Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing
Objective: To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war-injured patient from Ukraine. Methods: Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicr...
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Elsevier
2024-12-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716524001735 |
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| author | Frieder Fuchs Kyriaki Xanthopoulou Tessa Burgwinkel Rocío Arazo del Pino Esther Wohlfarth Florian Pavlu Ralf M. Hagen Paul G. Higgins |
| author_facet | Frieder Fuchs Kyriaki Xanthopoulou Tessa Burgwinkel Rocío Arazo del Pino Esther Wohlfarth Florian Pavlu Ralf M. Hagen Paul G. Higgins |
| author_sort | Frieder Fuchs |
| collection | DOAJ |
| description | Objective: To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war-injured patient from Ukraine. Methods: Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core-genome MLST. Results: Seven Gram-negative pathogens (Acinetobacter baumannii (n = 2; ST78, ST2), Klebsiella pneumoniae (n = 2; ST395), Pseudomonas aeruginosa (n = 1; ST1047), Escherichia coli (n = 1; ST46), Enterobacter cloacae complex (n = 1; ST231)) were molecularly confirmed non-identical. Antimicrobial susceptibility testing showed resistance to carbapenems (7/7 isolates) and last-resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the E. cloacae complex as Enterobacter hormaechei subsp. xiangfangensis. Six acquired carbapenemase genes (blaIMP-1, blaNDM-1, blaOXA-48, blaNDM-5, blaOXA-23 and blaOXA-72) were detected. Both A. baumannii isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both K. pneumoniae isolates shared sequence type and some resistance genes on an IncR plasmid but were different in core-genome MLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant Enterococcus faecium was also detected (VanA). Conclusions: War-injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission. |
| format | Article |
| id | doaj-art-07a1d2dc0c624313b8e07f951eafa8fb |
| institution | DOAJ |
| issn | 2213-7165 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj-art-07a1d2dc0c624313b8e07f951eafa8fb2025-08-20T02:39:38ZengElsevierJournal of Global Antimicrobial Resistance2213-71652024-12-013918418810.1016/j.jgar.2024.09.005Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencingFrieder Fuchs0Kyriaki Xanthopoulou1Tessa Burgwinkel2Rocío Arazo del Pino3Esther Wohlfarth4Florian Pavlu5Ralf M. Hagen6Paul G. Higgins7Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany; Corresponding author: Mailing address: Institute for Medical Microbiology, Immunology and Hygiene, Goldenfelsstr. 19-21, 50935 Cologne, Germany.Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, GermanyInstitute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, GermanyInstitute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, GermanyAntiinfectives Intelligence GmbH, Cologne, GermanyDepartment of Trauma Surgery and Orthopaedics, Bundeswehr Central Hospital Koblenz, Koblenz, GermanyDepartment of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, GermanyInstitute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, GermanyObjective: To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war-injured patient from Ukraine. Methods: Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core-genome MLST. Results: Seven Gram-negative pathogens (Acinetobacter baumannii (n = 2; ST78, ST2), Klebsiella pneumoniae (n = 2; ST395), Pseudomonas aeruginosa (n = 1; ST1047), Escherichia coli (n = 1; ST46), Enterobacter cloacae complex (n = 1; ST231)) were molecularly confirmed non-identical. Antimicrobial susceptibility testing showed resistance to carbapenems (7/7 isolates) and last-resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the E. cloacae complex as Enterobacter hormaechei subsp. xiangfangensis. Six acquired carbapenemase genes (blaIMP-1, blaNDM-1, blaOXA-48, blaNDM-5, blaOXA-23 and blaOXA-72) were detected. Both A. baumannii isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both K. pneumoniae isolates shared sequence type and some resistance genes on an IncR plasmid but were different in core-genome MLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant Enterococcus faecium was also detected (VanA). Conclusions: War-injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission.http://www.sciencedirect.com/science/article/pii/S2213716524001735XDRUkraineWarMDROCarbapenemResistance |
| spellingShingle | Frieder Fuchs Kyriaki Xanthopoulou Tessa Burgwinkel Rocío Arazo del Pino Esther Wohlfarth Florian Pavlu Ralf M. Hagen Paul G. Higgins Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing Journal of Global Antimicrobial Resistance XDR Ukraine War MDRO Carbapenem Resistance |
| title | Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing |
| title_full | Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing |
| title_fullStr | Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing |
| title_full_unstemmed | Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing |
| title_short | Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing |
| title_sort | coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole genome sequencing |
| topic | XDR Ukraine War MDRO Carbapenem Resistance |
| url | http://www.sciencedirect.com/science/article/pii/S2213716524001735 |
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