Abstract
BackgroundThis study aimed to determine the epidemiological, microbiological, and molecular characteristics of an outbreak of carbapenem-resistant Leclercia adecarboxylata in three hospitals associated with the unintended use of contaminated total parental nutrition (TPN).MethodsFor 10 days, 25 patients who received intravenous TPN from the same batch of a formula developed sepsis and had blood cultures positive for L. adecarboxylata. Antimicrobial susceptibility and carbapenemase production were performed in 31 isolates, including one from an unopened bottle of TPN. Carbapenemase-encoding genes, extended-spectrum β-lactamase–encoding genes were screened by PCR, and plasmid profiles were determined. Horizontal transfer of carbapenem resistance was performed by solid mating. Clonal diversity was performed by pulsed-field gel electrophoresis. The resistome was explored by whole-genome sequencing on two selected strains, and comparative genomics was performed using Roary.ResultsAll 31 isolates were resistant to aztreonam, cephalosporins, carbapenems, trimethoprim/sulfamethoxazole, and susceptible to gentamicin, tetracycline, and colistin. Lower susceptibility to levofloxacin (51.6%) and ciprofloxacin (22.6%) was observed. All the isolates were carbapenemase producers and positive for blaNDM-1, blaTEM-1B, and blaSHV-12 genes. One main lineage was detected (clone A, 83.9%; A1, 12.9%; A2, 3.2%). The blaNDM-1 gene is embedded in a Tn125-like element.Genome analysis showed genes encoding resistance for aminoglycosides, quinolones, trimethoprim, colistin, phenicols, and sulphonamides and the presence of IncFII (Yp), IncHI2, and IncHI2A incompatibility groups. Comparative genomics showed a major phylogenetic relationship among L. adecarboxylata I1 and USDA-ARS-USMARC-60222 genomes, followed by our two selected strains.ConclusionWe present epidemiological, microbiological, and molecular evidence of an outbreak of carbapenem-resistant L. adecarboxylata in three hospitals in western Mexico associated with the use of contaminated TPN.
Highlights
This study aimed to determine the epidemiological, microbiological, and molecular characteristics of an outbreak of carbapenem-resistant Leclercia adecarboxylata in three hospitals associated with the unintended use of contaminated total parental nutrition (TPN)
We present epidemiological, microbiological, and molecular evidence of an outbreak of carbapenemresistant L. adecarboxylata in three hospitals in western Mexico associated with the use of contaminated TPN
Leclercia adecarboxylata is a gram-negative rod with a phenotypic resemblance to Escherichia coli, and Lecler first described it in 1962 as Escherichia adecarboxylata
Summary
This study aimed to determine the epidemiological, microbiological, and molecular characteristics of an outbreak of carbapenem-resistant Leclercia adecarboxylata in three hospitals associated with the unintended use of contaminated total parental nutrition (TPN). TPN indications mainly include the presence of chronic intestinal obstruction, bowel pseudoobstruction with food intolerance in infants with an immature gastrointestinal system or a congenital gastrointestinal malformation, among others [1] Because manipulation of these supplements may enhance the risk for microbial contamination, absolute compliance to good manufacturing practices is required [2,3,4]. When these practices are not strictly followed, TPNrelated outbreaks may occur, commonly leading to sepsis with high mortality [5]. This bacterial species has global distribution in a variety of foods, water, and animals and exists as a commensal organism in the gut [7], and has been associated with bacteremia and wound infections and peritonitis, pneumonia, and other infections [8]
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