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Lázaro-Perona F, Dahdouh E, Sotillo A, Pérez-Blanco V, Villa J, Viedma E, Ruiz-Carrascoso G, Mingorance J. Dissemination of a single ST11 clone of OXA-48-producing Klebsiella pneumoniae within a large polyclonal hospital outbreak determined by genomic sequencing. Microb Genom 2022; 8. [PMID: 35394416 PMCID: PMC9453077 DOI: 10.1099/mgen.0.000808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The population structure of a set of OXA-48-producing Klebsiella pneumoniae isolates belonging to sequence type 11 (ST11 Kp-OXA) and obtained from two hospitals in Madrid in the period from 2012 to 2015 was studied by genome sequencing. Overall, 97 ST11 Kp-OXA isolates were sequenced and their population structure and demography were studied by Bayesian phylodynamic analysis using core-genome SNVs. In total, 92 isolates were from Hospital La Paz, 57 of them from two selected units. The remaining five isolates were from different units of Hospital Doce de Octubre. Altogether, 96 out of the 97 ST11 Kp-OXA isolates could be ascribed to a single lineage that evolved into three sublineages. Demographic inference showed an expansion of the ST11 Kp-OXA in the first half of 2013 in agreement with the registered incidences. Dated phylogeny showed transmission clusters within hospital wards, between wards and between hospitals. The ST11 Kp-OXA outbreak in Hospital La Paz was largely due to the expansion of a single clone that was transmitted between different units and to Hospital Doce de Octubre. This clone diverged into three sub-lineages and spread out following a mixed mode of neutral core-genome evolution with some features of antibiotic selection, frequent large deletions and plasmid loss and gain events.
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Affiliation(s)
- Fernando Lázaro-Perona
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Elias Dahdouh
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Alma Sotillo
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Verónica Pérez-Blanco
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Jennifer Villa
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Imas12, Avenida de Córdoba sn, Madrid 28041, Spain
| | - Esther Viedma
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Imas12, Avenida de Córdoba sn, Madrid 28041, Spain
| | - Guillermo Ruiz-Carrascoso
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Jesús Mingorance
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana 261, 28046 Madrid, Spain
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Hammerum AM, Porsbo LJ, Hansen F, Roer L, Kaya H, Henius A, Møller KL, Justesen US, Søes L, Røder BL, Thomsen PK, Wang M, Søndergaard TS, Holzknecht BJ, Østergaard C, Kjerulf A, Kristensen B, Hasman H. Surveillance of OXA-244-producing Escherichia coli and epidemiologic investigation of cases, Denmark, January 2016 to August 2019. ACTA ACUST UNITED AC 2020; 25. [PMID: 32400363 PMCID: PMC7219033 DOI: 10.2807/1560-7917.es.2020.25.18.1900742] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Carbapenemase-producing Escherichia coli are increasing worldwide. In recent years, an increase in OXA-244-producing E. coli isolates has been seen in the national surveillance of carbapenemase-producing organisms in Denmark. Aim Molecular characterisation and epidemiological investigation of OXA-244-producing E. coli isolates from January 2016 to August 2019. Methods For the epidemiological investigation, data from the Danish National Patient Registry and the Danish register of civil registration were used together with data from phone interviews with patients. Isolates were characterised by analysing whole genome sequences for resistance genes, MLST and core genome MLST (cgMLST). Results In total, 24 OXA-244-producing E. coli isolates were obtained from 23 patients. Among the 23 patients, 13 reported travelling before detection of the E. coli isolates, with seven having visited countries in Northern Africa. Fifteen isolates also carried an extended-spectrum beta-lactamase gene and one had a plasmid-encoded AmpC gene. The most common detected sequence type (ST) was ST38, followed by ST69, ST167, ST10, ST361 and ST3268. Three clonal clusters were detected by cgMLST, but none of these clusters seemed to reflect nosocomial transmission in Denmark. Conclusion Import of OXA-244 E. coli isolates from travelling abroad seems likely for the majority of cases. Community sources were also possible, as many of the patients had no history of hospitalisation and many of the E. coli isolates belonged to STs that are present in the community. It was not possible to point at a single country or a community source as risk factor for acquiring OXA-244-producing E. coli.
