title: Intra- and inter-species spread of carbapenemase genes in a non-hospitalized patient.
abstract: The purpose of this study was to report intra- and inter-species spread of carbapenemase genes between gram negative rods isolated from a non-hospitalized patient with bacteremia. The approach included chart review, antibiotic susceptibility testing and phenotypic screening for metallo-β-lactamase (MBL) detection, PCR and sequencing of bla, aac(6')-Ib and qnr genes, and plasmid analysis by PCR-based replicon typing. The clonal relationships between the isolates were analysed by comparing PFGE profiles. A non-hospitalized patient presented bacteraemia due to wild type Enterobacter cloacae (4.08), a VIM-1-producing E. cloacae (5.08), a VIM-1- and CTX-M-9-producing E. cloacae (7.08), a VIM-2-producing Pseudomonas aeruginosa, and catheter colonization by VIM-1-producing Klebsiella oxytoca. The patient had no previous hospitalization but had recently undergone an ambulatory colonoscopy. In E. cloacae 7.08 and K. oxytoca isolates, the bla(VIM-1) gene was located on a transferable plasmid of 48.5 kb, while in E. cloacae 5.08 the bla(VIM-1) gene was encoded on a 194 kb non-transferable plasmid. The bla(CTX-M-9) gene detected in E. cloacae was encoded on an HI2 plasmid of 290 kb. To date the prevalence of VIM-1 enzymes in the community is low. This molecular finding suggests an intra-species and/or inter-species horizontal spread of the MBL gene in the same non-hospitalized patient.
authors.affiliation: Service of Internal Medicine and Infectious Diseases, Hospital Universitari del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Sorlí
authors.forename: E
authors.initials: E
authors.lastname: Miró
authors.forename: C
authors.initials: C
authors.lastname: Segura
authors.forename: F
authors.initials: F
authors.lastname: Navarro
authors.forename: S
authors.initials: S
authors.lastname: Grau
authors.forename: M
authors.initials: M
authors.lastname: Salvado
authors.forename: J P
authors.initials: JP
authors.lastname: Horcajada
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology; D001426:Bacterial Proteins / Q000235:genetics*; D057785:Catheters / Q000382:microbiology; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D022761:Gene Transfer, Horizontal; D005838:Genotype; D006090:Gram-Negative Bacteria / Q000145:classification / Q000201:enzymology* / Q000235:genetics* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D010957:Plasmids / Q000032:analysis; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase