RESUMO
Enterobacteriaceae that are resistant to multiple drugs are a public health concern and present a challenge to health care providers in terms of prevention and control. This article describes the changing resistance mechanisms that allow bacteria to circumvent antibiotics and how multidrug-resistant bacterial infections can spread within hospitals, among health care facilities, and across national borders. It also discusses the challenges associated with identifying and treating these infections and what health care providers need to do to prevent their transmission.
Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae/tratamento farmacológico , Enterobacteriaceae/efeitos dos fármacos , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Enterobacteriaceae/genética , Infecções por Enterobacteriaceae/microbiologia , Genes MDR/genética , Humanos , Testes de Sensibilidade Microbiana , Minnesota , Resistência beta-Lactâmica/genética , beta-Lactamases/genéticaRESUMO
BACKGROUND: In Minnesota and North Dakota, a clonal strain of blaKPC-3-producing Enterobacter cloacae complex has been reported with increasing frequency. METHODS: Between July 2015 and February 2016, 13 carbapenem-resistant E. cloacae complex isolates were identified at our institution. Five blaKPC-positive isolates were identified by polymerase chain reaction and underwent pulsed-field gel electrophoresis and whole genome sequencing. Medical records of these patients were reviewed. RESULTS: All 5 case-isolates belonged to sequence type 171 and were blaKPC-3-positive. Three pulsed-field gel electrophoresis patterns with >90% similarity were identified in the 5 case-isolates. We identified overlaps in time and location between case patients. Plasmid types and resistance genes were nearly identical between the isolates. Whole genome sequencing showed isolates A, B, and D to be closely related with <10 core single-nucleotide polymorphisms differences. Isolates C and E were also closely related to each other, but more distantly to A, B, and D; all belonged to the clonal lineage of the major circulating E. cloacae complex strain in Minnesota and North Dakota. Despite having overlapping hospital stays, isolates for patients C and D were not identical. CONCLUSIONS: Isolates A and D were nearly identical, indicating possible transmission during hospitalization. Transmission of the other isolates may have occurred elsewhere. This report highlights the importance of using both epidemiologic and molecular data to track the spread of carbapenemase-producers.
Assuntos
Enterobacter cloacae/genética , Infecções por Enterobacteriaceae/epidemiologia , Genoma Bacteriano , Resistência beta-Lactâmica/genética , beta-Lactamases/genética , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Carbapenêmicos/farmacologia , Células Clonais , Eletroforese em Gel de Campo Pulsado , Enterobacter cloacae/classificação , Enterobacter cloacae/efeitos dos fármacos , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/transmissão , Expressão Gênica , Humanos , Testes de Sensibilidade Microbiana , Minnesota/epidemiologia , North Dakota/epidemiologia , Filogenia , Plasmídeos/química , Plasmídeos/metabolismo , Centros de Atenção Terciária , Sequenciamento Completo do Genoma , beta-Lactamases/metabolismoRESUMO
Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem in the United States. We explored the feasibility of active laboratory-based surveillance of CRE in a metropolitan area not previously considered to be an area of CRE endemicity. We provide a framework to address CRE surveillance and to monitor changes in the incidence of CRE infection over time.