A Nosocomial Foodborne Outbreak of a VIM Carbapenemase-Expressing Citrobacter freundii

Pletz, Mathias W.; Wollny, Antje; Dobermann, Ute-Heike; Rödel, Jürgen; Neubauer, Svetlana; Stein, Christoph; Brandt, Christian; Hartung, Anita; Mellmann, Alexander; Trommer, Sabine; Edel, Birgit; Patchev, Vladimir K.; Makarewicz, Oliwia; Maschmann, Jens

doi:10.1093/cid/ciy034

Cited by 38 publications

(30 citation statements)

References 13 publications

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“…C. freundii is a recognized emerging opportunistic pathogen and has been implicated in gastroenteritis and foodborne outbreaks (Ifeadike et al, 2012 ; Settanni et al, 2013 ). A most recent foodborne outbreak reported in Germany was caused by a novel ST (Pletz et al, 2018 ). In this study, we examined 82 isolates of C. freundii obtained from 62 diarrheal patients from the majority of whom no other pathogens were isolated and also from 20 healthy individuals to assess the genetic diversity and antimicrobial resistance and in vitro virulence phenotypes.…”

Section: Discussionmentioning

confidence: 99%

Genetic Diversity, Multidrug Resistance, and Virulence of Citrobacter freundii From Diarrheal Patients and Healthy Individuals

Liu

Chen²,

Liu

et al. 2018

Front. Cell. Infect. Microbiol.

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Objectives: Citrobacter freundii is a frequent cause of nosocomial infections and a known cause of diarrheal infections, and has increasingly become multidrug resistant (MDR). In this study, we aimed to determine the genetic diversity, the antimicrobial resistance profiles and in vitro virulence properties of C. freundii from diarrheal patients and healthy individuals.Methods: 82 C. freundii isolates were obtained from human diarrheal outpatients and healthy individuals. Multilocus Sequence Typing (MLST) of seven housekeeping genes was performed. Antimicrobial susceptibility testing was carried out using the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Adhesion and cytotoxicity to HEp-2 cells were assessed. PCR and sequencing were used to identify blaCTX−M, blaSHV, blaTEM, qnrA, qnrB, qnrS, qnrC, qnrD, aac(6')-Ib-cr, and qepA genes.Results: The 82 C. freundii isolates were divided into 76 sequence types (STs) with 65 STs being novel, displaying high genetic diversity. Phylogenetic analysis divided the 82 isolates into 5 clusters. All 82 isolates were sensitive to imipenem (IPM), but resistant to one or more other 16 antibiotics tested. Twenty-six isolates (31.7%) were multidrug resistant to three or more antibiotic classes out of the 10 distinct antibiotic classes tested. Five MDR isolates, all of which were isolated from 2014, harbored one or more of the resistance genes, blaTEM−1, blaCTX−M−9, aac(6')-Ib-cr, qnrS1, qnrB9, and qnrB13. All 11 qnrB-carrying C. freundii isolates belonged to cluster 1, and one C. freundii isolate carried a new qnrB gene (qnrB92). Six isolates showed strong cytotoxicity to HEp-2 cells, one of which was multidrug resistant.Conclusions: C. freundii isolates from human diarrheal outpatients and healthy individuals were diverse with variation in sequence types, antibiotic resistance profiles and virulence properties.

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Section: Discussionmentioning

confidence: 99%

Genetic Diversity, Multidrug Resistance, and Virulence of Citrobacter freundii From Diarrheal Patients and Healthy Individuals

Liu

Chen²,

Liu

et al. 2018

Front. Cell. Infect. Microbiol.

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“…C. freundii causes a broad spectrum of infections as an opportunistic pathogen, including infections of the urinary tract, respiratory tract, wounds, and bloodstream. Limited outbreaks involving clonal drug-resistant isolates have also been observed in healthcare settings 14 – 16 . In surveys from multiple North American healthcare facilities, 3–6% of Enterobacteriaceae infections were attributed to the Citrobacter genus 17 , 18 .…”

Section: Introductionmentioning

confidence: 99%

Citrobacter freundii fitness during bloodstream infection

Anderson

Mitchell

Zhao

et al. 2018

Sci Rep

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Sepsis resulting from microbial colonization of the bloodstream is a serious health concern associated with high mortality rates. The objective of this study was to define the physiologic requirements of Citrobacter freundii in the bloodstream as a model for bacteremia caused by opportunistic Gram-negative pathogens. A genetic screen in a murine host identified 177 genes that contributed significantly to fitness, the majority of which were broadly classified as having metabolic or cellular maintenance functions. Among the pathways examined, the Tat protein secretion system conferred the single largest fitness contribution during competition infections and a putative Tat-secreted protein, SufI, was also identified as a fitness factor. Additional work was focused on identifying relevant metabolic pathways for bacteria in the bloodstream environment. Mutations that eliminated the use of glucose or mannitol as carbon sources in vitro resulted in loss of fitness in the murine model and similar results were obtained upon disruption of the cysteine biosynthetic pathway. Finally, the conservation of identified fitness factors was compared within a cohort of Citrobacter bloodstream isolates and between Citrobacter and Serratia marcescens, the results of which suggest the presence of conserved strategies for bacterial survival and replication in the bloodstream environment.

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“…[7]. Beispiele: Norovirus in der Geriatrie [8], Scabies norvegica auf Normalstation [9], MRGN P. aeruginosa auf Intensivstation [10], MRGN krankenhausweit [11] FALLBEISPIEL Was bedeutet eigentlich Ausbruch?…”

Section: Merkeunclassified

“…Wiederholtes Testen von vorgeschnittenem Gemüse zeigte einen hohen Grad an Kontamination mit C. freundii, was auf eine mögliche Quelle hinweist.Dieser Ausbruch zeigt, dass ein explosionsartiger Anstieg mit multiresistenten Erregern auch durch eine Lebensmittelquelle verursacht werden kann. Der Ausbruch unterstreicht auch die Bedeutung einer angemessenen Kühlung, des Transports, der Wiedererwärmung und der Verteilung von Mahlzeiten im Krankenhaus[11].GrundlagenBegriffsbestimmungHier zunächst ein paar Begriffe, die zur Ausbruchsbeschreibung notwendig sind. ▪ Kolonisation: Besiedlung des Körpers mit Mikroorganismen ohne klinische Zeichen einer Infektion sowie meist ohne Auslösung einer Immunantwort.…”

unclassified

Ausbrüche infektiöser Erkrankungen im Krankenhaus – ein Ratgeber

Leistner¹

2018

Krankenh.hyg. up2date

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A Nosocomial Foodborne Outbreak of a VIM Carbapenemase-Expressing Citrobacter freundii

Cited by 38 publications

References 13 publications

Genetic Diversity, Multidrug Resistance, and Virulence of Citrobacter freundii From Diarrheal Patients and Healthy Individuals

Genetic Diversity, Multidrug Resistance, and Virulence of Citrobacter freundii From Diarrheal Patients and Healthy Individuals

Citrobacter freundii fitness during bloodstream infection

Ausbrüche infektiöser Erkrankungen im Krankenhaus – ein Ratgeber

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