title: Dissemination of multiresistant Enterobacter cloacae isolates producing OXA-48 and CTX-M-15 in a Spanish hospital.
abstract: Twenty-one multiresistant Enterobacter cloacae isolates producing OXA-48 (n=10), CTX-M-15 (n=7) or both (n=4) β-lactamases were detected in a Spanish hospital during a 1-year period (June 2013 to June 2014). The isolates were also resistant to non-β-lactam antimicrobials, further complicating the therapeutic options. Genotyping of the isolates identified two major clones (ST74 and ST66) that caused prolonged outbreaks in different buildings of the hospital as well as some sporadic isolates (ST78, ST45 and ST295). Isolates belonging to clone 1 (n=7) were carbapenem-resistant and carried the bla(OXA-48) gene on a conjugative IncL/M plasmid of ca. 65 kb. Clone 2 isolates (n=11) were resistant to cefepime and harboured the bla(CTX-M-15) gene on an ca. 150-kb, non-conjugative plasmid of the IncF group, co-harbouring the qnrB and aac(6')-Ib-cr genes encoding quinolone resistance. Four clone 2 isolates were also resistant to carbapenems owing to the co-production of OXA-48. Most of the isolates were recovered from critically ill patients and were admitted to intensive care units; a single patient was transferred from another Spanish hospital. Intrahospital and interhospital dissemination of multiresistant E. cloacae isolates is of major clinical concern as it could lead to endemic nosocomial situations.
authors: Department of Functional Biology, Section of Microbiology, University of Oviedo, Oviedo, Spain; Service of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Javier
authors: J
authors: Fernández
authors: Department of Functional Biology, Section of Microbiology, University of Oviedo, Oviedo, Spain.
authors: Ignacio
authors: I
authors: Montero
authors: Service of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Óscar
authors: Ó
authors: Martínez
authors: Service of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Ana
authors: A
authors: Fleites
authors: Medical and Molecular Microbiology, 'Emerging Antibiotic Resistance' Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland.
authors: Laurent
authors: L
authors: Poirel
authors: Medical and Molecular Microbiology, 'Emerging Antibiotic Resistance' Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland; HFR - Hôpital Cantonal, Fribourg, Switzerland.
authors: Patrice
authors: P
authors: Nordmann
authors: Department of Functional Biology, Section of Microbiology, University of Oviedo, Oviedo, Spain. Electronic address: rrodicio@uniovi.es.
authors: M Rosario
authors: MR
authors: Rodicio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D024881:Drug Resistance, Bacterial; D016972:Enterobacter cloacae / Q000145:classification / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D013030:Spain / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001618:beta-Lactamases
keywords: CTX-M-15; Carbapenemase; Enterobacter cloacae; Nosocomial outbreak; OXA-48; Plasmid-mediated quinolone resistance