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Affiliation(s)
- Anette M Hammerum
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Lone Jannok Porsbo
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Frank Hansen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Louise Roer
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Hülya Kaya
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Anna Henius
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ulrik S Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Lillian Søes
- Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Bent L Røder
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Philip K Thomsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mikala Wang
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Claus Østergaard
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Anne Kjerulf
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Brian Kristensen
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Hasman
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Ramos-Ramos JC, Lázaro-Perona F, Arribas JR, García-Rodríguez J, Mingorance J, Ruiz-Carrascoso G, Borobia AM, Paño-Pardo JR, Herruzo R, Arnalich F. Proof-of-concept trial of the combination of lactitol with Bifidobacterium bifidum and Lactobacillus acidophilus for the eradication of intestinal OXA-48-producing Enterobacteriaceae. Gut Pathog 2020; 12:15. [PMID: 32280375 PMCID: PMC7137496 DOI: 10.1186/s13099-020-00354-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/31/2020] [Indexed: 11/29/2023] Open
Abstract
Background The major reservoir of carbapenemase-producing Enterobacteriaceae (CPE) is the gastrointestinal tract of colonized patients. Colonization is silent and may last for months, but the risk of infection by CPE in colonized patients is significant. Methods Eight long-term intestinal carriers of OXA-48-producing Enterobacteriaceae (OXA-PE) were treated during 3 weeks with daily oral lactitol (Emportal®), Bifidobacterium bifidum and Lactobacillus acidophilus (Infloran®). Weekly stool samples were collected during the treatment period and 6 weeks later. The presence of OXA-PE was investigated by microbiological cultures and qPCR. Results At the end of treatment (EoT, secondary endpoint 1), four of the subjects had negative OXA-PE cultures. Three weeks later (secondary endpoint 2), six subjects were negative. Six weeks after the EoT (primary endpoint), three subjects had negative OXA-PE cultures. The relative intestinal load of OXA-PE decreased in all the patients during treatment. Conclusions The combination of prebiotics and probiotics was well tolerated. A rapid reduction on the OXA-PE intestinal loads was observed. At the EoT, decolonization was achieved in three patients. Clinical Trials Registration: NCT02307383. EudraCT Number: 2014-000449-65.
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Affiliation(s)
- Juan Carlos Ramos-Ramos
- 1Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Fernando Lázaro-Perona
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - José Ramón Arribas
- 1Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Julio García-Rodríguez
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Jesús Mingorance
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Guillermo Ruiz-Carrascoso
- 2Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Alberto M Borobia
- 3Departamento de Farmacología Clínica, Hospital Universitario La Paz, Paseo de La Catellana 261, 28046 Madrid, Spain
| | - José Ramón Paño-Pardo
- 1Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain.,6Present Address: Division of Infectious Diseases, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.,Present Address: Instituto de Investigaciones Sanitarias (IIS) de Aragón, Zaragoza, Spain
| | - Rafael Herruzo
- 4Servicio de Medicina Preventiva, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Francisco Arnalich
- 5Servicio de Medicina Interna, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 Madrid, Spain
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López-González L, Viñuela-Prieto JM, Rodriguez-Avial I, Manzano R, Candel FJ. Description of carbapenemase-producing Enterobacteriaceae isolates in a Spanish tertiary hospital. Epidemiological analysis and clinical impact. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:254-262. [PMID: 30968674 PMCID: PMC6609934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to carry out an epidemiological analysis of patients with carbapenemase-producing Enterobacteriaceae (CPE) isolations in our hospital as well as to perform a description of the genotypic temporal evolution of CPE isolated. METHODS An observational prospective cohort study was performed involving all patients with CPE isolates from clinical samples during November 2014 to November 2016 in a Spanish teaching hospital. Patients were clinically evaluated and classified either as infected or colonized. Information on the consumption of carbapenems in the hospital during the study period was also analyzed. PCR was used for identification of the carbapenemase genes blaKPC, blaVIM, and blaOXA-48. RESULTS A total of 301 CPE isolates were obtained (107 in 2014, 89 in 2015 and 105 in 2016). Klebsiella pneumoniae (73.4%) was the most prevalent microorganism. Hundred and seventy (56.7%) of carbapenemases detected were blaOXA-48, 73 (24.3%) were blaKPC and 57 (19%) were blaVIM. In year 2014 KPC was predominant while in 2016 OXA-48 predominated. In 2014 we observed a significant association between the medical wards and the ICU with a higher prevalence of OXA-48 (OR 4.15; P<0.001) and VIM (OR 7.40; P<0.001) in the univariate analysis, in the following years there was no association. Regarding the clinical significance of microbiological results after assessing our patients, 60% of isolates represented infection and 40% behaved as colonizers. One third of hospitalized patients with CPE isolation died within 30 days, regardless of whether they were colonized or infected. CONCLUSIONS We have observed an epidemiological change in the genotypes of our isolates along the study period. A thorough knowledge of the CPE's epidemiological distribution in each hospital is fundamental for optimizing antimicrobial chemotherapy.
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Affiliation(s)
- Laura López-González
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos. IdISSC Health Research Institute. Madrid. Spain
| | - José Manuel Viñuela-Prieto
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos. IdISSC Health Research Institute. Madrid. Spain
| | - Icíar Rodriguez-Avial
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos. IdISSC Health Research Institute. Madrid. Spain
| | - Rocío Manzano
- Department of Pharmacy, Hospital Clínico San Carlos. IdISSC Health Research Institute. Madrid. Spain
| | - Francisco Javier Candel
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos. IdISSC Health Research Institute. Madrid. Spain,Universidad Complutense. Madrid. Spain,Correspondence: Francisco Javier Candel González, Department of Clinical Microbiology and Infectious Diseases. Hospital Clínico San Carlos. IdISSC Health Research Institute. Universidad Complutense. Madrid. Spain Phone: +34 91 330 3486 E-mail:
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