scholarly journals Emergence of carbapenem-resistant and colistin-susceptible Enterobacter cloacae complex co-harboring blaIMP-1 and mcr-9 in Japan

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pegah Kananizadeh ◽  
Satoshi Oshiro ◽  
Shin Watanabe ◽  
Shu Iwata ◽  
Kyoko Kuwahara-Arai ◽  
...  
Keyword(s):  
Enterobacter Cloacae ◽  
Carbapenem Resistant ◽  
Enterobacter Cloacae Complex

scholarly journals Distinctive features of ertapenem mono-resistant carbapenem-resistant Enterobacterales in the United States: A cohort study

2021 ◽  
Author(s):  
Max W Adelman ◽  
Chris W Bower ◽  
Julian E Grass ◽  
Uzma A Ansari ◽  
Elizabeth A Soda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enterobacter Cloacae ◽  
The United States ◽  
Resistant Bacteria ◽  
Emerging Infections ◽  
Logistic Regression Models ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Sterile Site ◽  
Enterobacter Cloacae Complex

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are highly antibiotic-resistant bacteria. Whether CRE resistant only to ertapenem among carbapenems (ertapenem “mono-resistant”) represent a unique CRE subset with regards to risk factors, carbapenemase genes, and outcomes is unknown. Methods We analyzed surveillance data from nine CDC Emerging Infections Program (EIP) sites. A case was the first isolation of a carbapenem-resistant Enterobacter cloacae complex, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, or K. variicola from a normally sterile site or urine in an EIP catchment area resident in 2016-2017. We compared risk factors, carbapenemase genes, antibiotic susceptibility, and mortality of ertapenem “mono-resistant” cases to “other” CRE cases (resistant to ≥1 carbapenem other than ertapenem), and analyzed risk factors for mortality. Results Of 2009 cases, 1249 (62.2%) were ertapenem mono-resistant and 760 (37.8%) were other CRE. Ertapenem mono-resistant CRE cases were more frequently ≥80 years old (29.1% vs. 19.5%, p<0.0001) and female (67.9% vs 59.0%, p<0.0001). Ertapenem mono-resistant isolates were more likely to be Enterobacter cloacae complex (48.4% vs. 15.4%, p<0.0001) but less likely to be isolated from a normally sterile site (7.1% vs. 11.7%, p<0.01) or have a carbapenemase gene (2.4% vs. 47.4%, p<0.0001). Ertapenem mono-resistance was not associated with 90-day mortality in logistic regression models. Carbapenemase-positive isolates were associated with mortality (odds ratio 1.93, 95% confidence interval 1.30-2.86). Conclusions Ertapenem mono-resistant CRE rarely have carbapenemase genes and have distinct clinical and microbiologic characteristics from other CRE. These findings may inform antibiotic choice and infection prevention practices, particularly when carbapenemase testing is not available.

scholarly journals Enterobacter cloacae Complex Isolates Harboring blaNMC-A or blaIMI-Type Class A Carbapenemase Genes on Novel Chromosomal Integrative Elements and Plasmids

2017 ◽  
Vol 61 (5) ◽  
Author(s):  
David A. Boyd ◽  
Laura F. Mataseje ◽  
Ross Davidson ◽  
Johannes A. Delport ◽  
Jeff Fuller ◽  
...  
Keyword(s):  
Enterobacter Cloacae ◽  
Reference Laboratory ◽  
Chromosomal Locus ◽  
Complex Species ◽  
Content Type ◽  
Class A ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Enterobacter Ludwigii ◽  
Enterobacter Cloacae Complex

