Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors

Herrera, Sabina; Torralbo, B.; Herranz, S.; Bernal-Maurandi, J.; Rubio, Elisa; Pitart, Cristina; Fortes, I.; Valls, S.; Rodriguez, Lauren; Santana, Gemina; Bodro, Marta; García-Vidal, Carolina; Hernández‐Meneses, Marta; Puerta, Pedro; Morata, Laura; Villella, A.; Bertran, M. J.; Brey, M.; Soriano, Alejandro; Rı́o, Ana del; Martínez, José Antonio

doi:10.1007/s10096-023-04581-1

Cited by 6 publications

(1 citation statement)

References 29 publications

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“…Remarkably, we collected many recurrent isolates months or years from the index isolate collection date () with minimal pairwise SNP differences (i.e. <10 SNPs), suggesting the long duration of colonization achievable by 3GC-R K. pneumoniae [68]. We envision that a strategy of targeted K. pneumoniae gastrointestinal tract decolonization, such as using CRISPR-based technologies, could be part of the future treatment of 3GC-R K. pneumoniae infections [69].…”

Section: Discussionmentioning

confidence: 99%

Identification of a novel CG307 sub-clade in third-generation-cephalosporin-resistant Klebsiella pneumoniae causing invasive infections in the USA

Selvaraj Anand,

Wu,

Bremer

et al. 2024

Microbial Genomics

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Despite the notable clinical impact, recent molecular epidemiology regarding third-generation-cephalosporin-resistant (3GC-R) Klebsiella pneumoniae in the USA remains limited. We performed whole-genome sequencing of 3GC-R K. pneumoniae bacteraemia isolates collected from March 2016 to May 2022 at a tertiary care cancer centre in Houston, TX, USA, using Illumina and Oxford Nanopore Technologies platforms. A comprehensive comparative genomic analysis was performed to dissect population structure, transmission dynamics and pan-genomic signatures of our 3GC-R K. pneumoniae population. Of the 178 3GC-R K. pneumoniae bacteraemias that occurred during our study time frame, we were able to analyse 153 (86 %) bacteraemia isolates, 126 initial and 27 recurrent isolates. While isolates belonging to the widely prevalent clonal group (CG) 258 were rarely observed, the predominant CG, 307, accounted for 37 (29 %) index isolates and displayed a significant correlation (Pearson correlation test P value=0.03) with the annual frequency of 3GC-R K. pneumoniae bacteraemia. Interestingly, only 11 % (4/37) of CG307 isolates belonged to the commonly detected ‘Texas-specific’ clade that has been observed in previous Texas-based K. pneumoniae antimicrobial-resistance surveillance studies. We identified nearly half of our CG307 isolates (n=18) belonged to a novel, monophyletic CG307 sub-clade characterized by the chromosomally encoded bla SHV-205 and unique accessory genome content. This CG307 sub-clade was detected in various regions of the USA, with genome sequences from 24 additional strains becoming recently available in the National Center for Biotechnology Information (NCBI) SRA database. Collectively, this study underscores the emergence and dissemination of a distinct CG307 sub-clade that is a prevalent cause of 3GC-R K. pneumoniae bacteraemia among cancer patients seen in Houston, TX, and has recently been isolated throughout the USA.

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Section: Discussionmentioning

confidence: 99%

Identification of a novel CG307 sub-clade in third-generation-cephalosporin-resistant Klebsiella pneumoniae causing invasive infections in the USA

Selvaraj Anand,

Wu,

Bremer

et al. 2024

Microbial Genomics

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Active follow-up of patients identified with multidrug-resistant Gram-negative bacteria to discontinue contact precautions and isolation measures

Haanappel,

Voor in ‘t holt,

de Goeij

et al. 2024

Journal of Hospital Infection

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Extensively Drug-Resistant Pseudomonas aeruginosa Outbreak Associated With Artificial Tears

Grossman,

Rankin,

Maloney

et al. 2024

Clinical Infectious Diseases

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Background Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. Methods Cases were defined as a U.S. patient’s first isolation of P. aeruginosa sequence type 1203 with the carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to CDC between January 1, 2022–May 15, 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. Results We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and four (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears compared to controls (crude matched OR: 5.0, 95% CI: 1.1, 22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. FDA inspection of the manufacturing plant identified likely sources of contamination. Conclusions A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the U.S. The clinical impacts from this outbreak underscore the need for improved requirements for U.S. OTC product importers.

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Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors

Cited by 6 publications

References 29 publications

Identification of a novel CG307 sub-clade in third-generation-cephalosporin-resistant Klebsiella pneumoniae causing invasive infections in the USA

Identification of a novel CG307 sub-clade in third-generation-cephalosporin-resistant Klebsiella pneumoniae causing invasive infections in the USA

Active follow-up of patients identified with multidrug-resistant Gram-negative bacteria to discontinue contact precautions and isolation measures

Extensively Drug-Resistant Pseudomonas aeruginosa Outbreak Associated With Artificial Tears

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