Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study

• Published in: Frontiers in cellular and infection microbiology Vol. 11; p. 744431
• Main Authors: Yao, Yancheng, Falgenhauer, Linda, Falgenhauer, Jane, Hauri, Anja M, Heinmüller, Petra, Domann, Eugen, Chakraborty, Trinad, Imirzalioglu, Can
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 11.11.2021
• Subjects: Anti-Bacterial Agents - pharmacology; Bacterial Proteins - genetics; beta-Lactamases - genetics; Carbapenemase; Carbapenems - pharmacology; Cellular and Infection Microbiology; Citrobacter; Citrobacter - genetics; Enterobacteriaceae Infections - epidemiology; Germany; Hospitals; Humans; IncN-plasmid; Klebsiella pneumoniae - genetics; Microbial Sensitivity Tests; MLST; Plasmids - genetics; WGS; WGS; ARGs; MLST; Carbapenemase; IncN-plasmid; Citrobacter; Germany
• ISSN: 2235-2988; 2235-2988
• DOI: 10.3389/fcimb.2021.744431

The rise of Carbapenem-resistant Enterobacterales (CRE) represents an increasing threat to patient safety and healthcare systems worldwide. spp., long considered not to be a classical nosocomial pathogen, in contrast to and , is fast gaining importance as a clinical multidrug-resistant pathogen. We analyzed the genomes of 512 isolates of 21 CRE species obtained from 61 hospitals within a three-year-period and found that spp. ( were increasingly detected (n=56) within the study period. The carbapenemase-groups detected in spp. were KPC, OXA-48/-like and MBL (VIM, NDM) accounting for 42%, 31% and 27% respectively, which is comparable to those of in the same study. They accounted for 10%, 17% and 14% of all carbapenemase-producing CRE detected in 2017, 2018 and 2019, respectively. The carbapenemase genes were almost exclusively located on plasmids. The high genomic diversity of is represented by 22 ST-types. KPC-2 was the predominantly detected carbapenemase (n=19) and was located in 95% of cases on a highly-conserved multiple-drug-resistance-gene-carrying pMLST15 IncN plasmid. KPC-3 was rarely detected and was confined to a clonal outbreak of ST18. OXA-48 carbapenemases were located on plasmids of the IncL/M (pOXA-48) type. About 50% of VIM-1 was located on different IncN plasmids (pMLST7, pMLST5). These results underline the increasing importance of the species as emerging carriers of carbapenemases and therefore as potential disseminators of Carbapenem- and multidrug-resistance in the hospital setting.