Intestinal co-colonization with different carbapenemase-producing Enterobacterales isolates is not a rare event in an OXA-48 endemic area

• Main Authors: Marta Hernández-García, Blanca Pérez-Viso, Carolina Navarro-San Francisco, Fernando Baquero, María Isabel Morosini, Patricia Ruiz-Garbajosa, Rafael Cantón
• Format: Article
• Language: English
• Published: Elsevier 2019-10-01
• Series: EClinicalMedicine
• Online Access: http://www.sciencedirect.com/science/article/pii/S258953701930166X
• ISSN: 2589-5370

Background: The current spread of carbapenemase-producing Enterobacterales (CPE) is a great concern. Methods: We recovered 198 CPE from 162 patients admitted in our Hospital (March 2014-March 2016) during the R-GNOSIS European Project. Microbiological features and plasmid characteristics of CPE recovered from patients co-colonized with multiple CPE were studied. Findings: Thirty patients (18.5%; CI 95%= 12.5%–24.5%) presented co-colonization with multiple CPE producing the same (CPE-SC) (15.4%) or a different carbapenemase (CPE-DC) (4.3%). OXA-48 (83.3%) was the most frequent carbapenemase, followed by VIM-1 (26.7%), NDM-1 (10%) and KPC-3 (3.3%). CPE-DC-patients had longer admissions [63 days (20–107)] than the other patients. Moreover, hospital stay until CPE detection was lower [9 days (5–14)] (p = 0.0052) in CPE-SC-patients than in those with a single colonization; 56% showed co-colonization in the first positive sample, although most of them had previous admissions and had received multiple antibiotic treatments. CPE were more frequently recovered in clinical samples from co-colonized [CPE-DC (28.6%), CPE-SC (24%)] patients than from patients with a single CPE (15.2%). Among CPE-SCOXA-48 [80% (p = 0.11)], K. pneumoniae [88% (p = 0.006)] and E. coli [84% (p < 0.001)] were the most frequent species. In 60% of patients, K. pneumoniae and E. coli species were simultaneously recovered, frequently after a single OXA-48-K. pneumoniae colonization. High-risk clones (ST11, ST15, ST307) were detected in OXA-48-K. pneumoniae but a higher clonal diversity was found among E. coli. A frequent in-vivo cross-species plasmid transmission was shown, due to a dominant plasmid (IncL-pOXA-48), but also involving related or unrelated blaVIM-1-, blaNDM-1- and blaKPC-3-encoding plasmids. Interpretation: CPE co-colonization status should be monitored during epidemiological surveillance cultures, as these patients might be at a higher risk for infection. Funding: European Commission Framework Programme 7 and Instituto de Salud Carlos III, Spain Keywords: CPE co-colonization, OXA-48-producing E. coli and K. pneumoniae, in vivo cross-species transmission, IncL-pOXA-48