title: Clonal Dissemination of Enterobacter cloacae Harboring blaKPC-3 in the Upper Midwestern United States.
abstract: Carbapenemase-producing, carbapenem-resistant Enterobacteriaceae, or CP-CRE, are an emerging threat to human and animal health, because they are resistant to many of the last-line antimicrobials available for disease treatment. Carbapenemase-producing Enterobacter cloacae harboring blaKPC-3 recently was reported in the upper midwestern United States and implicated in a hospital outbreak in Fargo, North Dakota (L. M. Kiedrowski, D. M. Guerrero, F. Perez, R. A. Viau, L. J. Rojas, M. F. Mojica, S. D. Rudin, A. M. Hujer, S. H. Marshall, and R. A. Bonomo, Emerg Infect Dis 20:1583-1585, 2014, http://dx.doi.org/10.3201/eid2009.140344). In early 2009, the Minnesota Department of Health began collecting and screening CP-CRE from patients throughout Minnesota. Here, we analyzed a retrospective group of CP-E. cloacae isolates (n = 34) collected between 2009 and 2013. Whole-genome sequencing and analysis revealed that 32 of the strains were clonal, belonging to the ST171 clonal complex and differing collectively by 211 single-nucleotide polymorphisms, and it revealed a dynamic clone under positive selection. The phylogeography of these strains suggests that this clone existed in eastern North Dakota and western Minnesota prior to 2009 and subsequently was identified in the Minneapolis and St. Paul metropolitan area. All strains harbored identical IncFIA-like plasmids conferring a CP-CRE phenotype and an additional IncX3 plasmid. In a single patient with multiple isolates submitted over several months, we found evidence that these plasmids had transferred from the E. cloacae clone to an Escherichia coli ST131 bacterium, rendering it as a CP-CRE. The spread of this clone throughout the upper midwestern United States is unprecedented for E. cloacae and highlights the importance of continued surveillance to identify such threats to human health.
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Hargreaves
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Shaw
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Ginette
authors.initials: G
authors.lastname: Dobbins
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Snippes Vagnone
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Harper
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Dave
authors.initials: D
authors.lastname: Boxrud
authors.affiliation: Minnesota Department of Health, St. Paul, Minnesota, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.affiliation: Division of Pathogen Genomics, the Translational Genomics Research Institute, Flagstaff, Arizona, USA Department of Occupational and Environmental Health, George Washington University, Washington, DC, USA.
authors.forename: Maliha
authors.initials: M
authors.lastname: Aziz
authors.affiliation: Division of Pathogen Genomics, the Translational Genomics Research Institute, Flagstaff, Arizona, USA Department of Occupational and Environmental Health, George Washington University, Washington, DC, USA.
authors.forename: Lance B
authors.initials: LB
authors.lastname: Price
authors.affiliation: Minnesota Supercomputing Institute, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Kevin A T
authors.initials: KA
authors.lastname: Silverstein
authors.affiliation: Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Danzeisen
authors.affiliation: Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Youmans
authors.affiliation: Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Case
authors.affiliation: Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, Minnesota, USA Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Srinand
authors.initials: S
authors.lastname: Sreevatsan
authors.affiliation: Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, Minnesota, USA joh04207@umn.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Johnson
mesh_terms: D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D016972:Enterobacter cloacae / Q000187:drug effects* / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000382:microbiology* / Q000635:transmission; D016680:Genome, Bacterial; D005843:Geography; D006801:Humans; D008826:Microbial Sensitivity Tests; D015146:Midwestern United States; D008910:Minnesota; D009658:North Dakota; D010957:Plasmids / Q000235:genetics; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D004269:DNA, Bacterial; D001618:beta-Lactamases; C498060:beta-lactamase KPC-3, Enterobacter cloacae