Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES Journal of Infection and Public Health Pub Date : 2025-02-01 DOI:10.1016/j.jiph.2024.102645

Ibrahim A. Al-Zahrani , Thamer M. Brek

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Abstract

Background

Patients with severe COVID-19 may require intensive care unit (ICU) admission to manage life-threatening complications. However, ICU admission is associated with an increased risk of acquiring nosocomial infections caused by multidrug-resistant (MDR) bacteria, particularly carbapenem-resistant Enterobacterale (CRE). Enterobacter cloacae complex (ECC), a group of closely related species including Enterobacter cloacae, is a common cause of healthcare-associated infections (HAIs).

Methods

The study conducted a comprehensive genomic analysis of an extensively drug-resistant (XDR) E. cloacae strain (ECloa-JZ71) isolated from the blood of a critically ill COVID-19 patient in Jazan, Saudi Arabia.

Results

ECloa-JZ71 exhibited resistance to multiple antimicrobial agents, except for amikacin, gentamycin, and fosfomycin. Whole-genome sequencing revealed that ECloa-JZ71 had a rarely reported sequence type, ST1718. Resistance to β-lactam antibiotics was primarily mediated by the genes bla_CMH-3, bla_TEM-1B, bla_LAP-2, and bla_NDM-5. The strain was found to harbor IncFIB(pECLA) and IncX3 plasmid replicons, with the latter encoding the bla_NDM-5 gene. The IncX3 plasmid was identified as a significant contributor to the dissemination of the bla_NDM-5 gene among Enterobacterale species The coexistence of bla_NDM-5 and other carbapenem-hydrolyzing enzymes explains the reduced efficacy of β-lactam drugs in ECloa-JZ71. The coexistence of bla_NDM-5 and other carbapenem-hydrolyzing enzymes explains the reduced efficacy of β-lactam drugs in ECloa-JZ71. The presence of specific virulence factors along with carbapenem resistance in ECloa-JZ71 may enhance its pathogenesis, complicating treatment and control efforts.

Conclusion

The findings highlight the need for monitoring the spread of multidrug-resistant clones, conducting molecular epidemiological studies, and implementing effective infection control measures to prevent the dissemination of antimicrobial resistance in healthcare settings.

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携带blandm -5的广泛耐药阴沟肠杆菌ST1718在沙特阿拉伯的出现：来自全面基因组分析的见解

背景：重症COVID-19患者可能需要入住重症监护病房（ICU）以处理危及生命的并发症。然而，ICU住院与多药耐药（MDR）细菌引起的院内感染风险增加有关，特别是碳青霉烯耐药肠杆菌（CRE）。阴沟肠杆菌复合体（ECC）是包括阴沟肠杆菌在内的一组密切相关的物种，是卫生保健相关感染（HAIs）的常见原因。方法：本研究对从沙特阿拉伯吉赞市一名COVID-19危重患者血液中分离的广泛耐药（XDR）阴沟肠杆菌（ECloa-JZ71）进行了全面的基因组分析。结果：ECloa-JZ71对除阿米卡星、庆大霉素和磷霉素外的多种抗菌药物均表现出耐药。全基因组测序结果显示，ECloa-JZ71具有罕见报道的序列类型ST1718。β-内酰胺类抗生素耐药主要由blaCMH-3、blacem - 1b、blaLAP-2和blaNDM-5基因介导。发现该菌株含有IncFIB（pECLA）和IncX3质粒复制子，后者编码blaNDM-5基因。IncX3质粒被认为是blaNDM-5基因在肠杆菌中传播的重要因素，blaNDM-5与其他碳青霉烯水解酶的共存解释了β-内酰胺类药物在ECloa-JZ71中疗效降低的原因。blaNDM-5与其他碳青霉烯水解酶的共存解释了β-内酰胺类药物在ECloa-JZ71中的疗效降低。ECloa-JZ71中特异性毒力因子的存在以及碳青霉烯类耐药性可能会增强其发病机制，使治疗和控制工作复杂化。结论：研究结果强调需要监测耐多药克隆的传播，开展分子流行病学研究，并实施有效的感染控制措施，以防止卫生保健机构中抗菌素耐药性的传播。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.