Polyclonal Outbreak of KPC-3-Producing Enterobacter cloacae at a Single Hospital in Montréal, Québec, Canada

Haraoui, Louis-Patrick; Lévesque, Simon; Lefebvre, Brigitte; Blanchette, Ruth; Tomkinson, Melissa; Mataseje, Laura; Mulvey, Michael R.; Miller, Mark A.

doi:10.1128/jcm.02480-12

Cited by 19 publications

(20 citation statements)

References 8 publications

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“…have been described in North America, 18 but no plasmid-borne carbapenemases (or cephalosporinases) were detected in the Enterobacter isolates in this study. The positive MHT results in these isolates suggest the production of beta-lactam-hydrolyzing enzymes, such as de-repressed chromosomal AmpC determinants or constitutively expressed plasmid-borne enzymes that were not captured by our panel.…”

Section: Discussioncontrasting

confidence: 67%

Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Pannaraj¹,

Bard²,

Cerini

et al. 2015

Pediatric Infectious Disease Journal

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Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are on the rise worldwide but are not well described in pediatric populations. This study characterizes the clinical, phenotypic and genotypic characteristics of CRE infections at a free-standing US children's hospital. Methods CRE were defined as any clinical Enterobacteriaceae isolate non-susceptible to either imipenem or meropenem and resistant to ceftriaxone, cefotaxime and ceftazidime determined by routine antimicrobial susceptibility testing. The modified Hodge test was performed to screen for the production of carbapenemase. Clinical data were reviewed, and molecular characterization of phylogenetic and resistance-associated traits was performed. Results CRE isolates were recovered from sterile and non-sterile sites in 10 patients, 6 weeks to 24 years of age, between 2011 and 2013. Comorbidities included hematologic, genetic and urologic abnormalities. Two patients had traveled abroad (India, Lebanon) before CRE recovery. Carbapenemase determinants were detected in 5 cases, including KPC-3 in 2 Klebsiella pneumoniae (ST258 and ST18) and 1 Escherichia coli (ST131), and NDM-1 in 1 K. pneumoniae (ST37) and 1 E. coli (ST101) isolate. Additional resistance determinants were detected, including CTX-M-15, SHV-11, TEM-1, CMY-2, CMY-4 and CMY-42. Four patients died, including 2 of 3 patients with CRE bacteremia. There was no evidence of epidemiologic or molecular relatedness between any 2 cases. Conclusions This report documents the appearance of highly resistant Gram-negative pathogens in a vulnerable patient population at a pediatric tertiary referral center in a major US metropolitan area. Detailed understanding of the distribution and spread of CRE is essential for the timely detection and containment of these perilous pathogens.

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Section: Discussioncontrasting

confidence: 67%

Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Pannaraj¹,

Bard²,

Cerini

et al. 2015

Pediatric Infectious Disease Journal

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“…This work demonstrated that plasmid transfer between unrelated strains and species of bacteria within a hospital might be further contributing to the dissemination of CP-CRE (3). Other reports of the apparent in vivo transfer of plasmids exist (19), with evidence of plasmid-mediated transfer of bla between E. cloacae isolates in a health care setting (20).…”

supporting

confidence: 50%

Clonal Dissemination of Enterobacter cloacae Harboring bla _KPC-3 in the Upper Midwestern United States

Hargreaves

Shaw

Dobbins

et al. 2015

Antimicrob Agents Chemother

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Carbapenemase-producing, carbapenem-resistantEnterobacteriaceae, or CP-CRE, are an emerging threat to human and animal health, because they are resistant to many of the last-line antimicrobials available for disease treatment. Carbapenemase-producingEnterobacter cloacaeharboringblaKPC-3recently was reported in the upper midwestern United States and implicated in a hospital outbreak in Fargo, North Dakota (L. M. Kiedrowski, D. M. Guerrero, F. Perez, R. A. Viau, L. J. Rojas, M. F. Mojica, S. D. Rudin, A. M. Hujer, S. H. Marshall, and R. A. Bonomo, Emerg Infect Dis 20:1583–1585, 2014,http://dx.doi.org/10.3201/eid2009.140344). In early 2009, the Minnesota Department of Health began collecting and screening CP-CRE from patients throughout Minnesota. Here, we analyzed a retrospective group of CP-E. cloacaeisolates (n= 34) collected between 2009 and 2013. Whole-genome sequencing and analysis revealed that 32 of the strains were clonal, belonging to the ST171 clonal complex and differing collectively by 211 single-nucleotide polymorphisms, and it revealed a dynamic clone under positive selection. The phylogeography of these strains suggests that this clone existed in eastern North Dakota and western Minnesota prior to 2009 and subsequently was identified in the Minneapolis and St. Paul metropolitan area. All strains harbored identical IncFIA-like plasmids conferring a CP-CRE phenotype and an additional IncX3 plasmid. In a single patient with multiple isolates submitted over several months, we found evidence that these plasmids had transferred from theE. cloacaeclone to anEscherichia coliST131 bacterium, rendering it as a CP-CRE. The spread of this clone throughout the upper midwestern United States is unprecedented forE. cloacaeand highlights the importance of continued surveillance to identify such threats to human health.

