Abstract
BackgroundTwo of the most important pathogens contributing to the global rise in antimicrobial resistance (AMR) are Klebsiella pneumoniae and Enterobacter cloacae. Despite this, most of our knowledge about the changing patterns of disease caused by these two pathogens is based on studies with limited timeframes that provide few insights into their population dynamics or the dynamics in AMR elements that they can carry.ResultsWe investigate the population dynamics of two priority AMR pathogens over 7 years between 2007 and 2012 in a major UK hospital, spanning changes made to UK national antimicrobial prescribing policy in 2007. Between 2006 and 2012, K. pneumoniae showed epidemiological cycles of multi-drug-resistant (MDR) lineages being replaced approximately every 2 years. This contrasted E. cloacae where there was no temporally changing pattern, but a continuous presence of the mixed population.ConclusionsThe differing patterns of clonal replacement and acquisition of mobile elements shows that the flux in the K. pneumoniae population was linked to the introduction of globally recognized MDR clones carrying drug resistance markers on mobile elements. However, E. cloacae carries a chromosomally encoded ampC conferring resistance to front-line treatments and shows that MDR plasmid acquisition in E. cloacae was not indicative of success in the hospital. This led to markedly different dynamics in the AMR populations of these two pathogens and shows that the mechanism of the resistance and its location in the genome or mobile elements is crucial to predict population dynamics of opportunistic pathogens in clinical settings.
Highlights
Two of the most important pathogens contributing to the global rise in antimicrobial resistance (AMR) are Klebsiella pneumoniae and Enterobacter cloacae
E. cloacae carries a chromosomally encoded ampC conferring resistance to front-line treatments and shows that MDR plasmid acquisition in E. cloacae was not indicative of success in the hospital. This led to markedly different dynamics in the AMR populations of these two pathogens and shows that the mechanism of the resistance and its location in the genome or mobile elements is crucial to predict population dynamics of opportunistic pathogens in clinical settings
The sample types were mainly blood, followed by urine, wounds, and sputum, E. cloacae were isolated from a wider range of body sites compared to K. pneumoniae (Additional file 1: Figure S1)
Summary
Two of the most important pathogens contributing to the global rise in antimicrobial resistance (AMR) are Klebsiella pneumoniae and Enterobacter cloacae. Klebsiella pneumoniae and Enterobacter cloacae are amongst the primary threats to human health due to the range of hospital-acquired infections (HAIs) that they can cause and their potential for becoming multidrug-resistant [1]. The widespread acquisition of mobile CTX-M and other extended-spectrum beta-lactamases (ESBLs) encoded on conjugative (transferable) plasmids [2, 3] has been a major driver in the success of K. pneumoniae as hospital pathogen. E. cloacae carry a chromosomally encoded AmpC beta-lactamase which has a wide spectrum of activity conferring intrinsic resistance to many front-line treatment options including penicillins, penicillinpenicillinase inhibitor combinations, and (when ampC becomes derepressed) third-generation cephalosporins, making it a major contributor towards intrinsic resistance for Enterobacter spp
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