Intestinal co-colonization with different carbapenemase-producing <i>Enterobacterales</i> isolates is not a rare event in an OXA-48 endemic area.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 31709416.
- Also identified by DOI 10.1016/j.eclinm.2019.09.005 and PMC identifier 6833436.
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Abstract
The current spread of carbapenemase-producing <i>Enterobacterales</i> (CPE) is a great concern. We recovered 198 CPE from 162 patients admitted in our Hospital (March 2014-March 2016) during the R-GNOSIS European Project. Microbiological features and plasmid characteristics of CPE recovered from patients co-colonized with multiple CPE were studied. Thirty patients (18.5%; CI 95%= 12.5%-24.5%) presented co-colonization with multiple CPE producing the same (CPE-SC) (15.4%) or a different carbapenemase (CPE-DC) (4.3%). OXA-48 (83.3%) was the most frequent carbapenemase, followed by VIM-1 (26.7%), NDM-1 (10%) and KPC-3 (3.3%). CPE-DC-patients had longer admissions [63 days (20-107)] than the other patients. Moreover, hospital stay until CPE detection was lower [9 days (5-14)] (<i>p</i> = 0.0052) in CPE-SC-patients than in those with a single colonization; 56% showed co-colonization in the first positive sample, although most of them had previous admissions and had received multiple antibiotic treatments. CPE were more frequently recovered in clinical samples from co-colonized [CPE-DC (28.6%), CPE-SC (24%)] patients than from patients with a single CPE (15.2%). Among CPE-SC-OXA-48 [80% (<i>p</i> = 0.11)], <i>K. pneumoniae</i> [88% (<i>p</i> = 0.006)] and <i>E. coli</i> [84% (<i>p</i> < 0.001)] were the most frequent species. In 60% of patients, <i>K. pneumoniae</i> and <i>E. coli</i> species were simultaneously recovered, frequently after a single OXA-48-<i>K. pneumoniae</i> colonization. High-risk clones (ST11, ST15, ST307) were detected in OXA-48-<i>K. pneumoniae</i> but a higher clonal diversity was found among <i>E. coli</i>. A frequent <i>in-vivo</i> cross-species plasmid transmission was shown, due to a dominant plasmid (IncL-pOXA-48), but also involving related or unrelated <i>bla</i> <sub>VIM-1</sub>-, <i>bla</i> <sub>NDM-1</sub>- and <i>bla</i> <sub>KPC-3</sub>-encoding plasmids. CPE co-colonization status should be monitored during epidemiological surveillance cultures, as these patients might be at a higher risk for infection. European Commission Framework Programme 7 and Instituto de Salud Carlos III, Spain.