Colonization of a hand washing sink in a veterinary hospital by an Enterobacter hormaechei strain carrying multiple resistances to high importance antimicrobials

Autor: Fannana Rafa, Marc S. Marenda, Glenn F. Browning, Kanishka Indiwari Kamathewatta, Rhys N. Bushell, Helen Billman-Jacobe
Jazyk: angličtina
Rok vydání: 2020
Předmět:
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Veterinary medicine
030106 microbiology
Enterobacter
Drug resistance
Microbial Sensitivity Tests
Antimicrobial resistance
Enterobacter hormaechei
lcsh:Infectious and parasitic diseases
03 medical and health sciences
Hospitals
Animal
Medical microbiology
Antibiotic resistance
Intensive care
Drug Resistance
Multiple
Bacterial
medicine
Animals
Humans
Pharmacology (medical)
lcsh:RC109-216
Hospitals
Teaching
Veterinary hospital
Phylogeny
biology
Whole Genome Sequencing
business.industry
Research
Public Health
Environmental and Occupational Health
Australia
High-Throughput Nucleotide Sequencing
IncH12 plasmid
biology.organism_classification
Antimicrobial
Multiple drug resistance
Intensive Care Units
030104 developmental biology
Infectious Diseases
Population Surveillance
ICU
Colistin
Equipment Contamination
business
medicine.drug
Zdroj: Antimicrobial Resistance and Infection Control, Vol 9, Iss 1, Pp 1-16 (2020)
Antimicrobial Resistance and Infection Control
ISSN: 2047-2994
DOI: 10.1186/s13756-020-00828-0
Popis: Background Hospital intensive care units (ICUs) are known reservoirs of multidrug resistant nosocomial bacteria. Targeted environmental monitoring of these organisms in health care facilities can strengthen infection control procedures. A routine surveillance of extended spectrum beta-lactamase (ESBL) producers in a large Australian veterinary teaching hospital detected the opportunistic pathogen Enterobacter hormaechei in a hand washing sink of the ICU. The organism persisted for several weeks, despite two disinfection attempts. Four isolates were characterized in this study. Methods Brilliance-ESBL selective plates were inoculated from environmental swabs collected throughout the hospital. Presumptive identification was done by conventional biochemistry. Genomes of multidrug resistant Enterobacter were entirely sequenced with Illumina and Nanopore platforms. Phylogenetic markers, mobile genetic elements and antimicrobial resistance genes were identified in silico. Antibiograms of isolates and transconjugants were established with Sensititre microdilution plates. Results The isolates possessed a chromosomal Tn7-associated silver/copper resistance locus and a large IncH12 conjugative plasmid encoding resistance against tellurium, arsenic, mercury and nine classes of antimicrobials. Clusters of antimicrobial resistance genes were associated with class 1 integrons and IS26, IS903 and ISCR transposable elements. The blaSHV-12, qnrB2 and mcr-9.1 genes, respectively conferring resistance to cephalosporins, quinolones and colistin, were present in a locus flanked by two IS903 copies. ESBL production and enrofloxacin resistance were confirmed phenotypically. The isolates appeared susceptible to colistin, possibly reflecting the inducible nature of mcr-9.1. Conclusions The persistence of this strain in the veterinary hospital represented a risk of further accumulation and dissemination of antimicrobial resistance, prompting a thorough disinfection of the ICU. The organism was not recovered from subsequent environmental swabs, and nosocomial Enterobacter infections were not observed in the hospital during that period. This study shows that targeted routine environmental surveillance programs to track organisms with major resistance phenotypes, coupled with disinfection procedures and follow-up microbiological cultures are useful to control these risks in sensitive areas of large veterinary hospitals.
Databáze: OpenAIRE
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