title: Epidemiologic and Genotypic Review of Carbapenemase-Producing Organisms in British Columbia, Canada, between 2008 and 2014.
abstract: Carbapenemase-producing organisms (CPOs) are a serious emerging problem for health care facilities worldwide. Owing to their resistance to most antimicrobial therapies, CPOs are difficult to treat and pose a challenge for infection prevention and control. Since 2010, lab-based surveillance for CPOs and PCR-based testing were implemented in British Columbia (BC), Canada. A review of CPOs in BC from 2008 to March 2014 was done to characterize the resistance mechanisms and possible clonal strain transmission and to compare pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and plasmid restriction fragment length polymorphism (RFLP) as molecular typing tools. During this study period, a total of 177 CPO cases were identified. Patient demographics and travel history were reviewed, and a descriptive analysis was carried out. PFGE profiles, MLST, and plasmid RFLP analysis for a subset of Escherichia coli, Klebsiella pneumoniae, and Enterobacter species isolates were obtained and analyzed. Our findings demonstrate that CPOs have been increasing in number in BC over time, from 1 isolate/year retrospectively identified in 2008 and 2009 to 82 isolates in 2013 and 30 isolates in the first quarter of 2014. Overall, K. pneumoniae isolates lack clonality, although some seemingly related clusters have been found. Plasmid analysis showed evidence of the spread of plasmids carrying carbapenemase-encoding genes between the examined isolates. Analysis of Enterobacter cloacae isolates revealed a more clonal nature of these CPOs in BC. The presence of related clusters provides evidence of interpatient organism transmission both within and between institutions. Although in our study, NDM-harboring E. cloacae isolates appeared to spread clonally, the spread of carbapenem resistance in K. pneumoniae seems to be plasmid mediated.
authors.affiliation: British Columbia Center for Disease Control Public Health Laboratory, Provincial Health Services Authority, Vancouver, British Columbia, Canada Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Inna
authors.initials: I
authors.lastname: Sekirov
authors.affiliation: British Columbia Center for Disease Control Public Health Laboratory, Provincial Health Services Authority, Vancouver, British Columbia, Canada.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Croxen
authors.affiliation: British Columbia Center for Disease Control Public Health Laboratory, Provincial Health Services Authority, Vancouver, British Columbia, Canada.
authors.forename: Corrinne
authors.initials: C
authors.lastname: Ng
authors.affiliation: British Columbia Center for Disease Control Public Health Laboratory, Provincial Health Services Authority, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Azana
authors.affiliation: British Columbia Center for Disease Control Public Health Laboratory, Provincial Health Services Authority, Vancouver, British Columbia, Canada.
authors.forename: Yin
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Mataseje
authors.affiliation: Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Boyd
authors.affiliation: Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
authors.forename: Chand
authors.initials: C
authors.lastname: Mangat
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada Surrey Memorial Hospital, Fraser Health Authority, Surrey, British Columbia, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mack
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada Surrey Memorial Hospital, Fraser Health Authority, Surrey, British Columbia, Canada.
authors.forename: Manal
authors.initials: M
authors.lastname: Tadros
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada Surrey Memorial Hospital, Fraser Health Authority, Surrey, British Columbia, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brodkin
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kibsey
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Stefanovic
authors.affiliation: Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Champagne
authors.affiliation: Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mulvey
authors.affiliation: British Columbia Center for Disease Control Public Health Laboratory, Provincial Health Services Authority, Vancouver, British Columbia, Canada Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada linda.hoang@bccdc.ca.
authors.forename: Linda M N
authors.initials: LM
authors.lastname: Hoang
mesh_terms: D001419:Bacteria / Q000145:classification* / Q000235:genetics*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000266:history / Q000382:microbiology*; D001426:Bacterial Proteins / Q000096:biosynthesis / Q000235:genetics*; D001955:British Columbia / Q000453:epidemiology; D016000:Cluster Analysis; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000145:classification / Q000235:genetics; D005838:Genotype; D049674:History, 21st Century; D006801:Humans; D007711:Klebsiella pneumoniae / Q000145:classification / Q000235:genetics; D058885:Multilocus Sequence Typing; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase