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Resistance genes shared among unrelated bacteria in CRE outbreak
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ATLANTA — Researchers found that antimicrobial resistance genes were shared among unrelated bacteria during an outbreak of carbapenem-resistant Enterobacteriaceae in a Kentucky hospital, according to findings presented at ASM Microbe.
“Clinicians should be aware that infections due to rare resistance genes in unrelated bacteria may indicate a single antimicrobial resistance plasmid-mediated outbreak,” Richard Stanton, PhD, health scientist in the CDC’s Division of Healthcare Quality Promotion, told Infectious Disease News. “Rapid identification of antibiotic resistant threats is critical for aggressive response and control through colonization screening and implementation of appropriate infection control measures, such as contact precautions.”
Stanton and colleagues investigated an outbreak of CRE that occurred during a 6-month period in 2016 and 2017 at an acute-care hospital in Kentucky. They sequenced 18 clinical isolates — 16 Klebsiella pneumoniae and two Escherichia coli isolates — and determined the infections were caused by bacteria carrying one of two different antimicrobial resistance plasmids with different carbapenemases that were circulating among unrelated bacteria, Stanton said.
“These findings show that horizontal transfer of antimicrobial resistance genes can occur between otherwise unrelated strains and species of CRE,” he said.
Stanton and colleagues noted that CRE is responsible for more than 9,000 health care-associated infections and 600 deaths per year.
“Although a reservoir was not identified, this investigation highlights that environmental cleaning is a critical component in infection control efforts, as plasmid exchange can occur in areas of dense bacterial growth, such as in biofilms,” Stanton said.
He said the findings have impacted how health care-associated outbreaks are investigated.
“With the development of long-read next generation sequencing technology, we now have the ability to detect plasmid-mediated outbreaks spanning multiple bacterial species. Traditional laboratory methods would not identify these outbreaks,” Stanton said. “Due to these advances and our outbreak response experiences, we now recognize two types of health care-associated outbreaks: those due to a single pathogen and those due to mobile antimicrobial resistance plasmids spreading antibiotic resistance across pathogens.” – by Bruce Thiel
Reference:
Stanton RA, et al. Abstract 702. Presented at: ASM Microbe; June 7-11, 2018; Atlanta.
Disclosure: The authors report no relevant financial disclosures.