A Prolonged Outbreak of KPC-3-Producing Enterobacter cloacae and Klebsiella pneumoniae Driven by Multiple Mechanisms of Resistance Transmission at a Large Academic Burn Center
A Prolonged Outbreak of KPC-3-Producing Enterobacter cloacae and Klebsiella pneumoniae Driven by Multiple Mechanisms of Resistance Transmission at a Large Academic Burn Center
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DOI：
10.1128/aac.01516-16
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发表时间：
2017-02-01
影响因子：
4.9
通讯作者：
Rutala, William A.
中科院分区：
文献类型：
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作者：
Kanamori, Hajime;Parobek, Christian M.;Rutala, William A.
产碳青霉烯酶肺炎克雷伯菌（KPC）的阴沟肠杆菌最近已在美国得到确认。全基因组测序（WGS）已成为一种有用的工具，用于分析疫情和确定医疗机构中多重耐药微生物（包括碳青霉烯类耐药肠杆菌科（CRE））的传播网络。我们经历了一场持续的CRE E爆发。cloxacin和K.尽管采取了严格的感染控制措施，但在一个大型学术烧伤中心，为了了解持续这次爆发的分子机制，我们通过使用WGS调查了CRE爆发分离株。22株CRE临床分离株，包括E. clopidae（n = 15）和K. pneumoniae（n = 7）进行基因测序和分析。WGS发现，这次疫情在流行病学上似乎没有联系，但实际上在很长一段时间内与基因有关。多种机制被发现可以解释持续爆发的产KPC-3大肠杆菌。cloxacin和K.肺炎。这种爆发主要是由E.耐药基因114型（ST 114），分布有多个耐药决定簇。质粒和转座子分析表明，大多数blaKPC-3是通过一个相同的Tn 4401 b元件的一部分，共同的质粒。WGS分析表明，在与转座子相关的菌株和/或质粒水平下，烧伤中心内的传播动力学复杂，突出了产KPC肠杆菌科利用多种模式进行抗性基因繁殖的能力的多功能性。
Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae has been recently recognized in the United States. Whole-genome sequencing (WGS) has become a useful tool for analysis of outbreaks and for determining transmission networks of multidrug-resistant organisms in health care settings, including carbapenem-resistant Enterobacteriaceae (CRE). We experienced a prolonged outbreak of CRE E. cloacae and K. pneumoniae over a 3-year period at a large academic burn center despite rigorous infection control measures. To understand the molecular mechanisms that sustained this outbreak, we investigated the CRE outbreak isolates by using WGS. Twenty-two clinical isolates of CRE, including E. cloacae (n = 15) and K. pneumoniae (n = 7), were sequenced and analyzed genetically. WGS revealed that this outbreak, which seemed epidemiologically unlinked, was in fact genetically linked over a prolonged period. Multiple mechanisms were found to account for the ongoing outbreak of KPC-3-producing E. cloacae and K. pneumoniae. This outbreak was primarily maintained by a clonal expansion of E. cloacae sequence type 114 (ST114) with distribution of multiple resistance determinants. Plasmid and transposon analyses suggested that the majority of blaKPC-3 was transmitted via an identical Tn4401b element on part of a common plasmid. WGS analysis demonstrated complex transmission dynamics within the burn center at levels of the strain and/or plasmid in association with a transposon, highlighting the versatility of KPC-producing Enterobacteriaceae in their ability to utilize multiple modes to resistance gene propagation.