A prolonged multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales due to horizontal transmission of the IncN plasmid

• Published in: Scientific reports Vol. 10; no. 1; p. 4139
• Main Authors: Yamagishi, Takuya, Matsui, Mari, Sekizuka, Tsuyoshi, Ito, Hiroaki, Fukusumi, Munehisa, Uehira, Tomoko, Tsubokura, Miyuki, Ogawa, Yoshihiko, Miyamoto, Atsushi, Nakamori, Shoji, Tawa, Akio, Yoshimura, Takahisa, Yoshida, Hideki, Hirokawa, Hidetetsu, Suzuki, Satowa, Matsui, Tamano, Shibayama, Keigo, Kuroda, Makoto, Oishi, Kazunori
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05.03.2020; Nature Publishing Group
• Subjects: 45; 45/23; 45/29; 45/77; 631/208/212/2301; 692/699/255/1318; 692/700/478/174; Aged; Aged, 80 and over; Antibiotics; Bacterial Proteins - genetics; Bacterial Proteins - metabolism; beta-Lactamases - genetics; beta-Lactamases - metabolism; Carbapenemase; Case-Control Studies; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae Infections - microbiology; Enterobacteriaceae Infections - transmission; Epidemiology; Female; Fistulae; Fluoroscopy; Gel electrophoresis; Genomes; Humanities and Social Sciences; Humans; Male; multidisciplinary; Multilocus Sequence Typing; Nucleotide sequence; Outbreaks; Pancreaticoduodenectomy; Patients; Peritoneum; Plasmids; Plasmids - genetics; Pulsed-field gel electrophoresis; Risk factors; Science; Science (multidisciplinary); Surgery; Whole Genome Sequencing
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-60659-2

A multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) occurred at an acute care hospital in Japan. This study was conducted to understand the mechanisms of IMP-6-CPE transmission by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing and whole-genome sequencing (WGS), and identify risk factors for IMP-6-CPE acquisition in patients who underwent abdominal surgery. Between July 2013 and March 2014, 22 hospitalized patients infected or colonized with IMP-6-CPE ( Escherichia coli [n = 8], Klebsiella oxytoca [n = 5], Enterobacter cloacae [n = 5], Klebsiella pneumoniae [n = 3] and Klebsiella aerogenes [n = 1]) were identified. There were diverse PFGE profiles and sequence types (STs) in most of the species except for K. oxytoca . All isolates of K. oxytoca belonged to ST29 with similar PFGE profiles, suggesting their clonal transmission. Plasmid analysis by WGS revealed that all 22 isolates but one shared a ca. 50-kb IncN plasmid backbone with bla IMP-6 suggesting interspecies gene transmission, and typing of plasmids explained epidemiological links among cases. A case-control study showed pancreatoduodenectomy, changing drains in fluoroscopy room, continuous peritoneal lavage and enteric fistula were associated with IMP-6-CPE acquisition among the patients. Plasmid analysis of isolates in an outbreak of IMP-6-CPE suggested interspecies gene transmission and helped to clarify hidden epidemiological links between cases.