Genomic Investigation of a Putative Endoscope-Associated Carbapenem-Resistant Enterobacter cloacae Outbreak Reveals a Wide Diversity of Circulating Strains and Resistance Mutations

Hawken, Shawn E.; Washer, Laraine; Williams, Christopher L.; Newton, Duane W.; Snitkin, Evan S.

doi:10.1093/cid/cix934

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…The association of ST171 E. xiangfangensis with outbreaks is not rare; repeated reports from different geographic locations have demonstrated the same association ( 20 – 24 ). This association suggests that ST171 is a lineage of Enterobacter , which might be well adapted to causing infections in healthcare settings.…”

Section: Discussionmentioning

confidence: 93%

Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China

Wu¹,

Li²,

Feng³

et al. 2021

Emerg. Infect. Dis.

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The clinical importance of Enterobacter spp. remains unclear because phenotype-based Enterobacter species identification is unreliable. We performed a genomic study on 48 cases of Enterobacter -caused bloodstream infection by using in silico DNA–DNA hybridization to identify precise species. Strains belonged to 12 species; Enterobacter xiangfangensis (n = 21) and an unnamed species (taxon 1, n = 8) were dominant. Most (63.5%) Enterobacter strains (n = 349) with genomes in GenBank from human blood are E. xiangfangensis ; taxon 1 (19.8%) was next most common. E. xiangfangensis and taxon 1 were associated with increased deaths (20.7% vs. 15.8%), lengthier hospitalizations (median 31 d vs. 19.5 d), and higher resistance to aztreonam, cefepime, ceftriaxone, piperacillin-tazobactam, and tobramycin. Strains belonged to 37 sequence types (STs); ST171 ( E. xiangfangensis ) was most common (n = 6). Four ST171 strains belonged to a defined clone. Precise species identification has greater implications for epidemiology and infection control than treatment.

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Section: Discussionmentioning

confidence: 93%

Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China

Wu¹,

Li²,

Feng³

et al. 2021

Emerg. Infect. Dis.

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“…While resistance in E. coli and K. pneumoniae typically requires gene acquisition ( Manges et al, 2019 ; Wyres and Holt, 2016 ), E. cloacae complex can resist cephalosporins and carbapenems through increased AmpC beta-lactamase and decreased porin expression ( Pavez et al, 2016 ; Babouee Flury et al, 2016 ; Lee et al, 2017 ). Such resistance emerges through adaptation and de novo mutations that are rapidly selected from the local reservoir of susceptible progenitors under antibiotic selection pressure ( Hawken et al, 2018 ; Moradigaravand et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Metapopulation ecology links antibiotic resistance, consumption, and patient transfers in a network of hospital wards

Shapiro

Leboucher

Myard-Dury

et al. 2020

eLife

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Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and between-ward patient transfers (or connectivity) impact population-level AMR in hospital networks can help optimize antibiotic stewardship and infection control strategies. Here, we used a metapopulation framework to explain variations in the incidence of infections caused by 7 major bacterial species and their drug-resistant variants in a network of 357 hospital wards. We found that ward-level antibiotic consumption volume had a stronger influence on the incidence of the more resistant pathogens, while connectivity had the most influence on hospital-endemic species and carbapenem-resistant pathogens. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data provide evidence that both antibiotic use and connectivity measurably influence hospital AMR. Finally, we provide a ranking of key antibiotics by their estimated population-level impact on AMR that might help inform antimicrobial stewardship strategies.

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“…A small cluster of ST171 isolates from Boston instead contained bla KPC-4 on an unrelated IncHI2 plasmid (Pecora et al, 2015). A duodenoscope-mediated outbreak of CREC in a Michigan hospital also found likely patient-to-patient transmission of bla KPC -positive ST171 (KPC allele unreported) (Hawken et al, 2018). However, the hospital collection included diverse clones in which carbapenem-resistance was driven primarily by chromosomal mutations rather than carbapenemase genes.…”

Section: Genomic Insights Into the Spread Of Crec Within The United Smentioning

confidence: 99%

Multidrug-Resistant Enterobacter cloacae Complex Emerging as a Global, Diversifying Threat

2019

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The Enterobacter cloacae complex (ECC) includes common nosocomial pathogens capable of producing a wide variety of infections. Broad-spectrum antibiotic resistance, including the recent emergence of resistance to last-resort carbapenems, has led to increased interest in this group of organisms and carbapenem-resistant E. cloacae complex (CREC) in particular. Molecular typing methods based on heat-shock protein sequence, pulsed-field gel electrophoresis, comparative genomic hybridization, and, most recently, multilocus sequence typing have led to the identification of over 1069 ECC sequence types in 18 phylogenetic clusters across the globe. Whole-genome sequencing and comparative genomics, moreover, have facilitated global analyses of clonal composition of ECC and specifically of CREC. Epidemiological and genomic studies have revealed diverse multidrug-resistant ECC clones including several potential epidemic lineages. Together with intrinsic β-lactam resistance, members of the ECC exhibit a unique ability to acquire genes encoding resistance to multiple classes of antibiotics, including a variety of carbapenemase genes. In this review, we address recent advances in the molecular epidemiology of multidrug-resistant E. cloacae complex, focusing on the global expansion of CREC.

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Genomic Investigation of a Putative Endoscope-Associated Carbapenem-Resistant Enterobacter cloacae Outbreak Reveals a Wide Diversity of Circulating Strains and Resistance Mutations

Cited by 10 publications

References 11 publications

Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China

Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China

Metapopulation ecology links antibiotic resistance, consumption, and patient transfers in a network of hospital wards

Multidrug-Resistant Enterobacter cloacae Complex Emerging as a Global, Diversifying Threat

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