Dataset Information

Characterization of Extensively Drug-Resistant (XDR) Carbapenemase-Producing Enterobacterales (CPE) in Canada from 2019 to 2020.

ABSTRACT: Data regarding the epidemiology of extensively drug-resistant (XDR) carbapenemase-producing Enterobacterales (CPE) in Canada are scarce. Among CPE patients identified by the Canadian Nosocomial Infection Surveillance Program, the following were each significantly associated with XDR status: international travel history; CPE acquisition from a health care exposure abroad; presence of the New Delhi metallo-β-lactamase (NDM) carbapenemase gene; E. coli sequence type (ST) 167, ST405, and ST648; E. cloaceae ST177; C. freundii ST22; and resistance to all antimicrobials except colistin, tigecycline, and ceftazidime-avibactam. IMPORTANCE Extensively drug-resistant (XDR) carbapenemase-producing Enterobacterales (CPE) are a global public health concern. XDR CPE are among the most drug-resistant and difficult-to-treat bacteria, and infected patients are likely to experience adverse outcomes. Because XDR status further reduces effective therapeutic options, it is critical for clinicians to consider resistance and therapeutic options not only in the context of a patient with CPE but also in the context of potential XDR status. Our study reports on patient characteristics associated with the acquisition of an XDR CPE. Our study also reports on the species and carbapenemases associated with XDR status among Enterobacterales identified in Canada. Among a panel of 22 antibiotics, including novel combination drugs, we showed which retained the highest activity against XDR CPE, which may help guide the selection of antibiotic treatments.

SUBMITTER: Bartoszko JJ

PROVIDER: S-EPMC9430190 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Characterization of Extensively Drug-Resistant (XDR) Carbapenemase-Producing <i>Enterobacterales</i> (CPE) in Canada from 2019 to 2020.

Bartoszko Jessica J JJ Mitchell Robyn R Katz Kevin K Mulvey Michael M Mataseje Laura L

Microbiology spectrum 20220811 4

Data regarding the epidemiology of extensively drug-resistant (XDR) carbapenemase-producing <i>Enterobacterales</i> (CPE) in Canada are scarce. Among CPE patients identified by the Canadian Nosocomial Infection Surveillance Program, the following were each significantly associated with XDR status: international travel history; CPE acquisition from a health care exposure abroad; presence of the New Delhi metallo-β-lactamase (NDM) carbapenemase gene; E. coli sequence type (ST) 167, ST405, and ST64 ...[more]

PMID: 35950772

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Project description:Hospital wastewater is an increasingly recognized reservoir for resistant Gram-negative organisms. Factors involved in establishment and persistence of Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) in hospital wastewater plumbing are unclear. This study was conducted at a hospital with endemic KPCOs linked to wastewater reservoirs and robust patient perirectal screening for silent KPCO carriage. Over 5 months, both rooms occupied and rooms not occupied by KPCO-positive patients were sampled at three wastewater sites within each room (sink drain, sink P-trap, and toilet or hopper). Risk factors for KPCO positivity were assessed using logistic regression. Whole-genome sequencing (WGS) identified environmental seeding by KPCO-positive patients. A total of 219/475 (46%) room sampling events were KPCO positive in at least one wastewater site. KPCO-positive patient exposure was associated with increased risk of environmental positivity for the room and toilet/hopper. Previous positivity and intensive care unit room type were consistently associated with increased risk. Tube feeds were associated with increased risk for the drain, while exposure to patients with Clostridioides difficile was associated with decreased risk. Urinary catheter exposure was associated with increased risk of P-trap positivity. P-trap heaters reduced risk of P-trap and sink drain positivity. WGS identified genomically linked environmental seeding in 6 of 99 room occupations by 40 KPCO-positive patients. In conclusion, KPCO-positive patients seed the environment in at least 6% of opportunities; once positive for KPCOs, wastewater sites are at greater risk of being positive subsequently. Increased nutrient exposure, e.g., due to tube food disposal down sinks, may increase risk; frequent flushing may be protective.IMPORTANCEKlebsiella pneumoniae carbapenemase-producing organisms (KPCOs) are bacteria that are resistant to most antibiotics and thus are challenging to treat when they cause infections in patients. These organisms can be acquired by patients who are hospitalized for other reasons, complicating their hospital stay and even leading to death. Hospital wastewater sites, such as sink drains and toilets, have played a role in many reported outbreaks over the past decade. The significance of our research is in identifying risk factors for environmental positivity for KPCOs, which will facilitate further work to prevent transmission of these organisms to patients from the hospital environment.

Project description:Carbapenem-resistant Enterobacterales (CRE) are divided into two distinct groups: carbapenemase-producing (CPE) and non-carbapenemase-producing (non-CPE). The population of non-CPE growing on CPE selective plates during routine screening is usually not reported and is not well defined. This study aimed to characterize non-CPE isolates growing on those plates. Isolates were collected from two medical institutions in Israel between May and November 2022. Species identification and antibiotic susceptibility testing were performed using VITEK systems. Further analyses focused on Klebsiella pneumoniae and Escherichia coli which were the most common isolates. Meropenem MIC was determined by E-test. Fourier-transform infrared spectroscopy (FTIR) was used to analyze phenotypic similarity, and whole genome sequencing was conducted on a subset of non-CPE isolates. Of 260 isolates growing on selective CPE screening plates, 60.4% were non-CPE. The most common non-CP isolates were K. pneumoniae (65.6%) followed by E. coli (20.4%). Of the non-CP K. pneumoniae and E. coli isolates, 78.2% were susceptible to meropenem. All non-CP K. pneumoniae and E. coli isolates were multidrug-resistant (MDR) and belonged to multiple FTIR clusters. The 21 sequenced non-CPE isolates carried multiple mechanisms of resistance. Isolates had multiple beta-lactamases and all had penicillin-binding protein modifications and porin mutations; in meropenem-resistant K. pneumoniae isolates, both Ompk35 and Ompk36 were mutated. The majority of isolates growing on selective CPE screening plates are non-CPE but are MDR. Laboratory reporting of these MDR bacteria might be useful for guiding treatment and prophylaxis when indicated, as well as for infection control.ImportanceSelective screening plates for carbapenemase-producing Enterobacterales (CPE) are used to detect CPE carriers for infection control purposes. We characterized non-CPE isolates that grew on selective CPE screening plates, which are intended to filter them out. We found that 60% of isolates that grew on these plates were not CPE. They included both meropenem-susceptible and meropenem-resistant isolates and were multidrug-resistant with multiple resistance mechanisms. These test results, which are usually not reported by laboratories, may be clinically valuable.

Dataset Information

Characterization of Extensively Drug-Resistant (XDR) Carbapenemase-Producing Enterobacterales (CPE) in Canada from 2019 to 2020.

Publications

Characterization of Extensively Drug-Resistant (XDR) Carbapenemase-Producing <i>Enterobacterales</i> (CPE) in Canada from 2019 to 2020.

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