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- Title
Strain-specific transmission in an outbreak of ESBL-producing Enterobacteriaceae in the hemato-oncology care unit: a cohort study.
- Authors
Makiko Uemura; Osamu Imataki; Shumpei Uchida; Haruyuki Nakayama-Imaohji; Yukiko Ohue; Harumi Matsuka; Hatsune Mori; Hiroaki Dobashi; Tomomi Kuwahara; Norimitsu Kadowaki; Uemura, Makiko; Imataki, Osamu; Uchida, Shumpei; Nakayama-Imaohji, Haruyuki; Ohue, Yukiko; Matsuka, Harumi; Mori, Hatsune; Dobashi, Hiroaki; Kuwahara, Tomomi; Kadowaki, Norimitsu
- Abstract
<bold>Background: </bold>Extended-spectrum β-lactamase (ESBL)-producing bacteria are resistant to several types of antibiotics excluding carbapenems. A transmissibility of ESBL-producing Enterobacteriaceae would be depending on each bacterial property, however, that has not been elucidated in clinical setting. In this study, we attempted to identify the source of an outbreak of ESBL-producing bacteria in a medical oncology and immunology care unit.<bold>Methods: </bold>An ESBL-producing Enterobacteriaceae (ESBL-E) outbreak observed between July 2012 and August 2012 in Kagawa University Hospital was surveyed using various molecular microbiology techniques. We used Pulsed-field gel electrophoresis (PFGE), PCR-based ESBL gene typing, and direct sequence of ESBL gene as molecular microbiology typing method to distinguish each strain.<bold>Results: </bold>The typical prevalence of ESBL-E isolation in the unit was 7.0 per month (1.7 per week). The prevalence of ESBL-E isolation during the target research period was 20.0 per month (5.0 per week). In total, 19 isolates (11 K. pneumoniae and 8 E. coli) were obtained from clinical samples, including four control strains (two each of both bacteria), that were physically different from those obtained from other inpatient units in our hospital. Pulsed-field gel electrophoresis (PFGE) for K. pneumoniae (digested by XbaI) produced similar patterns excluding one control strain. PCR classification of the ESBL gene for K. pneumoniae revealed that all strains other than the control strain carried SHV and CTX-M-9. This result was reconfirmed by direct DNA sequencing. Although the outbreak of K. pneumoniae was considered to be "clonal," PFGE and PCR classification of the ESBL genes for E. coli uncovered at least six different "non-clonal" strains possessing individual ESBL gene patterns. According to the result of an antibiogram, the pattern of antimicrobial susceptibility was more variable for K. pneumoniae than for E. coli.<bold>Conclusions: </bold>Typing by PFGE and ESBL gene PCR analysis is practical for discriminating various organisms. In our cohort, two outbreaks were concomitantly spread with different transmission strategies, namely clonal and non-clonal, in the same unit. This might represent clinical evidence that transmissibility differs according to the type of strain. We speculated that patient-to-patient transmission of ESBL-E occurred according to the properties of each individual strain.
- Subjects
JAPAN; BETA lactamases; ENTEROBACTERIACEAE diseases; ONCOLOGY; CARBAPENEMS; MOLECULAR microbiology; KLEBSIELLA pneumoniae; MULTIDRUG resistance in bacteria; NUCLEOTIDE sequencing; PREVENTION; INFECTIOUS disease transmission; ENTEROBACTERIACEAE; DISEASE outbreaks; ESCHERICHIA coli; ESCHERICHIA coli diseases; GENETIC techniques; HOSPITAL wards; HYDROLASES; KLEBSIELLA; LONGITUDINAL method; MICROBIAL sensitivity tests; POLYMERASE chain reaction; PULSED-field gel electrophoresis; KLEBSIELLA infections
- Publication
BMC Infectious Diseases, 2017, Vol 17, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-016-2144-4