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Multispecies outbreak of VIM-producing multidrug resistant bacteria driven by a promiscuous IncA/C2 plasmid
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2 01 2021
Source: Clin Infect Dis. 72(3):414-420 -
Alternative Title:Clin Infect Dis
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Personal Author:
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Description:Background:
Antibiotic resistance is often spread through bacterial populations via conjugative plasmids. However, plasmid transfer is not well recognized in clinical settings because of technical limitations and healthcare- associated infections are usually caused by clonal transmission of a single pathogen. In 2015, multiple species of carbapenem-resistant Enterobacteriaceae (CRE), all producing a rare carbapenemase, were identified among patients in an intensive care unit (ICU). This observation suggested a large, previously unrecognized plasmid transmission chain and prompted our investigation.
Methods:
Electronic medical record review, infection control observations, and environmental sampling completed the epidemiologic outbreak investigation. Laboratory analysis, conducted on patient and environmental isolates, included long-read whole genome sequencing to fully elucidate plasmid DNA structures. Bioinformatics analyses were applied to infer plasmid transmission chains and results were subsequently confirmed using plasmid conjugation experiments.
Results:
Fourteen VIM-producing CRE were identified in twelve patients, and one additional isolate was obtained from a patient room sink drain. Whole genome sequencing identified horizontal transfer of blaVIM-1, a rare carbapenem resistance mechanism in the United States, via a promiscuous IncA/C2 plasmid which spread among five bacterial species isolated from patients and the environment.
Conclusions:
This investigation represents the largest known outbreak of VIM-producing CRE in the United States to date and comprises numerous bacterial species and strains. We present evidence of in-hospital plasmid transmission, as well as environmental contamination. Our findings demonstrate the potential for two types of hospital-acquired infection outbreaks: those due to clonal expansion and those due to spread of conjugative plasmids encoding antibiotic resistance across species.
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Pubmed ID:32255490
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Pubmed Central ID:PMC10327870
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