Integrated analysis of patient networks and plasmid genomes reveals a regional, multi-species outbreak of carbapenemase-producing Enterobacterales carrying both blaIMP and mcr-9 genes
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America..
BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) are challenging in healthcare, with resistance to multiple classes of antibiotics. This study describes the emergence of IMP-encoding CPE amongst diverse Enterobacterales species between 2016 and 2019 across a London regional network.
METHODS: We performed a network analysis of patient pathways, using electronic health records, to identify contacts between IMP-encoding CPE positive patients. Genomes of IMP-encoding CPE isolates were overlayed with patient contacts to imply potential transmission events.
RESULTS: Genomic analysis of 84 Enterobacterales isolates revealed diverse species (predominantly Klebsiella spp, Enterobacter spp, E. coli); 86% (72/84) harboured an IncHI2 plasmid carrying blaIMP and colistin resistance gene mcr-9 (68/72). Phylogenetic analysis of IncHI2 plasmids identified three lineages showing significant association with patient contacts and movements between four hospital sites and across medical specialities, which was missed on initial investigations.
CONCLUSIONS: Combined, our patient network and plasmid analyses demonstrate an interspecies, plasmid-mediated outbreak of blaIMPCPE, which remained unidentified during standard investigations. With DNA sequencing and multi-modal data incorporation, the outbreak investigation approach proposed here provides a framework for real-time identification of key factors causing pathogen spread. Plasmid-level outbreak analysis reveals that resistance spread may be wider than suspected, allowing more interventions to stop transmission within hospital networks.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
The Journal of infectious diseases - (2024) vom: 20. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wan, Yu [VerfasserIn] |
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| Links: |
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| Themen: |
Carbapenem-resistant Enterobacterales |
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| Anmerkungen: |
Date Revised 28.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1093/infdis/jiae019 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367363127 |
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| 100 | 1 | |a Wan, Yu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Integrated analysis of patient networks and plasmid genomes reveals a regional, multi-species outbreak of carbapenemase-producing Enterobacterales carrying both blaIMP and mcr-9 genes |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 28.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. | ||
| 520 | |a BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) are challenging in healthcare, with resistance to multiple classes of antibiotics. This study describes the emergence of IMP-encoding CPE amongst diverse Enterobacterales species between 2016 and 2019 across a London regional network | ||
| 520 | |a METHODS: We performed a network analysis of patient pathways, using electronic health records, to identify contacts between IMP-encoding CPE positive patients. Genomes of IMP-encoding CPE isolates were overlayed with patient contacts to imply potential transmission events | ||
| 520 | |a RESULTS: Genomic analysis of 84 Enterobacterales isolates revealed diverse species (predominantly Klebsiella spp, Enterobacter spp, E. coli); 86% (72/84) harboured an IncHI2 plasmid carrying blaIMP and colistin resistance gene mcr-9 (68/72). Phylogenetic analysis of IncHI2 plasmids identified three lineages showing significant association with patient contacts and movements between four hospital sites and across medical specialities, which was missed on initial investigations | ||
| 520 | |a CONCLUSIONS: Combined, our patient network and plasmid analyses demonstrate an interspecies, plasmid-mediated outbreak of blaIMPCPE, which remained unidentified during standard investigations. With DNA sequencing and multi-modal data incorporation, the outbreak investigation approach proposed here provides a framework for real-time identification of key factors causing pathogen spread. Plasmid-level outbreak analysis reveals that resistance spread may be wider than suspected, allowing more interventions to stop transmission within hospital networks | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a IMP carbapenemase | |
| 650 | 4 | |a carbapenem-resistant Enterobacterales | |
| 650 | 4 | |a horizontal gene transfer | |
| 650 | 4 | |a patient pathways | |
| 650 | 4 | |a spatiotemporal network | |
| 700 | 1 | |a Myall, Ashleigh C |e verfasserin |4 aut | |
| 700 | 1 | |a Boonyasiri, Adhiratha |e verfasserin |4 aut | |
| 700 | 1 | |a Bolt, Frances |e verfasserin |4 aut | |
| 700 | 1 | |a Ledda, Alice |e verfasserin |4 aut | |
| 700 | 1 | |a Mookerjee, Siddharth |e verfasserin |4 aut | |
| 700 | 1 | |a Weiße, Andrea Y |e verfasserin |4 aut | |
| 700 | 1 | |a Getino, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Turton, Jane F |e verfasserin |4 aut | |
| 700 | 1 | |a Abbas, Hala |e verfasserin |4 aut | |
| 700 | 1 | |a Prakapaite, Ruta |e verfasserin |4 aut | |
| 700 | 1 | |a Sabnis, Akshay |e verfasserin |4 aut | |
| 700 | 1 | |a Abdolrasouli, Alireza |e verfasserin |4 aut | |
| 700 | 1 | |a Malpartida-Cardenas, Kenny |e verfasserin |4 aut | |
| 700 | 1 | |a Miglietta, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Donaldson, Hugo |e verfasserin |4 aut | |
| 700 | 1 | |a Gilchrist, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Hopkins, Katie L |e verfasserin |4 aut | |
| 700 | 1 | |a Ellington, Matthew J |e verfasserin |4 aut | |
| 700 | 1 | |a Otter, Jonathan A |e verfasserin |4 aut | |
| 700 | 1 | |a Larrouy-Maumus, Gerald |e verfasserin |4 aut | |
| 700 | 1 | |a Edwards, Andrew M |e verfasserin |4 aut | |
| 700 | 1 | |a Rodriguez-Manzano, Jesus |e verfasserin |4 aut | |
| 700 | 1 | |a Didelot, Xavier |e verfasserin |4 aut | |
| 700 | 1 | |a Barahona, Mauricio |e verfasserin |4 aut | |
| 700 | 1 | |a Holmes, Alison H |e verfasserin |4 aut | |
| 700 | 1 | |a Jauneikaite, Elita |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Frances |e verfasserin |4 aut | |
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