ABSTRACT Carbapenem-resistant Enterobacter cloacae complex isolates submitted to a reference laboratory from 2010 to 2015 were screened by PCR for seven common carbapenemase gene groups, namely, KPC, NDM, OXA-48, VIM, IMP, GES, and NMC-A/IMI. Nineteen of the submitted isolates (1.7%) were found to harbor Ambler class A bla NMC-A or bla IMI-type carbapenemases. All 19 isolates were resistant to at least one carbapenem but susceptible to aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, and ciprofloxacin. Most isolates (17/19) gave positive results with the Carba-NP test for phenotypic carbapenemase detection. Isolates were genetically diverse by pulsed-field gel electrophoresis macrorestriction analysis, multilocus sequence typing, and hsp60 gene analysis. The genes were found in various Enterobacter cloacae complex species; however, bla NMC-A was highly associated with Enterobacter ludwigii. Whole-genome sequencing and bioinformatics analysis revealed that all NMC-A (n = 10), IMI-1 (n = 5), and IMI-9 (n = 2) producers harbored the carbapenemase gene on EludIMEX-1-like integrative mobile elements (EcloIMEXs) located in the identical chromosomal locus. Two novel genes, bla IMI-5 and bla IMI-6, were harbored on different IncFII-type plasmids. Enterobacter cloacae complex isolates harboring bla NMC-A/IMI-type carbapenemases are relatively rare in Canada. Though mostly found integrated into the chromosome, some variants are located on plasmids that may enhance their mobility potential.

Molecular characterisation of carbapenem-resistant Enterobacter cloacae complex in Colombia: bla KPC and the ‘changing landscape’

2018 ◽  
Vol 13 ◽  
pp. 184-189 ◽  
Author(s):  
Elsa De La Cadena ◽  
Adriana Correa ◽  
Juan Sebastián Muñoz ◽  
Laura J. Rojas ◽  
Cristhian Hernández-Gómez ◽  
...  
Keyword(s):  
Enterobacter Cloacae ◽  
Molecular Characterisation ◽  
Carbapenem Resistant ◽  
Enterobacter Cloacae Complex

scholarly journals 177. Distinctive Features of Ertapenem Mono-Resistant Carbapenem-Resistant Enterobacterales in the United States: A Cohort Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S108-S109
Author(s):  
Max W Adelman ◽  
Chris W Bower ◽  
Julian E Grass ◽  
Uzma Ansari ◽  
Isaac See ◽  
...  
Keyword(s):  
Risk Factors ◽  
Polymerase Chain Reaction ◽  
Survival Analysis ◽  
Enterobacter Cloacae ◽  
Incident Case ◽  
Chain Reaction ◽  
Carbapenem Resistant ◽  
Sterile Site ◽  
Polymerase Chain ◽  
Enterobacter Cloacae Complex

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are highly antibiotic-resistant bacteria. Whether CRE resistant only to ertapenem among carbapenems (ertapenem mono-resistant) represent a unique CRE subset with regards to risk factors, carbapenemase genes, and outcomes is unknown. Methods We analyzed laboratory- and population-based surveillance data from nine sites participating in CDC’s Emerging Infections Program (EIP). We defined an incident case as the first isolation of Enterobacter cloacae complex, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, or K. variicola resistant to doripenem, ertapenem, imipenem, or meropenem (determined at clinical laboratory) from a normally sterile site or urine identified from a resident of the EIP catchment area in 2016-2017. We compared risk factors, carbapenemase genes (determined via polymerase chain reaction at CDC), and mortality of cases with ertapenem “mono-resistant” to “other” CRE (resistant to ≥ 1 carbapenem other than ertapenem). We additionally conducted survival analysis to determine the effect of ertapenem mono-resistant status and isolate source (sterile vs. urine) on survival. Results Of 2009 cases, 1249 (62.2%) were ertapenem mono-resistant and 760 (37.8%) were other CRE (Figure 1). Ertapenem mono-resistant CRE cases were more frequently ≥ 80 years old (29.1% vs. 19.5%, p< 0.0001), female (67.9% vs 59.0%, p< 0.0001), and white (62.6% vs. 45.1%, p< 0.0001). Ertapenem mono-resistant isolates were more likely than other CRE to be Enterobacter cloacae complex (48.4% vs. 15.4%, p< 0.0001) but less likely to be isolated from a normally sterile site (7.1% vs. 11.7%, p< 0.01) or have a carbapenemase gene (2.4% vs. 47.4%, p< 0.0001) (Figure 2). Ertapenem mono-resistance was not associated with difference in 90-day mortality (unadjusted odds ratio [OR] 0.82, 95% confidence interval [CI] 0.63-1.06) in logistic models or survival analysis (Figure 3). Figure 1. Flow diagram of carbapenem-resistant Enterobacterales cases included in analysis, 2017-2018. CRE, carbapenem-resistant Enterobacterales; MIC, minimum inhibitory concentration. Ertapenem mono-resistant CRE are only resistant to ertapenem (among carbapenems). Other CRE are resistant to ≥1 carbapenem other than ertapenem. We excluded isolates that (1) had no interpretable MICs for any carbapenem, (2) were only tested against ertapenem, (3) had unknown death status, or (4) were not associated with patient’s first incident case. Figure 2. Proportion of ertapenem mono-resistant carbapenem-resistant Enterobacterales (CRE) vs. other CRE isolates with specific carbapenemase genes. KPC, Klebsiella pneumoniae carbapenemase; NDM, New Delhi metallo-ß-lactamase; OXA, oxacillinase. Ertapenem mono-resistant carbapenem-resistant Enterobacterales (CRE) are only resistant to ertapenem (among carbapenems). Other CRE are resistant to ≥1 carbapenem other than ertapenem. Testing via reverse transcriptase polymerase chain reaction. Figure 3. Survival analysis comparing patients with carbapenem-resistant Enterobacterales (CRE) that are ertapenem mono-resistant to other CRE (i.e., resistant to ≥1 carbapenem other than ertapenem), either total (A) or stratified by isolate site (B). Ertapenem mono-resistant) isolates were not associated with decreased mortality, and sterile isolate source (i.e., non-urinary isolates) was associated with increased mortality regardless of ertapenem mono-resistance. Conclusion Ertapenem mono-resistant CRE rarely have carbapenemase genes and have distinct clinical and microbiologic characteristics compared to other CRE. These findings may inform antibiotic choice particularly when testing for carbapenemases is not readily available. Disclosures All Authors: No reported disclosures

