Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital
The genus <i>Enterobacter</i> is a member of the ESKAPE group, which contains the major resistant bacterial pathogens. <i>Enterobacter cloacae</i> complex (ECC) has emerged as a clinically significant cause of a wide variety of nosocomial infections. Carbapenem-nonsusceptible...
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MDPI AG
2022-01-01
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| author | Chao-Ju Chen Po-Liang Lu Shu-Huei Jian Hsiao-Ling Fu Po-Hao Huang Chung-Yu Chang |
| author_facet | Chao-Ju Chen Po-Liang Lu Shu-Huei Jian Hsiao-Ling Fu Po-Hao Huang Chung-Yu Chang |
| author_sort | Chao-Ju Chen |
| collection | DOAJ |
| description | The genus <i>Enterobacter</i> is a member of the ESKAPE group, which contains the major resistant bacterial pathogens. <i>Enterobacter cloacae</i> complex (ECC) has emerged as a clinically significant cause of a wide variety of nosocomial infections. Carbapenem-nonsusceptible <i>Enterobacter cloacae</i> complex (CnsECC) has become an emerging threat to public health but there is still a lack of comprehensive molecular and clinical epidemiological analysis. A total of 157 CnsECC isolates were recovered during October 2011 to August 2017. <i>hsp60</i> gene sequencing and pulsed-field gel electrophoresis (PFGE) were applied to discriminate the species, genetic clusters and clonal relatedness. All the isolates were subjected to polymerase chain reaction (PCR) analysis for carbapenemase, AmpC-type β-lactamase, and extended spectrum β-lactamase (ESBL) genes. Clinical data were collected on all patients for comparing clinical risks and outcomes between patients with carbapenemase-producing (CP)-CnsECC compared with non-CP-CnsECC infection. The most commonly identified species was <i>E. hormaechei</i> subsp. <i>hoffmannii</i> (47.1%), followed by <i>E. hormaechei</i> subsp. <i>steigerwaltii</i> (24.8%). Different species of CnsECC isolates showed heterogeneity in resistance patterns to piperacillin/tazobactam, cefepime and levofloxacin. In the present study, we observed that <i>E. hormaechei</i> subsp. <i>hoffmannii</i> was characterized with higher cefepime and levofloxacin resistance rate but lower piperacillin/tazobactam resistance rate relative to other species of CnsECC. CP-CnsECC comprised 41.1% (65 isolates) and all of these isolates carried IMP-8. In this study, 98% of patients had antimicrobial therapy prior to culture, with a total of 57/150 (38%) patients being exposed to carbapenems. Chronic pulmonary disease (OR: 2.51, 95% CI: 1.25–5.06), received ventilator support (OR: 5.54, 95% CI: 2.25–12.03), steroid exposure (OR: 3.88, 95% CI: 1.91–7.88) and carbapenems exposure (OR: 2.17, 95% CI: 1.10–4.25) were considered risk factors associated with CP-CnsECC infection. The results suggest that CP-CnsECC are associated with poorer outcomes including in-hospital mortality, 30-day mortality and 100-day mortality. Our study provides insights into the epidemic potential of IMP-8-producing <i>E. cloacae</i> for healthcare-associated infections and underscores the importance of understanding underlying resistance mechanisms of CnsECC to direct antibiotic treatment decisions. |
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| spelling | doaj.art-317fabe2cd43472e8be2dde7ff24cb972023-11-23T21:31:12ZengMDPI AGPathogens2076-08172022-01-0111215110.3390/pathogens11020151Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University HospitalChao-Ju Chen0Po-Liang Lu1Shu-Huei Jian2Hsiao-Ling Fu3Po-Hao Huang4Chung-Yu Chang5Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, TaiwanCollege of Medicine, Kaohsiung Medical University, Kaohsiung 80708, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, TaiwanM.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, TaiwanGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, TaiwanGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, TaiwanThe genus <i>Enterobacter</i> is a member of the ESKAPE group, which contains the major resistant bacterial pathogens. <i>Enterobacter cloacae</i> complex (ECC) has emerged as a clinically significant cause of a wide variety of nosocomial infections. Carbapenem-nonsusceptible <i>Enterobacter cloacae</i> complex (CnsECC) has become an emerging threat to public health but there is still a lack of comprehensive molecular and clinical epidemiological analysis. A total of 157 CnsECC isolates were recovered during October 2011 to August 2017. <i>hsp60</i> gene sequencing and pulsed-field gel electrophoresis (PFGE) were applied to discriminate the species, genetic clusters and clonal relatedness. All the isolates were subjected to polymerase chain reaction (PCR) analysis for carbapenemase, AmpC-type β-lactamase, and extended spectrum β-lactamase (ESBL) genes. Clinical data were collected on all patients for comparing clinical risks and outcomes between patients with carbapenemase-producing (CP)-CnsECC compared with non-CP-CnsECC infection. The most commonly identified species was <i>E. hormaechei</i> subsp. <i>hoffmannii</i> (47.1%), followed by <i>E. hormaechei</i> subsp. <i>steigerwaltii</i> (24.8%). Different species of CnsECC isolates showed heterogeneity in resistance patterns to piperacillin/tazobactam, cefepime and levofloxacin. In the present study, we observed that <i>E. hormaechei</i> subsp. <i>hoffmannii</i> was characterized with higher cefepime and levofloxacin resistance rate but lower piperacillin/tazobactam resistance rate relative to other species of CnsECC. CP-CnsECC comprised 41.1% (65 isolates) and all of these isolates carried IMP-8. In this study, 98% of patients had antimicrobial therapy prior to culture, with a total of 57/150 (38%) patients being exposed to carbapenems. Chronic pulmonary disease (OR: 2.51, 95% CI: 1.25–5.06), received ventilator support (OR: 5.54, 95% CI: 2.25–12.03), steroid exposure (OR: 3.88, 95% CI: 1.91–7.88) and carbapenems exposure (OR: 2.17, 95% CI: 1.10–4.25) were considered risk factors associated with CP-CnsECC infection. The results suggest that CP-CnsECC are associated with poorer outcomes including in-hospital mortality, 30-day mortality and 100-day mortality. Our study provides insights into the epidemic potential of IMP-8-producing <i>E. cloacae</i> for healthcare-associated infections and underscores the importance of understanding underlying resistance mechanisms of CnsECC to direct antibiotic treatment decisions.https://www.mdpi.com/2076-0817/11/2/151<i>Enterobacter cloacae</i> complexcarbapenemcarbapenemase-producing <i>Enterobacteriaceae</i>molecular epidemiology |
| spellingShingle | Chao-Ju Chen Po-Liang Lu Shu-Huei Jian Hsiao-Ling Fu Po-Hao Huang Chung-Yu Chang Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital Pathogens <i>Enterobacter cloacae</i> complex carbapenem carbapenemase-producing <i>Enterobacteriaceae</i> molecular epidemiology |
| title | Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital |
| title_full | Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital |
| title_fullStr | Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital |
| title_full_unstemmed | Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital |
| title_short | Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem-Nonsusceptible <i>Enterobacter cloacae</i> Complex Infections in a Taiwan University Hospital |
| title_sort | molecular epidemiology risk factors and clinical outcomes of carbapenem nonsusceptible i enterobacter cloacae i complex infections in a taiwan university hospital |
| topic | <i>Enterobacter cloacae</i> complex carbapenem carbapenemase-producing <i>Enterobacteriaceae</i> molecular epidemiology |
| url | https://www.mdpi.com/2076-0817/11/2/151 |
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