Long-lasting outbreak due to CTX-M-15-producing Klebsiella pneumoniae ST336 in a rehabilitation ward: report and literature review

Valsdóttir, Freyja; Jelle, Asdis E.; Guðlaugsson, Ólafur; Hilmarsdóttir, I.

doi:10.1016/j.jhin.2017.04.002

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…As with the single report in Portugal, we identified bla CTX-M-1 and bla CTX-M-32 in sheep, but we also identified the bla CTX-M-15 , bla CTX-M-14 , bla CTX-M-98 , and bla SHV-12 genes. CTX-M-15 is the most prevalent ESBL worldwide and particularly in humans in Europe [11,29,30]. Nevertheless, the presence of CTX-M-15 in food-producing animals is no longer an exception, even though CTX-M-1 is still more prevalent in animals [28].…”

Section: Discussionmentioning

confidence: 99%

First Global Report of Plasmid-Mediated mcr-1 and Extended-Spectrum Beta-Lactamase-Producing Escherichia coli from Sheep in Portugal

et al. 2021

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Resistances to extended-spectrum cephalosporins (ESC) and colistin are One Health issues since genes encoding these resistances can be transmitted between all sectors of the One Health concept, i.e., human, animal, and the environment. Among food-producing animals, sheep farming has long been overlooked. To fill in this knowledge gap, we looked for ESC- and colistin resistance in 21 faecal samples collected from sheep in one farm in the south of Portugal. ESC-resistant isolates were selected on MacConkey agar plates supplemented with cefotaxime. Susceptibility testing was performed by the disk-diffusion method according to CLSI, while colistin MIC was determined by broth microdilution. ESC- and colistin-resistance genes were identified by PCR, and the clonality of all isolates was assessed by XbaI-PFGE. The replicon content was determined by PCR according to the PCR-based replicon typing (PBRT) scheme. Sixty-two non-duplicate ESC-resistant E. coli isolates were identified, which all presented an extended-spectrum beta-lactamase (ESBL) phenotype, mostly due to the presence of CTX-M genes. One CTX-M-1-producing E. coli was concomitantly colistin-resistant and presented the plasmid-mediated mcr-1 gene. Nearly all isolates showed associated resistances to non-beta-lactam antibiotics, which could act as co-selectors, even in the absence of beta-lactam use. The results showed a high proportion of ESBL-producing E. coli in sheep faeces. Their dissemination was very dynamic, with the spread of successful clones between animals, but also a large diversity of clones and plasmids, sometimes residing in the same animal. This study highlights the need for global surveillance in all food-producing sectors, in order to avoid the dissemination of genes conferring resistance to last-resort antibiotics in human medicine.

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Section: Discussionmentioning

confidence: 99%

First Global Report of Plasmid-Mediated mcr-1 and Extended-Spectrum Beta-Lactamase-Producing Escherichia coli from Sheep in Portugal

et al. 2021

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“…Moreover, the prevalence of bla CTX-M-15 gene (18.2%) herein is higher than other regions of China (10,28), which is similar to those in Europe and America (30), indicating the rapid dissemination of bla CTX-M-15 . The bla CTX-M-15 gene was frequently found to be associated with outbreaks caused by multidrug resistant K. pneumonia worldwide (31,32). Meanwhile, high prevalence of CRKP-ST11 isolates cocarrying bla KPC-2 , bla SHV-12 , bla TEM-1 , bla CTX-M-65 and/or bla DHA-1 in our hospital was in line with previous studies (33), which may be mainly attributed to spread of elements such as plasmids or clonal dissemination of such strains.…”

Section: Discussionmentioning

confidence: 99%

Clonal dissemination of KPC-2-producing Klebsiella pneumoniae ST11 and ST48 clone among multiple departments in a tertiary teaching hospital in Jiangsu Province, China

