A cluster of carbapenemase-producing Enterobacter cloacae complex ST171 at a tertiary care center demonstrating an ongoing regional threat

Edwin C. Pereira, Melissa Anacker, Jeana Houseman, Mary E. Horn, Tim Johnson, Ruth Lynfield, Paula Snippes Vagnone, Medora Witwer, Susan E Kline

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)767-772
Number of pages6
JournalAmerican journal of infection control
Volume47
Issue number7
DOIs
StatePublished - Jul 2019

Bibliographical note

Funding Information:
Funding/support: Funding provided in part by the US Centers for Disease Control and Prevention Emerging Infections Program Cooperative Agreement 5U50CK000204-05 , and the Epidemiology and Laboratory Capacity Cooperative Agreement 5 NU50CK000371-03-00 .

Publisher Copyright:
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • Hospital outbreak
  • Infection control
  • KPC
  • Molecular typing
  • Plasmids
  • β-Lactamases

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