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- Title
Molecular investigation of an outbreak associated with total parenteral nutrition contaminated with NDM-producing Leclercia adecarboxylata.
- Authors
Garza-González, Elvira; Bocanegra-Ibarias, Paola; Rodríguez-Noriega, Eduardo; González-Díaz, Esteban; Silva-Sanchez, Jesús; Garza-Ramos, Ulises; Contreras-Coronado-Tovar, Iván Fernando; Santos-Hernández, José Ecil; Gutiérrez-Bañuelos, David; Mena-Ramirez, Juan Pablo; Ramírez-De-los-Santos, Saúl; Camacho-Ortiz, Adrián; Morfín-Otero, Rayo
- Abstract
<bold>Background: </bold>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).<bold>Methods: </bold>For 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.<bold>Results: </bold>All 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.<bold>Conclusion: </bold>We 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.
- Subjects
MEXICO; PARENTERAL feeding; PULSED-field gel electrophoresis; GENES; COMPARATIVE genomics; ENTEROBACTER cloacae; CARBAPENEMASE
- Publication
BMC Infectious Diseases, 2021, Vol 21, Issue 1, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-021-05923-0