Dynamics of MDR Enterobacter cloacae outbreaks in a neonatal unit in Nepal: insights using wider sampling frames and next-generation sequencing.
Bottom Line: These were compared with two contemporaneous community-associated drug-resistant isolates from adults, a unit soap dispenser isolate and a set of historical invasive isolates (n=14) from the same geographical locality.The smaller, second outbreak was likely associated with a contaminated soap dispenser.The two community-acquired adult cases and three sets of historical hospital-associated neonatal isolates represented four additional genetic clusters.
Affiliation: Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK email@example.com.Show MeSH
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Mentions: The isolates causing infection showed large variation in antimicrobial susceptibilities based on locally available disc diffusion results (Figure 1b), with 10 distinct E. cloacae susceptibility profiles identified in the 16 neonates with epidemiological information available (plus 1 additional profile in an adult without epidemiological data) and 2 Citrobacter profiles, complicating the definition of epidemiological case clusters. Broth microdilution results were more consistent between isolates, showing seven distinct E. cloacae profiles and one Citrobacter profile (Figure 2). In contrast, gene presence/absence identified only four E. cloacae profiles, with five isolates showing discrepancies with regard to broth microdilution results (Figure 2). Resistance gene presence corresponded fully with bacterial strain genetic clusters (Figures 2 and 3; genetic clusters contained strains with <10 SNVs). Nineteen isolates from 13 individuals (all isolates in Genetic cluster A) were blaNDM-1 positive; 3 of these were susceptible to meropenem by broth microdilution, while 11/17 tested (65%) had been susceptible by disc diffusion.Figure 2.
Affiliation: Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK firstname.lastname@example.org.