1887

Abstract

A hospital outbreak of carbapenem-resistant Enterobacterales was detected by routine surveillance. Whole genome sequencing and subsequent analysis revealed a conserved promiscuous carrying plasmid as the defining factor within this outbreak. Four different species of Enterobacterales were involved in the outbreak. ST399 accounted for 35 of all the 55 isolates. Comparative genomics analysis using publicly available ST399 genomes showed that the outbreak ST399 isolates formed a unique clade. We developed a mathematical model of pOXA-48-like plasmid transmission between host lineages and used it to estimate its conjugation rate, giving a lower bound of 0.23 conjugation events per lineage per year. Our analysis suggests that co-evolution between the pOXA-48-like plasmid and ST399 could have played a role in the outbreak. This is the first study to report carbapenem-resistant ST399 carrying blaOXA-48 as the main cause of a plasmid-borne outbreak within a hospital setting. Our findings suggest complementary roles for both plasmid conjugation and clonal expansion in the emergence of this outbreak.

Funding
This study was supported by the:
  • Wellcome Trust (Award 220422/Z/20/Z)
    • Principle Award Recipient: LiamP. Shaw
  • Rosetrees Trust and the Stoneygate Trust (Award M683)
    • Principle Award Recipient: ElitaJauneikaite
  • National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford (Award NIHR200915)
    • Principle Award Recipient: AliceLedda
  • NIHR HPRU in Genomics and Enabling Data at the University of Warwick (Award NIHR200892)
    • Principle Award Recipient: XavierDidelot
  • National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology at Imperial College London (Award HPRU-2012–10080)
    • Principle Award Recipient: XavierDidelot
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
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2022-04-20
2024-06-18
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