Highlights
- •We observed 5 inpatients with carbapenemase-producing Enterobacter cloacae complex.
- •Pulsed-field gel electrophoresis patterns for 2 patient isolates were identical.
- •These 2 patients were in the same intensive care unit room 13 days apart.
- •Whole genome sequencing showed that these 2 isolates were closely related.
- •All isolates matched the clonal lineage of the main circulating strain in the region.
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.
Key Words
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Article info
Publication history
Published online: January 31, 2019
Footnotes
Funding/support: Funding provided in part by the US Centers for Disease Control and Prevention Emerging Infections Program Cooperative Agreement 5U50CK000204-05, and the Epidemiology and Laboratory Capacity Cooperative Agreement 5 NU50CK000371-03-00.
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
