title: Protracted Regional Dissemination of GIM-1-Producing Serratia marcescens in Western Germany.
abstract: The metallo-beta-lactamase GIM-1 has been found in various bacterial host species nearly exclusively in western Germany. However, not much is known about the epidemiology of GIM-1-positiveSerratia marcescensHere we report on a surprisingly protracted regional dissemination. In-hospital transmission was investigated by using conventional epidemiological tools to identify spatiotemporal links. Strain typing was performed using pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS). Bayesian phylogeny was used to infer the time axis of the observed occurrence. ThirteenS. marcescensstrains from 10 patients from 6 different German hospitals were investigated. Suspected in-hospital transmissions were confirmed by molecular typing at a higher resolution by WGS than by PFGE. A detailed sequence analysis demonstrated the spread of one predominant strain variant but also provided evidence for transfer of theblaGIM-1gene cassette between different strains. A Bayesian phylogenetic analysis showed that the most recent common ancestor of the identified clonal cluster could be dated back to April 1993 (95% highest posterior density interval, January 1973 to March 2003) and that this strain might have already harbored theblaGIM-1at that time and, therewith, years before the first detection of this resistance gene in clinical specimens. This study shows a long-standing clonal and plasmid-mediated expansion of GIM-1-producingS. marcescensthat might have gone unnoticed in the absence of a standardized and effective molecular screening for carbapenemases. The systematic and early detection of resistance is thus highly advisable, especially for the prevention of potentially long-term dissemination that may progress beyond control.
authors.affiliation: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Wendel
authors.affiliation: Department of Medical Microbiology, National Reference Centre for Multidrug-Resistant Gram-Negative Bacteria, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kaase
authors.affiliation: Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.|German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.
authors.forename: Ingo B
authors.initials: IB
authors.lastname: Autenrieth
authors.affiliation: Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.|German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Peter
authors.affiliation: Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.|German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Oberhettinger
authors.affiliation: Medizinisches Versorgungszentrum Dr. Stein, Division of Microbiology, Mönchengladbach, Germany.
authors.forename: Heime
authors.initials: H
authors.lastname: Rieber
authors.affiliation: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Pfeffer
authors.affiliation: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany Colin.Mackenzie@uni-duesseldorf.de.
authors.forename: Colin R
authors.identifier: 0000-0001-7732-2698
authors.initials: CR
authors.lastname: MacKenzie
authors.affiliation: Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.|German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Willmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D001499:Bayes Theorem; D002999:Clone Cells; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D016521:Electrophoresis, Gel, Pulsed-Field; D015870:Gene Expression; D016680:Genome, Bacterial; D005838:Genotype; D005858:Germany; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D010802:Phylogeny; D010957:Plasmids / Q000737:chemistry / Q000378:metabolism; D016868:Serratia Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D012706:Serratia marcescens / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000254:growth & development; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Serratia; beta-lactamases; infection control; molecular epidemiology