Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study

The rise of Carbapenem-resistant Enterobacterales (CRE) represents an increasing threat to patient safety and healthcare systems worldwide. Citrobacter spp., long considered not to be a classical nosocomial pathogen, in contrast to Klebsiella pneumoniae and Escherichia coli, is fast gaining importan...

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Autores principales:	Yancheng Yao, Linda Falgenhauer, Jane Falgenhauer, Anja M. Hauri, Petra Heinmüller, Eugen Domann, Trinad Chakraborty, Can Imirzalioglu
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	Citrobacter Carbapenemase Germany WGS IncN-plasmid MLST Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/cd3307c100834fe89e789bd5e2bbd514
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spelling	oai:doaj.org-article:cd3307c100834fe89e789bd5e2bbd5142021-11-11T07:19:51ZCarbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study2235-298810.3389/fcimb.2021.744431https://doaj.org/article/cd3307c100834fe89e789bd5e2bbd5142021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcimb.2021.744431/fullhttps://doaj.org/toc/2235-2988The rise of Carbapenem-resistant Enterobacterales (CRE) represents an increasing threat to patient safety and healthcare systems worldwide. Citrobacter spp., long considered not to be a classical nosocomial pathogen, in contrast to Klebsiella pneumoniae and Escherichia coli, is fast gaining importance as a clinical multidrug-resistant pathogen. We analyzed the genomes of 512 isolates of 21 CRE species obtained from 61 hospitals within a three-year-period and found that Citrobacter spp. (C. freundii, C. portucalensis, C. europaeus, C. koseri and C. braakii) were increasingly detected (n=56) within the study period. The carbapenemase-groups detected in Citrobacter spp. were KPC, OXA-48/-like and MBL (VIM, NDM) accounting for 42%, 31% and 27% respectively, which is comparable to those of K. pneumoniae in the same study. They accounted for 10%, 17% and 14% of all carbapenemase-producing CRE detected in 2017, 2018 and 2019, respectively. The carbapenemase genes were almost exclusively located on plasmids. The high genomic diversity of C. freundii is represented by 22 ST-types. KPC-2 was the predominantly detected carbapenemase (n=19) and was located in 95% of cases on a highly-conserved multiple-drug-resistance-gene-carrying pMLST15 IncN plasmid. KPC-3 was rarely detected and was confined to a clonal outbreak of C. freundii ST18. OXA-48 carbapenemases were located on plasmids of the IncL/M (pOXA-48) type. About 50% of VIM-1 was located on different IncN plasmids (pMLST7, pMLST5). These results underline the increasing importance of the Citrobacter species as emerging carriers of carbapenemases and therefore as potential disseminators of Carbapenem- and multidrug-resistance in the hospital setting.Yancheng YaoYancheng YaoLinda FalgenhauerLinda FalgenhauerJane FalgenhauerJane FalgenhauerAnja M. HauriAnja M. HauriPetra HeinmüllerEugen DomannEugen DomannEugen DomannTrinad ChakrabortyTrinad ChakrabortyCan ImirzaliogluCan ImirzaliogluFrontiers Media S.A.articleCitrobacterCarbapenemaseGermanyWGSIncN-plasmidMLSTMicrobiologyQR1-502ENFrontiers in Cellular and Infection Microbiology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Citrobacter Carbapenemase Germany WGS IncN-plasmid MLST Microbiology QR1-502
spellingShingle	Citrobacter Carbapenemase Germany WGS IncN-plasmid MLST Microbiology QR1-502 Yancheng Yao Yancheng Yao Linda Falgenhauer Linda Falgenhauer Jane Falgenhauer Jane Falgenhauer Anja M. Hauri Anja M. Hauri Petra Heinmüller Eugen Domann Eugen Domann Eugen Domann Trinad Chakraborty Trinad Chakraborty Can Imirzalioglu Can Imirzalioglu Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study
description	The rise of Carbapenem-resistant Enterobacterales (CRE) represents an increasing threat to patient safety and healthcare systems worldwide. Citrobacter spp., long considered not to be a classical nosocomial pathogen, in contrast to Klebsiella pneumoniae and Escherichia coli, is fast gaining importance as a clinical multidrug-resistant pathogen. We analyzed the genomes of 512 isolates of 21 CRE species obtained from 61 hospitals within a three-year-period and found that Citrobacter spp. (C. freundii, C. portucalensis, C. europaeus, C. koseri and C. braakii) were increasingly detected (n=56) within the study period. The carbapenemase-groups detected in Citrobacter spp. were KPC, OXA-48/-like and MBL (VIM, NDM) accounting for 42%, 31% and 27% respectively, which is comparable to those of K. pneumoniae in the same study. They accounted for 10%, 17% and 14% of all carbapenemase-producing CRE detected in 2017, 2018 and 2019, respectively. The carbapenemase genes were almost exclusively located on plasmids. The high genomic diversity of C. freundii is represented by 22 ST-types. KPC-2 was the predominantly detected carbapenemase (n=19) and was located in 95% of cases on a highly-conserved multiple-drug-resistance-gene-carrying pMLST15 IncN plasmid. KPC-3 was rarely detected and was confined to a clonal outbreak of C. freundii ST18. OXA-48 carbapenemases were located on plasmids of the IncL/M (pOXA-48) type. About 50% of VIM-1 was located on different IncN plasmids (pMLST7, pMLST5). These results underline the increasing importance of the Citrobacter species as emerging carriers of carbapenemases and therefore as potential disseminators of Carbapenem- and multidrug-resistance in the hospital setting.
format	article
author	Yancheng Yao Yancheng Yao Linda Falgenhauer Linda Falgenhauer Jane Falgenhauer Jane Falgenhauer Anja M. Hauri Anja M. Hauri Petra Heinmüller Eugen Domann Eugen Domann Eugen Domann Trinad Chakraborty Trinad Chakraborty Can Imirzalioglu Can Imirzalioglu
author_facet	Yancheng Yao Yancheng Yao Linda Falgenhauer Linda Falgenhauer Jane Falgenhauer Jane Falgenhauer Anja M. Hauri Anja M. Hauri Petra Heinmüller Eugen Domann Eugen Domann Eugen Domann Trinad Chakraborty Trinad Chakraborty Can Imirzalioglu Can Imirzalioglu
author_sort	Yancheng Yao
title	Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study
title_short	Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study
title_full	Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study
title_fullStr	Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study
title_full_unstemmed	Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study
title_sort	carbapenem-resistant citrobacter spp. as an emerging concern in the hospital-setting: results from a genome-based regional surveillance study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/cd3307c100834fe89e789bd5e2bbd514
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Carbapenem-Resistant Citrobacter spp. as an Emerging Concern in the Hospital-Setting: Results From a Genome-Based Regional Surveillance Study

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