molecular typing of extended-spectrum -lactamases in Escherichia coli, Enterobacter cloacae and Citrobacter freundii isolates from Laghouat Hospital, Algeria

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