title: Emergence of OXA-48 carbapenemase-producing Enterobacter cloacae ST89 infection in Poland.
abstract: BACKGROUND
  The utility of carbapenems, which are considered 'last-line' agents, is being diminished by the growing incidence of various resistance mechanisms in bacteria. We aimed to investigate the molecular mechanism of carbapenem resistance in Enterobacter cloacae recovered from a 76-year-old patient who had undergone coronary artery bypass grafting and repair of the mitral and tricuspid valves. Interestingly, the patient had no prior history of hospital admission abroad.
  
  
  METHODS
  The Carba-NP test II and synergy testing were performed to confirm carbapenemase activity. PCR was used to detect carbapenemase-encoding genes. Nucleotide and amino acid sequence analysis was performed to identify OXA-48 variants. Moreover, we performed multilocus sequence typing (MLST) of multidrug-resistant (MDR) E. cloacae.
  
  
  RESULTS
  We detected no significant increase in zone diameter around disks with inhibitors. However, the Carba-NP test II revealed carbapenemase activity in all isolates. All isolates showed the presence of the exact OXA-48 carbapenemase variant. Furthermore, MLST analysis revealed that the MDR E. cloacae isolates belonged to ST89.
  
  
  CONCLUSIONS
  We report a case of infection caused by a unique carbapenem-resistant E. cloacae ST89 producing OXA-48 carbapenemase. Interestingly, these pathogens developed resistance to other 'last-resort' agents, namely colistin and tigecycline. There is a crucial need for surveillance programs aimed at screening for carbapenemase-producing Gram-negative bacteria, especially in patients transferred from high-incidence areas.
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland. Electronic address: piotr.majewski@umb.edu.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Majewski
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wieczorek
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Paweł Tomasz
authors.initials: PT
authors.lastname: Sacha
authors.affiliation: Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Frank
authors.affiliation: Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Juszczyk
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Dominika
authors.initials: D
authors.lastname: Ojdana
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Wioletta
authors.initials: W
authors.lastname: Kłosowska
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Wieczorek
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Sieńko
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Anna Diana
authors.initials: AD
authors.lastname: Michalska
authors.affiliation: Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hirnle
authors.affiliation: Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, ul. Waszyngtona 15A, 15-629 Bialystok, Poland.
authors.forename: Elżbieta Anna
authors.initials: EA
authors.lastname: Tryniszewska
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis / Q000235:genetics*; D021821:Communicable Diseases, Emerging; D016972:Enterobacter cloacae / Q000145:classification / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D011044:Poland / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Antimicrobial drug resistance; Carbapenemase; Enterobacter cloacae; Infection control; OXA-48