A Prolonged Multispecies Outbreak of IMP-6 Carbapenemase-Producing
www.nature.com/scientificreports OPEN A prolonged multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales due to horizontal transmission of the IncN plasmid Takuya Yamagishi1,11, Mari Matsui2,11, Tsuyoshi Sekizuka3,11, Hiroaki Ito4, Munehisa Fukusumi1,4, Tomoko Uehira5, Miyuki Tsubokura6, Yoshihiko Ogawa5, Atsushi Miyamoto7, Shoji Nakamori7, Akio Tawa8, Takahisa Yoshimura9, Hideki Yoshida9, Hidetetsu Hirokawa9, Satowa Suzuki2, Tamano Matsui1, Keigo Shibayama10, Makoto Kuroda3 & Kazunori Oishi1* A multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) occurred at an acute care hospital in Japan. This study was conducted to understand the mechanisms of IMP-6-CPE transmission by pulsed-feld gel electrophoresis (PFGE), multilocus sequence typing and whole-genome sequencing (WGS), and identify risk factors for IMP-6-CPE acquisition in patients who underwent abdominal surgery. Between July 2013 and March 2014, 22 hospitalized patients infected or colonized with IMP-6-CPE (Escherichia coli [n = 8], Klebsiella oxytoca [n = 5], Enterobacter cloacae [n = 5], Klebsiella pneumoniae [n = 3] and Klebsiella aerogenes [n = 1]) were identifed. There were diverse PFGE profles and sequence types (STs) in most of the species except for K. oxytoca. All isolates of K. oxytoca belonged to ST29 with similar PFGE profles, suggesting their clonal transmission. Plasmid analysis by WGS revealed that all 22 isolates but one shared a ca. 50-kb IncN plasmid backbone with blaIMP-6 suggesting interspecies gene transmission, and typing of plasmids explained epidemiological links among cases. A case-control study showed pancreatoduodenectomy, changing drains in fuoroscopy room, continuous peritoneal lavage and enteric fstula were associated with IMP-6-CPE acquisition among the patients.
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