TY - JOUR
T1 - Clonal Spread and Intra- and Inter-Species Plasmid Dissemination Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales During a Hospital Outbreak in Barcelona, Spain
AU - Marí-Almirall, Marta
AU - Ferrando, Núria
AU - Fernández, Mariana José
AU - Cosgaya, Clara
AU - Viñes, Joaquim
AU - Rubio, Elisa
AU - Cuscó, Anna
AU - Muñoz, Laura
AU - Pellice, Martina
AU - Vergara, Andrea
AU - Campo, Irene
AU - Rodríguez-Serna, Laura
AU - Santana, Gemina
AU - Del Río, Ana
AU - Francino, Olga
AU - Ciruela, Pilar
AU - Ballester, Frederic
AU - Marco, Francesc
AU - Martínez, José Antonio
AU - Soriano, Álex
AU - Pitart, Cristina
AU - Vila Estapé, Jordi
AU - Roca, Ignasi
PY - 2021
Y1 - 2021
N2 - Objectives: The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in Catalonia, Spain. Methods: Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of bla genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids. Results: From July 2018 to February 2019, 125 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of Klebsiella pneumoniae belonging to sequence type ST15 and additional isolates of K. pneumoniae, Escherichia coli and Enterobacter sp. from different STs. All isolates but one carried the bla allelic variant. The bla gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn 4401 element designated NTE-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTE-pMC-2-1 module was highly conserved. Conclusion: We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15 K. pneumoniae but also the intra- and inter-species transmission of the bla gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.
AB - Objectives: The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in Catalonia, Spain. Methods: Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of bla genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids. Results: From July 2018 to February 2019, 125 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of Klebsiella pneumoniae belonging to sequence type ST15 and additional isolates of K. pneumoniae, Escherichia coli and Enterobacter sp. from different STs. All isolates but one carried the bla allelic variant. The bla gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn 4401 element designated NTE-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTE-pMC-2-1 module was highly conserved. Conclusion: We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15 K. pneumoniae but also the intra- and inter-species transmission of the bla gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.
KW - Klebsiella
KW - Outbreak
KW - Antibiotic resistance
KW - Carbapenemase
KW - Epidemiology
KW - Plasmid
KW - High-risk clone
KW - KPC
U2 - 10.3389/fmicb.2021.781127
DO - 10.3389/fmicb.2021.781127
M3 - Article
C2 - 34867923
SN - 1664-302X
VL - 12
JO - Frontiers in Microbiology
JF - Frontiers in Microbiology
ER -