Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates
| Title: | Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates |
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| Authors: | Tilman G. Schultze, Philip G. Ferstl, David Villinger, Michael Hogardt, Wolf O. Bechstein, Stephan Göttig, Thomas A. Wichelhaus, Stefan Zeuzem, Jonel Trebicka, Oliver Waidmann, Martin-Walter Welker, Volkhard A. J. Kempf |
| Source: | Frontiers in Microbiology, Vol 12 (2021) |
| Publisher Information: | Frontiers Media S.A., 2021. |
| Publication Year: | 2021 |
| Collection: | LCC:Microbiology |
| Subject Terms: | carbapenem resistance, liver transplantation, transmission, whole-genome sequencing, infection control, antimicrobial stewardship, Microbiology, QR1-502 |
| More Details: | Background: Carbapenem-resistant Gram-negative bacteria (CRGN) cause life-threatening infections due to limited antimicrobial treatment options. The occurrence of CRGN is often linked to hospitalization and antimicrobial treatment but remains incompletely understood. CRGN are common in patients with severe illness (e.g., liver transplantation patients). Using whole-genome sequencing (WGS), we aimed to elucidate the evolution of CRGN in this vulnerable cohort and to reconstruct potential transmission routes.Methods: From 351 patients evaluated for liver transplantation, 18 CRGN isolates (from 17 patients) were analyzed. Using WGS and bioinformatic analysis, genotypes and phylogenetic relationships were explored. Potential epidemiological links were assessed by analysis of patient charts.Results: Carbapenem-resistant (CR) Klebsiella pneumoniae (n=9) and CR Pseudomonas aeruginosa (n=7) were the predominating pathogens. In silico analysis revealed that 14/18 CRGN did not harbor carbapenemase-coding genes, whereas in 4/18 CRGN, carbapenemases (VIM-1, VIM-2, OXA-232, and OXA-72) were detected. Among all isolates, there was no evidence of plasmid transfer-mediated carbapenem resistance. A close phylogenetic relatedness was found for three K. pneumoniae isolates. Although no epidemiological context was comprehensible for the CRGN isolates, evidence was found that the isolates resulted of a transmission of a carbapenem-susceptible ancestor before individual radiation into CRGN.Conclusion: The integrative epidemiological study reveals a high diversity of CRGN in liver cirrhosis patients. Mutation of carbapenem-susceptible ancestors appears to be the dominant way of CR acquisition rather than in-hospital transmission of CRGN or carbapenemase-encoding genetic elements. This study underlines the need to avoid transmission of carbapenem-susceptible ancestors in vulnerable patient cohorts. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1664-302X 94500681 |
| Relation: | https://www.frontiersin.org/articles/10.3389/fmicb.2021.791574/full; https://doaj.org/toc/1664-302X |
| DOI: | 10.3389/fmicb.2021.791574 |
| Access URL: | https://doaj.org/article/be945006810d48bf8c3e145d1c5be855 |
| Accession Number: | edsdoj.be945006810d48bf8c3e145d1c5be855 |
| Database: | Directory of Open Access Journals |
| ISSN: | 1664302X 94500681 |
|---|---|
| DOI: | 10.3389/fmicb.2021.791574 |
| Published in: | Frontiers in Microbiology |
| Language: | English |