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“…Since its initial identification, sporadic cases with KPC-harboring Enterobacter spp. have been described and several outbreaks have been reported worldwide (10–15). According to two surveillance studies (in 2006 and 2009), a total of 758 KPC-positive Gram-negative isolates were collected, revealing that Enterobacter spp.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Genome Analysis of Carbapenemase-Producing Enterobacter spp.: New Insights into Phylogeny, Population Structure, and Resistance Mechanisms

Chavda

Chen

Fouts

et al. 2016

mBio

167

159

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Knowledge regarding the genomic structure of Enterobacter spp., the second most prevalent carbapenemase-producing Enterobacteriaceae, remains limited. Here we sequenced 97 clinical Enterobacter species isolates that were both carbapenem susceptible and resistant from various geographic regions to decipher the molecular origins of carbapenem resistance and to understand the changing phylogeny of these emerging and drug-resistant pathogens. Of the carbapenem-resistant isolates, 30 possessed blaKPC-2, 40 had blaKPC-3, 2 had blaKPC-4, and 2 had blaNDM-1. Twenty-three isolates were carbapenem susceptible. Six genomes were sequenced to completion, and their sizes ranged from 4.6 to 5.1 Mbp. Phylogenomic analysis placed 96 of these genomes, 351 additional Enterobacter genomes downloaded from NCBI GenBank, and six newly sequenced type strains into 19 phylogenomic groups—18 groups (A to R) in the Enterobacter cloacae complex and Enterobacter aerogenes. Diverse mechanisms underlying the molecular evolutionary trajectory of these drug-resistant Enterobacter spp. were revealed, including the acquisition of an antibiotic resistance plasmid, followed by clonal spread, horizontal transfer of blaKPC-harboring plasmids between different phylogenomic groups, and repeated transposition of the blaKPC gene among different plasmid backbones. Group A, which comprises multilocus sequence type 171 (ST171), was the most commonly identified (23% of isolates). Genomic analysis showed that ST171 isolates evolved from a common ancestor and formed two different major clusters; each acquiring unique blaKPC-harboring plasmids, followed by clonal expansion. The data presented here represent the first comprehensive study of phylogenomic interrogation and the relationship between antibiotic resistance and plasmid discrimination among carbapenem-resistant Enterobacter spp., demonstrating the genetic diversity and complexity of the molecular mechanisms driving antibiotic resistance in this genus.

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Polyclonal Outbreak of KPC-3-Producing Enterobacter cloacae at a Single Hospital in Montréal, Québec, Canada

Cited by 19 publications

References 8 publications

Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Clonal Dissemination of Enterobacter cloacae Harboring bla _KPC-3 in the Upper Midwestern United States

Comprehensive Genome Analysis of Carbapenemase-Producing Enterobacter spp.: New Insights into Phylogeny, Population Structure, and Resistance Mechanisms

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Polyclonal Outbreak of KPC-3-Producing Enterobacter cloacae at a Single Hospital in Montréal, Québec, Canada

Cited by 19 publications

References 8 publications

Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Clonal Dissemination of Enterobacter cloacae Harboring bla KPC-3 in the Upper Midwestern United States

Comprehensive Genome Analysis of Carbapenemase-Producing Enterobacter spp.: New Insights into Phylogeny, Population Structure, and Resistance Mechanisms

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Clonal Dissemination of Enterobacter cloacae Harboring bla _KPC-3 in the Upper Midwestern United States