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Dynamics of MDR Enterobacter cloacae outbreaks in a neonatal unit in Nepal: insights using wider sampling frames and next-generation sequencing.

Stoesser N, Sheppard AE, Shakya M, Sthapit B, Thorson S, Giess A, Kelly D, Pollard AJ, Peto TE, Walker AS, Crook DW - J. Antimicrob. Chemother. (2015)

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.

View Article: PubMed Central - PubMed

Affiliation: Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK nicole.stoesser@ndm.ox.ac.uk.

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Related in: MedlinePlus

Resistance gene presence (black shading)/absence (white shading) for each isolate using genomic data and corresponding antimicrobial susceptibility profiling using the BD Phoenix Automated System (automated broth microdilution method). Black borders have been placed around individual susceptibility results that represent a genotype/phenotype discrepancy. Black borders around global susceptibility profiles correspond to host strain genetic clusters. Plasmid Inc types identified in isolates are represented by black shading. Sequence data were not available for CIT 13B. AMC, amoxicillin/clavulanate; AMK, amikacin; ATM, aztreonam; CFZ, cefazolin; CIP, ciprofloxacin; CST, colistin; CRO, ceftriaxone; ETP, ertapenem; FEP, cefepime; GEN, gentamicin; LVX, levofloxacin; MEM, meropenem; NIT, nitrofurantoin; PIP, piperacillin; TZP, piperacillin/tazobactam; TMP, trimethoprim; TOB, tobramycin; SIR, susceptible, intermediate or resistant, respectively.
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DKU521F2: Resistance gene presence (black shading)/absence (white shading) for each isolate using genomic data and corresponding antimicrobial susceptibility profiling using the BD Phoenix Automated System (automated broth microdilution method). Black borders have been placed around individual susceptibility results that represent a genotype/phenotype discrepancy. Black borders around global susceptibility profiles correspond to host strain genetic clusters. Plasmid Inc types identified in isolates are represented by black shading. Sequence data were not available for CIT 13B. AMC, amoxicillin/clavulanate; AMK, amikacin; ATM, aztreonam; CFZ, cefazolin; CIP, ciprofloxacin; CST, colistin; CRO, ceftriaxone; ETP, ertapenem; FEP, cefepime; GEN, gentamicin; LVX, levofloxacin; MEM, meropenem; NIT, nitrofurantoin; PIP, piperacillin; TZP, piperacillin/tazobactam; TMP, trimethoprim; TOB, tobramycin; SIR, susceptible, intermediate or resistant, respectively.

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.


Dynamics of MDR Enterobacter cloacae outbreaks in a neonatal unit in Nepal: insights using wider sampling frames and next-generation sequencing.

Stoesser N, Sheppard AE, Shakya M, Sthapit B, Thorson S, Giess A, Kelly D, Pollard AJ, Peto TE, Walker AS, Crook DW - J. Antimicrob. Chemother. (2015)

Resistance gene presence (black shading)/absence (white shading) for each isolate using genomic data and corresponding antimicrobial susceptibility profiling using the BD Phoenix Automated System (automated broth microdilution method). Black borders have been placed around individual susceptibility results that represent a genotype/phenotype discrepancy. Black borders around global susceptibility profiles correspond to host strain genetic clusters. Plasmid Inc types identified in isolates are represented by black shading. Sequence data were not available for CIT 13B. AMC, amoxicillin/clavulanate; AMK, amikacin; ATM, aztreonam; CFZ, cefazolin; CIP, ciprofloxacin; CST, colistin; CRO, ceftriaxone; ETP, ertapenem; FEP, cefepime; GEN, gentamicin; LVX, levofloxacin; MEM, meropenem; NIT, nitrofurantoin; PIP, piperacillin; TZP, piperacillin/tazobactam; TMP, trimethoprim; TOB, tobramycin; SIR, susceptible, intermediate or resistant, respectively.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356206&req=5

DKU521F2: Resistance gene presence (black shading)/absence (white shading) for each isolate using genomic data and corresponding antimicrobial susceptibility profiling using the BD Phoenix Automated System (automated broth microdilution method). Black borders have been placed around individual susceptibility results that represent a genotype/phenotype discrepancy. Black borders around global susceptibility profiles correspond to host strain genetic clusters. Plasmid Inc types identified in isolates are represented by black shading. Sequence data were not available for CIT 13B. AMC, amoxicillin/clavulanate; AMK, amikacin; ATM, aztreonam; CFZ, cefazolin; CIP, ciprofloxacin; CST, colistin; CRO, ceftriaxone; ETP, ertapenem; FEP, cefepime; GEN, gentamicin; LVX, levofloxacin; MEM, meropenem; NIT, nitrofurantoin; PIP, piperacillin; TZP, piperacillin/tazobactam; TMP, trimethoprim; TOB, tobramycin; SIR, susceptible, intermediate or resistant, respectively.
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.

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.

View Article: PubMed Central - PubMed

Affiliation: Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK nicole.stoesser@ndm.ox.ac.uk.

Show MeSH
Related in: MedlinePlus