Cao

et al. 2019

Ann Transl Med

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Background: The world-wide prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a threat to the public health. The objective of this study was to determine the epidemiological and molecular patterns of KPC-producing Klebsiella pneumoniae (K. pneumoniae) clinical isolates.Methods: In this study, a total of 82 non-duplicated CRKP isolates were analyzed for the prevalence of resistant determinants including carbapenemase, extended spectrum β-lactamase (ESBLs), and AmpC as well as integrons and cassette regions by polymerase chain reaction (PCR) and DNA sequencing. The genetic relatedness was investigated by pulsed field gel electrophoresis (PFGE) and multi-locus sequencing typing (MLST).Results: Overall, bla KPC-2 (n=75) was the predominant carbapenemase gene, followed by high prevalence of bla SHV (92.7%) and bla CTX-M (90.2%). PFGE and MLST analysis revealed that 65 out of 68 KPC-2producing CRKP belonged to the ST11 clone and were distributed mainly in the department of neurology ICU. Moreover, first report on clonal dissemination of KPC-2-producing CRKP ST48 clone and NDM-5-producing CRKP ST337 clone was also identified. Class I integron were detected in 17 (20.7%) of 82 isolates with aadA2 being the most common cassette. And a novel cassette array of integron, aac(6')-IIbla CARB/PSE-1 was identified.Conclusions: All in all, KPC-2-producing CRKP ST11 and ST48 clone were widely disseminated in multiple departments of our hospital, which triggers the need for active surveillance and implementation of infection control measures.

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“…The neurorehabilitation setting is also known to be characterized by a higher prevalence of MDRO; patients undergoing the most invasive treatments are more likely to be colonized, increasing the risk of prolonged hospital stays, exposure to antibiotic therapies and morbidity [10]. Rehabilitation units represent a challenge for infection control, also due to the dependency of patients and the environment that encourages socialization [11].…”

Section: Introductionmentioning

confidence: 99%

Impact of Multidrug-Resistant Organisms on Severe Acquired Brain Injury Rehabilitation: An Observational Study

Castellani,

Maietti,

Colombo

et al. 2024

Microorganisms

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Healthcare-associated infections (HAIa) and antimicrobial resistance are expected to be the next threat to human health and are most frequent in people with severe acquired brain injury (SABI), who can be more easily colonized by multidrug-resistant organisms (MDROs). The study’s aim is to investigate the impact of MDRO colonizations and infections on SABI rehabilitation outcomes. This retrospective observational study was performed in a tertiary referral specialized rehabilitation hospital. The main outcomes were the presence of carbapenemase-producing Enterobacteriaceae (CPE) colonization, type and timing of HAI and MDRO HAI, and the number of CPE transmissions. We included 48 patients, 31% carrying CPE on admission and 33% colonized during the hospitalization. A total of 101 HAI were identified in 40 patients, with an overall incidence of 10.5/1000 patient days. Some 37% of patients had at least one MDRO infection, with a MDRO infection incidence of 2.8/1000 patient days. The number of HAIs was significantly correlated with the length of stay (LOS) (r = 0.453, p = 0.001). A significant correlation was found between colonization and type of hospital room (p = 0.013). Complications and HAI significantly affected LOS. We suggest that CPE carriers might be at risk of HAI and worse outcomes compared with non-CPE carriers.

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Long-lasting outbreak due to CTX-M-15-producing Klebsiella pneumoniae ST336 in a rehabilitation ward: report and literature review

Cited by 4 publications

References 39 publications

First Global Report of Plasmid-Mediated mcr-1 and Extended-Spectrum Beta-Lactamase-Producing Escherichia coli from Sheep in Portugal

First Global Report of Plasmid-Mediated mcr-1 and Extended-Spectrum Beta-Lactamase-Producing Escherichia coli from Sheep in Portugal

Clonal dissemination of KPC-2-producing Klebsiella pneumoniae ST11 and ST48 clone among multiple departments in a tertiary teaching hospital in Jiangsu Province, China

Impact of Multidrug-Resistant Organisms on Severe Acquired Brain Injury Rehabilitation: An Observational Study

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