Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019
Abstract Objectives: Molecular epidemiological description of an OXA-48 CPE outbreak affecting a tertiary-care hospital ward in Ireland over an extended period (2018–2019). Methods: Microbiological testing and whole-genome sequencing (WGS) were performed on all 56 positive OXA-48 outbreak case i...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X21002060/type/journal_article |
| _version_ | 1811157212313157632 |
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| author | Carina Brehony Lisa Domegan Margaret Foley Margaret Fitzpatrick Jacqueline P. Cafferkey Karina O’Connell Binu Dinesh Eleanor McNamara Fionnuala Duffy Fidelma Fitzpatrick Karen Burns |
| author_facet | Carina Brehony Lisa Domegan Margaret Foley Margaret Fitzpatrick Jacqueline P. Cafferkey Karina O’Connell Binu Dinesh Eleanor McNamara Fionnuala Duffy Fidelma Fitzpatrick Karen Burns |
| author_sort | Carina Brehony |
| collection | DOAJ |
| description |
Abstract
Objectives:
Molecular epidemiological description of an OXA-48 CPE outbreak affecting a tertiary-care hospital ward in Ireland over an extended period (2018–2019).
Methods:
Microbiological testing and whole-genome sequencing (WGS) were performed on all 56 positive OXA-48 outbreak case isolates.
Results:
In total, 7 different species were identified: Enterobacter hormaechei (n = 35, 62.5%), Escherichia coli (n = 12, 21.4%), Klebsiella pneumoniae (n = 5, 8.9%), Klebsiella oxytoca (n = 1, 1.8%), Klebsiella michiganensis (n = 1, 1.8%), Citrobacter freundii (n = 1, 1.8%), and Serratia marcesens (n = 1, 1.8%). E. hormaechei ST78 was the most common genotype (n = 14, 25%). Two major pOXA-48 plasmid types were identified throughout the outbreak, ‘types’ 1 and 2, and 5 major E. hormaechei clonal groupings were identified: ST78, ST108, ST1126, ST135, and ST66. Within each of the ST108, ST1126, ST135 and ST66 groups, the pOXA-48 harbored within each isolate were the same. Within ST78, 9 isolates contained the pOXA48 ‘type 2’ plasmid and 5 contained the ‘type 1’ plasmid. Environmental specimens were taken from different outbreak ward locations: handwash basins, sink and shower drains, and taps. Of 394 environmental specimens, OXA-48 CPE was isolated from 26 (6.6%).
Conclusions:
This prolonged outbreak of OXA-48 CPE was confined to one ward, but it exemplifies the complexity and difficulty in the control of these organisms. With multiple species and genotypes involved, they may be better described as ‘plasmid outbreaks.’ WGS provided insights into this diversity and potential transmission among cases, though its usefulness would be enhanced by analysis as close as possible to real time so that interventions can be implemented as soon as data are available.
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| first_indexed | 2024-04-10T05:03:19Z |
| format | Article |
| id | doaj.art-1fcccf5f427e41b6a58c7c5fd84eb644 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:03:19Z |
| publishDate | 2021-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-1fcccf5f427e41b6a58c7c5fd84eb6442023-03-09T12:27:47ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2021-01-01110.1017/ash.2021.206Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019Carina Brehony0https://orcid.org/0000-0002-2967-2762Lisa Domegan1Margaret Foley2Margaret Fitzpatrick3Jacqueline P. Cafferkey4Karina O’Connell5Binu Dinesh6Eleanor McNamara7Fionnuala Duffy8Fidelma Fitzpatrick9Karen Burns10European Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden Public Health Laboratory, Cherry Orchard, Health Service Executive, Dublin, IrelandEuropean Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden Health Service Executive, Health Protection Surveillance Centre, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, IrelandPublic Health Laboratory, Cherry Orchard, Health Service Executive, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, IrelandDepartment of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland Abstract Objectives: Molecular epidemiological description of an OXA-48 CPE outbreak affecting a tertiary-care hospital ward in Ireland over an extended period (2018–2019). Methods: Microbiological testing and whole-genome sequencing (WGS) were performed on all 56 positive OXA-48 outbreak case isolates. Results: In total, 7 different species were identified: Enterobacter hormaechei (n = 35, 62.5%), Escherichia coli (n = 12, 21.4%), Klebsiella pneumoniae (n = 5, 8.9%), Klebsiella oxytoca (n = 1, 1.8%), Klebsiella michiganensis (n = 1, 1.8%), Citrobacter freundii (n = 1, 1.8%), and Serratia marcesens (n = 1, 1.8%). E. hormaechei ST78 was the most common genotype (n = 14, 25%). Two major pOXA-48 plasmid types were identified throughout the outbreak, ‘types’ 1 and 2, and 5 major E. hormaechei clonal groupings were identified: ST78, ST108, ST1126, ST135, and ST66. Within each of the ST108, ST1126, ST135 and ST66 groups, the pOXA-48 harbored within each isolate were the same. Within ST78, 9 isolates contained the pOXA48 ‘type 2’ plasmid and 5 contained the ‘type 1’ plasmid. Environmental specimens were taken from different outbreak ward locations: handwash basins, sink and shower drains, and taps. Of 394 environmental specimens, OXA-48 CPE was isolated from 26 (6.6%). Conclusions: This prolonged outbreak of OXA-48 CPE was confined to one ward, but it exemplifies the complexity and difficulty in the control of these organisms. With multiple species and genotypes involved, they may be better described as ‘plasmid outbreaks.’ WGS provided insights into this diversity and potential transmission among cases, though its usefulness would be enhanced by analysis as close as possible to real time so that interventions can be implemented as soon as data are available. https://www.cambridge.org/core/product/identifier/S2732494X21002060/type/journal_article |
| spellingShingle | Carina Brehony Lisa Domegan Margaret Foley Margaret Fitzpatrick Jacqueline P. Cafferkey Karina O’Connell Binu Dinesh Eleanor McNamara Fionnuala Duffy Fidelma Fitzpatrick Karen Burns Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019 Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019 |
| title_full | Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019 |
| title_fullStr | Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019 |
| title_full_unstemmed | Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019 |
| title_short | Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018–2019 |
| title_sort | molecular epidemiology of an extended multiple species oxa 48 cpe outbreak in a hospital ward in ireland 2018 2019 |
| url | https://www.cambridge.org/core/product/identifier/S2732494X21002060/type/journal_article |
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