Integrated Analysis of Patient Networks and Plasmid Genomes to Investigate a Regional, Multispecies Outbreak of Carbapenemase-Producing Enterobacterales Carrying Both bla<inf>IMP</inf> and mcr-9 Genes
Issued Date
2024-07-15
Resource Type
ISSN
00221899
eISSN
15376613
Scopus ID
2-s2.0-85199994432
Pubmed ID
38245822
Journal Title
Journal of Infectious Diseases
Volume
230
Issue
1
Start Page
e159
End Page
e170
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Infectious Diseases Vol.230 No.1 (2024) , e159-e170
Suggested Citation
Wan Y., Myall A.C., Boonyasiri A., Bolt F., Ledda A., Mookerjee S., Weiße A.Y., Getino M., Turton J.F., Abbas H., Prakapaite R., Sabnis A., Abdolrasouli A., Malpartida-Cardenas K., Miglietta L., Donaldson H., Gilchrist M., Hopkins K.L., Ellington M.J., Otter J.A., Larrouy-Maumus G., Edwards A.M., Rodriguez-Manzano J., Didelot X., Barahona M., Holmes A.H., Jauneikaite E., Davies F. Integrated Analysis of Patient Networks and Plasmid Genomes to Investigate a Regional, Multispecies Outbreak of Carbapenemase-Producing Enterobacterales Carrying Both bla<inf>IMP</inf> and mcr-9 Genes. Journal of Infectious Diseases Vol.230 No.1 (2024) , e159-e170. e170. doi:10.1093/infdis/jiae019 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/100251
Title
Integrated Analysis of Patient Networks and Plasmid Genomes to Investigate a Regional, Multispecies Outbreak of Carbapenemase-Producing Enterobacterales Carrying Both bla<inf>IMP</inf> and mcr-9 Genes
Author(s)
Wan Y.
Myall A.C.
Boonyasiri A.
Bolt F.
Ledda A.
Mookerjee S.
Weiße A.Y.
Getino M.
Turton J.F.
Abbas H.
Prakapaite R.
Sabnis A.
Abdolrasouli A.
Malpartida-Cardenas K.
Miglietta L.
Donaldson H.
Gilchrist M.
Hopkins K.L.
Ellington M.J.
Otter J.A.
Larrouy-Maumus G.
Edwards A.M.
Rodriguez-Manzano J.
Didelot X.
Barahona M.
Holmes A.H.
Jauneikaite E.
Davies F.
Myall A.C.
Boonyasiri A.
Bolt F.
Ledda A.
Mookerjee S.
Weiße A.Y.
Getino M.
Turton J.F.
Abbas H.
Prakapaite R.
Sabnis A.
Abdolrasouli A.
Malpartida-Cardenas K.
Miglietta L.
Donaldson H.
Gilchrist M.
Hopkins K.L.
Ellington M.J.
Otter J.A.
Larrouy-Maumus G.
Edwards A.M.
Rodriguez-Manzano J.
Didelot X.
Barahona M.
Holmes A.H.
Jauneikaite E.
Davies F.
Corresponding Author(s)
Other Contributor(s)
Abstract
Background. Carbapenemase-producing Enterobacterales (CPE) are challenging in healthcare, with resistance to multiple classes of antibiotics. This study describes the emergence of imipenemase (IMP)–encoding CPE among diverse Enterobacterales species between 2016 and 2019 across a London regional network. Methods. We performed a network analysis of patient pathways, using electronic health records, to identify contacts between IMP-encoding CPE–positive patients. Genomes of IMP-encoding CPE isolates were overlaid with patient contacts to imply potential transmission events. Results. Genomic analysis of 84 Enterobacterales isolates revealed diverse species (predominantly Klebsiella spp, Enterobacter spp, and Escherichia coli); 86% (72 of 84) harbored an IncHI2 plasmid carrying blaIMP and colistin resistance gene mcr-9 (68 of 72). Phylogenetic analysis of IncHI2 plasmids identified 3 lineages showing significant association with patient contacts and movements between 4 hospital sites and across medical specialties, which was missed in initial investigations. Conclusions. Combined, our patient network and plasmid analyses demonstrate an interspecies, plasmid-mediated outbreak of blaIMPCPE, which remained unidentified during standard investigations. With DNA sequencing and multimodal data incorporation, the outbreak investigation approach proposed here provides a framework for real-time identification of key factors causing pathogen spread. Plasmid-level outbreak analysis reveals that resistance spread may be wider than suspected, allowing more interventions to stop transmission within hospital networks.