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A cluster of carbapenemase-producing Enterobacter cloacae complex ST171 at a tertiary care center demonstrating an
Edwin C Pereira1, Melissa Anacker2, Jeana Houseman3
1Saint Paul Infectious Disease Associates, St. Paul, MN.
Background:
In Minnesota and North Dakota, a clonal strain of blaKPC-3-producing Enterobacter cloacae complex has been reported with increasing frequency.
Methods:
Between July 2015 and February 2016, 13 carbapenem-resistant E. cloacae complex isolates were identified at our institution. Five blaKPC-positive isolates were identified by polymerase chain reaction and underwent pulsed-field gel electrophoresis and whole genome sequencing. Medical records of these patients were reviewed.
Results:
All 5 case-isolates belonged to sequence type 171 and were blaKPC-3-positive. Three pulsed-field gel electrophoresis patterns with >90% similarity were identified in the 5 case-isolates. We identified overlaps in time and location between case patients. Plasmid types and resistance genes were nearly identical between the isolates. Whole genome sequencing showed isolates A, B, and D to be closely related with <10 core single-nucleotide polymorphisms differences. Isolates C and E were also closely related to each other, but more distantly to A, B, and D; all belonged to the clonal lineage of the major circulating E. cloacae complex strain in Minnesota and North Dakota. Despite having overlapping hospital stays, isolates for patients C and D were not identical.
Conclusions:
Isolates A and D were nearly identical, indicating possible transmission during hospitalization. Transmission of the other isolates may have occurred elsewhere. This report highlights the importance of using both epidemiologic and molecular data to track the spread of carbapenemase-producers.
Insights
A clonal strain of carbapenem-resistant Enterobacter cloacae complex producing blaKPC-3 is spreading in Minnesota and North Dakota. Molecular and epidemiologic data are crucial for tracking carbapenemase-producing Enterobacteriaceae spread.
Area of Science:
- Antimicrobial resistance
- Molecular epidemiology
- Infectious diseases
Background:
- A clonal strain of blaKPC-3-producing Enterobacter cloacae complex is increasingly reported in Minnesota and North Dakota.
- Carbapenem resistance in Enterobacteriaceae poses a significant public health threat.
Purpose of the Study:
- To investigate the molecular characteristics and potential transmission of carbapenem-resistant Enterobacter cloacae complex isolates identified at an institution.
- To highlight the importance of integrated epidemiologic and molecular surveillance for carbapenemase-producing organisms.
Main Methods:
- Identification of carbapenem-resistant E. cloacae complex isolates.
- Polymerase chain reaction for blaKPC detection.
- Pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) for molecular typing.
- Review of patient medical records for epidemiologic data.
Main Results:
- Five blaKPC-3-positive E. cloacae complex isolates, all sequence type 171, were identified.
- PFGE revealed three patterns with >90% similarity among isolates.
- WGS confirmed close genetic relatedness among some isolates, consistent with the major circulating clonal lineage in the region.
- Overlaps in patient time and location suggest potential hospital transmission.
Conclusions:
- The findings indicate the presence and spread of a specific clonal strain of blaKPC-3-producing E. cloacae complex.
- Close genetic relatedness and overlapping patient data suggest possible hospital-acquired transmission.
- Combined epidemiologic and molecular data are essential for effective surveillance and control of carbapenemase-producing Enterobacteriaceae.
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