A Nosocomial Respiratory Infection Outbreak of Carbapenem-Resistant Escherichia coli ST131 With Multiple Transmissible blaKPC–2 Carrying Plasmids

• Main Authors: Lin Gong, Na Tang, Dongke Chen, Kaiwen Sun, Ruiting Lan, Wen Zhang, Haijian Zhou, Min Yuan, Xia Chen, Xiaofei Zhao, Jie Che, Xuemei Bai, Yunfei Zhang, Hongtao Xu, Timothy R. Walsh, Jinxing Lu, Jianguo Xu, Juan Li, Jie Feng
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-09-01
• Series: Frontiers in Microbiology
• Subjects: blaKPC–2; Escherichia coli ST131; outbreak; respiratory infection; transmissible plasmids
• Online Access: https://www.frontiersin.org/article/10.3389/fmicb.2020.02068/full

Escherichia coli sequence type 131 (ST131) is well known for its multidrug resistance profile. Carbapenems have been considered the treatment of choice for E. coli ST131 infections, and resistance to carbapenems is emerging due to the acquisition of carbapenemase-encoding genes. In this study, 45 carbapenem-resistant E. coli strains were collected in a hospital. The resistance mechanisms, plasmid profiles, and genetic relatedness of these strains were determined. Phylogenetic relationships between these strains were assessed by molecular profiling and aligned with patient clinical details. The genetic context of blaKPC–2 was analyzed to trace the potential dissemination of blaKPC–2. The 45 carbapenem-resistant E. coli ST131 strains were closely related. Initially prevalent only in a single ward, ST131 subsequently spread to other ward, resulting in a respiratory infection outbreak of carbapenem-resistant E. coli ST131. Eight of the 30 patients died within 28 days of the first isolation of E. coli ST131. The blaKPC–2-positive plasmid profiles suggest that the carbapenem resistance was due to the acquisition by E. coli ST131 of transmissible plasmids pE0272_KPC and pE0171_KPC carrying blaKPC–2. Additionally, diverse multidrug resistance elements were transferred and rearranged between these plasmids mediated by IS26. Our research indicates that clinical attention should be paid to the importance of E. coli ST131 in respiratory infections and the spread of blaKPC-carrying E. coli ST131.