Infection and Drug Resistance (Mar 2023)

Carbapenem-Resistant and ESBL-Producing Enterobacterales Emerging in Central Texas

  • Parker JK,
  • Gu R,
  • Estrera GA,
  • Kirkpatrick B,
  • Rose DT,
  • Mavridou DAI,
  • Mondy KE,
  • Davies BW

Journal volume & issue
Vol. Volume 16
pp. 1249 – 1261

Abstract

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Jennifer K Parker,1 Richard Gu,1 Gregory A Estrera,1 Betsy Kirkpatrick,2 Dusten T Rose,3 Despoina AI Mavridou,1,4 Kristin E Mondy,5 Bryan W Davies1,4 1Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, USA; 2Austin Public Health, City of Austin, Austin, TX, USA; 3Department of Pharmacy, Ascension Seton, Dell Seton Medical Center at The University of Texas, Austin, TX, USA; 4John Ring LaMontagne Center for Infectious Diseases, The University of Texas at Austin, Austin, TX, USA; 5Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USACorrespondence: Bryan W Davies, Email [email protected]: Carbapenem-resistant Enterobacterales (CRE) are subject to intense global monitoring in an attempt to maintain awareness of prevalent and emerging resistance mechanisms and to inform treatment and infection prevention strategies. CRE and extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales are not usually examined collectively in regards to their shared pool of resistance determinants. Here, we genetically and phenotypically assess clinical isolates of CRE and extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales in the growing region of Central Texas, where CRE are emergent and occurrence of non-carbapenemase-producing-CRE (non-CP-CRE) infections is increasing.Methods: CRE (n=16) and ESBL-producing Enterobacterales (n=116) isolates were acquired from a regional hospital in Central Texas between December 2018 and January 2020. Isolates were assessed genetically and phenotypically using antibiotic susceptibility testing, targeted PCR, and whole genome sequencing.Results: CRE infections are increasing in incidence in Central Texas, and Klebsiella pneumoniae is causing the majority of these infections. Moreover, K. pneumoniae sequence type (ST) 307 is commonly found among both non-CP-CRE and EBSL-producing strains. Isolates carry similar plasmids harboring the gene for the ESBL CTX-M-15 and belong to the global lineage, rather than the Texas lineage, of ST307. Antibiotic resistance profiles, sequence data, and clinical records suggest that porin mutations may promote the transition of ST307 isolates from ESBL-producing to non-CP-CRE. In addition to antibiotic resistance mechanisms, several CRE isolates harbor active colicinogenic plasmids, which might influence the competitiveness of these bacteria during patient colonization.Conclusion: K. pneumoniae of the global ST307 lineage is circulating in Central Texas and is responsible for both non-CP CRE and ESBL-producing Enterobacterales infections. Enhanced surveillance is needed to understand the possible routes for the emergence of non-CP-CRE from EBSL-producing strains.Keywords: beta-lactam, Klebsiella, colicin, genetics, carbapenemase

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