Genomic epidemiology, antimicrobial resistance and virulence factors of <i>Enterobacter cloacae</i> complex causing potential community-onset bloodstream infections in a tertiary care hospital of Nepal.
Nguyen Thi Nguyen, To
Pham, Duy Thanh
Rabaa, Maia A
Dixit, Sameer M
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Manandhar, S., Nguyen, Q., Nguyen Thi Nguyen, T., Pham, D. T., Rabaa, M. A., Dongol, S., Basnyat, B., et al. (2022). Genomic epidemiology, antimicrobial resistance and virulence factors of <i>Enterobacter cloacae</i> complex causing potential community-onset bloodstream infections in a tertiary care hospital of Nepal.. JAC-antimicrobial resistance, 4 (3) https://doi.org/10.1093/jacamr/dlac050
<h4>Objectives</h4>Community-onset bloodstream infections (BSIs) caused by carbapenemase-producing <i>Enterobacter cloacae</i> complex (ECC) species are increasing internationally. This observation suggests that ECC are emerging pathogens, requiring for detailed understanding on their genomic epidemiology including transmission dynamics and antimicrobial resistance profiles.<h4>Patients and methods</h4>We performed WGS on 79 <i>Enterobacter</i> spp. isolated from the patients with clinically significant BSIs and admitted to emergency department of a major tertiary hospital in Nepal between April 2016 and October 2017.<h4>Results</h4>We identified 5 species and 13 STs of ECC. <i>Enterobacter xiangfangensis</i> ST171, one of the globally emerging carbapenem resistant ECC clones with epidemic potential, was the most prevalent (42%). Phylogenetic analysis showed a large (>19 400 SNPs) core genome SNP distance across major STs, which was minimal (<30 SNPs) among the isolates of each prevalent ST, suggesting the relatively recent importation of major STs followed by local clonal expansions. Genomic evidence for resistance to all major antimicrobial classes except for colistin and macrolides was detected. A limited number of isolates also carried <i>bla</i> <sub>NDM-1</sub> (<i>n </i>= 2) and <i>bla</i> <sub>OXA-48</sub> (<i>n </i>= 1) carbapenemase genes. Virulence factors encoding siderophores (24%), T6SSD (25%) and fimbriae (54%) were detected.<h4>Conclusions</h4>Our study highlighted that MDR ECC clones are important pathogens of BSIs in community. Though of low prevalence, carbapenem resistance observed in our ECC isolates raised concern about further community dissemination, underscoring the need for community surveillance to identify MDR ECC clones with epidemic potential.
Royal Society (100087/14/Z)
Oak Foundation (AK OCAY-15-547)
Wellcome Trust (100087)
External DOI: https://doi.org/10.1093/jacamr/dlac050
This record's URL: https://www.repository.cam.ac.uk/handle/1810/338896
Attribution-NonCommercial 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc/4.0/