scholarly journals Emergence of Enterobacter cloacae Complex Co-Producing IMP-10 and CTX-M, and Klebsiella pneumoniae Producing VIM-1 in Clinical Isolates in Japan

2020 ◽  
Vol 8 (11) ◽  
pp. 1816
Author(s):  
Satoshi Nishida ◽  
Naohisa Matsunaga ◽  
Yuta Kamimura ◽  
Shinobu Ishigaki ◽  
Taiji Furukawa ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bacterial Species ◽  
Klebsiella Oxytoca ◽  
Tertiary Care ◽  
Enterobacter Cloacae ◽  
Clinical Isolates ◽  
University Hospital ◽  
Healthcare Settings ◽  
Carbapenem Resistant ◽  
Enterobacter Cloacae Complex

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging threat in healthcare settings worldwide. Objectives: We evaluated the presence of carbapenemase genes in CPE in a tertiary care university hospital in Tokyo, Japan. Methods: Carbapenem-resistant clinical isolates were collected in 2018 at Teikyo University Hospital (Tokyo, Japan). Bacterial species were identified using MALDI-TOF MS. Carbapenemase production was evaluated using a carbapenemase inactivation method. The presence of carbapenemase genes was confirmed by multiplex PCR and DNA sequencing. Results: Four CPE isolates were identified: two Enterobacter cloacae complex strains and Klebsiella oxytoca and Klebsiella pneumoniae strains. Three of the isolates (E. cloacae complex and K. oxytoca) were IMP-1-type producers, including IMP-10 in their produced metallo-β-lactamase, and are epidemic in East Japan. The IMP-10-producing E. cloacae complex strain also produced CTX-M ESBL. The other CPE isolate (K. pneumoniae) is a VIM-1 producer. VIM-1-producing K. pneumoniae is epidemic in Europe, especially in Greece. Accordingly, the VIM-1 producer was isolated from a patient with a medical history in Greece. Conclusions: This study revealed the emergence of E. cloacae complex co-producing IMP-1-type carbapenemase and CTX-M ESBL, and K. pneumoniae producing VIM-1 carbapenemase in clinical isolates in Japan. Metallo-β-lactamase was the most prevalent type of carbapenemase at Teikyo University Hospital, especially IMP-1-type carbapenemase. The detection of VIM-1-producing K. pneumoniae suggests that epidemic CPE from overseas can spread to countries with low CPE prevalence, such as Japan, highlighting the need for active surveillance.

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