Abstract
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 blaIMP-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.
Highlights
A multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) occurred at an acute care hospital in Japan
Because of the continued detection of Carbapenem-resistant Enterobacterales (CRE), which totalled more than 100 cases between 2010 and 2014, and affected neighbouring healthcare facilities, an investigation was initiated by the Osaka City Public Health Office (OCPHO) and the National Institute of Infectious Diseases (NIID) as a public health response in March 2014
The isolates consisted of five different species of Enterobacteriaceae including E. coli (n = 8, 36%), K. oxytoca (n = 5, 23%), E. cloacae (n = 5, 23%), K. pneumoniae (n = 3, 14%) and K. aerogenes (n = 1, 5%)
Summary
A multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) occurred at an acute care hospital in Japan. 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. Plasmid analysis of isolates in an outbreak of IMP-6-CPE suggested interspecies gene transmission and helped to clarify hidden epidemiological links between cases. In Japan, the predominant carbapenemase detected in Enterobacterales is an IMP type metallo-β-lactamase (MBL), and sporadic cases or small outbreaks of IMP producers have been reported across www.nature.com/scientificreports the country[8,9,10,11,12]. The objectives of this study were to describe the features of this long-standing outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) outbreak through a plasmid analysis and to identify risk factors of its acquisition among patients who underwent abdominal surgery in ONH
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