1887

Microbiology Society logo

Volume 154, Issue 12

Characterization of an extended-spectrum beta-lactamase nosocomial outbreak, and other misidentified as () Free

Abstract

is a Gram-negative bacterium within the complex, and has been shown to be of clinical significance by causing nosocomial infections, including sepsis. is spread via horizontal transfer and is often associated with extended-spectrum beta-lactamase production, which increases the challenges associated with treatment by limiting therapeutic options. This report considers 10 strains of (identified by 16S rDNA sequencing) that had originally been identified by phenotyping as () . Seven strains were from different neonates during a nosocomial outbreak in a California hospital. PFGE analysis revealed a clonal relationship among six of the seven isolates and therefore a previously unrecognized outbreak had occurred over a three-month period. Antibiotic-resistance profiles were determined and extended-spectrum beta-lactamase activity was detected. The association of the organism with powdered infant formula, neonatal hosts and suggested that the virulence of these organisms may be similar. Virulence traits were tested and all strains were shown to invade both gut epithelial (Caco-2) and blood–brain barrier endothelial cells (rBCEC4), and to persist in macrophages (U937). Due to misidentification we suggest that may be an under-reported cause of bacterial infection, especially in neonates. Also, its isolation from various sources, including powdered infant milk formula, makes it a cause for concern and merits further investigation.

  • Received:
  • Accepted:
  • Revised:
  • Published Online:
Keyword(s): BBB, blood–brain barrier , ESBL, extended-spectrum beta-lactamase and HPS, human plasma serum
SGM
Loading

Article metrics loading...

/content/journal/micro/10.1099/mic.0.2008/021980-0
2008-12-01
2024-04-25
Loading full text...

Full text loading...

/deliver/fulltext/micro/154/12/3659.html?itemId=/content/journal/micro/10.1099/mic.0.2008/021980-0&mimeType=html&fmt=ahah

References

  1. Aldová E., Hausner O., Postupa R. 1983; Tween-esterase activity in Enterobacter sakazakii . Zentralbl Bakteriol Mikrobiol Hyg [A] 256:103–108
     [Google Scholar]
  2. Bauernfeind A., Grimm H., Schweighart S. 1990; A new plasmidic cefotaximase in a clinical isolate of Escherichia coli . Infection 18:294–298
     [Google Scholar]
  3. Biering G., Karlsson S., Clark N. C., Jonsdottir K. E., Ludvigsson P., Steingrimsson O. 1989; Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. J Clin Microbiol 27:2054–2056
     [Google Scholar]
  4. British Society for Antimicrobial Chemotherapy; 2007; BSAC standardized disc susceptibility testing method (version 6).
  5. Campos L. C., Lobianco L. F., Seki L. M., Santos R. M., Asensi M. D. 2007; Outbreak of Enterobacter hormaechei septicaemia in newborns caused by contaminated parenteral nutrition in Brazil. J Hosp Infect 66:95–97
     [Google Scholar]
  6. Caubilla-Barron J., Hurrell E., Townsend S., Cheetham P., Loc-Carrillo C., Fayet O., Prère M. F., Forsythe S. J. 2007; Genotypic and phenotypic analysis of Enterobacter sakazakii strains from an outbreak resulting in fatalities in a neonatal intensive care unit in France. J Clin Microbiol 45:3979–3985
     [Google Scholar]
  7. Coignard B., Vaillant V., Vincent J.-P., Leflèche A., Mariani-Kurkdjian P., Bernet C., L'Hériteau F., Sénéchal H., Grimont P., Bingen E., Desenclos J.-C. (2006; Infections sévères à Enterobacter sakazakii chez des nouveau-nés ayant consommé une préparation en poudre pour nourrissons. BEH 200410–13
     [Google Scholar]
  8. da Silva C. L., Miranda L. E., Moreira B. M., Rebello D., Carson L. A., Kellum M. E., de Almeida M. C., Sampaio J. L., O'Hara C. M. 2002; Enterobacter hormaechei bloodstream infection at three neonatal intensive care units in Brazil. Pediatr Infect Dis J 21:175–177
     [Google Scholar]
  9. Euler A. R., Byrne W. J., Cousins L. M., Ament M. E., Walsh J. H. 1977; Increased serum gastrin concentrations and gastric acid hyposecretion in the immediate newborn period. Gastroenterology 72:1271–1273
     [Google Scholar]
  10. Fanning S., Forsythe S. J. 2007 Isolation and identification of Enterobacter sakazakii. Chapter 2 in Emerging Issues in Food Safety.Enterobacter sakazakii pp 27–59 Edited by Farber J. M., Forsythe S. J. Washington, DC: American Society for Microbiology;
     [Google Scholar]
  11. FAO-WHO 2006 Enterobacter sakazakii and Salmonella in powdered infant formula. Second Risk Assessment Workshop Rome, Italy: World Health Organization;
     [Google Scholar]
  12. Gerner-Smidt P., Hise K., Kincaid J., Hunter S., Rolando S., Hyytia-Trees E., Ribot E. M., Swaminathan B. 2006; PulseNet USA: a five-year update. Foodborne Pathog Dis 3:9–19
     [Google Scholar]
  13. Health Protection Agency. 2006; Laboratory detection and reporting of bacteria with extended spectrum beta-lactamases. National Standard Method QSOP 51:2
     [Google Scholar]
  14. Hervas J. A., Ballesteros F., Alomar A., Gil J., Benedi V. J., Alberti S. 2001; Increase of Enterobacter in neonatal sepsis: a twenty-two-year study. Pediatr Infect Dis J 20:134–140
     [Google Scholar]
  15. Himelright I., Harris E., Lorch V., Anderson M. 2002; Enterobacter sakazakii infections associated with the use of powdered infant formula –. Tennessee: 2001 MMWR Weekly 51:298–300
     [Google Scholar]
  16. Ho P. L., Shek H. L. R., Chow K. H., Duan R. S., Mak G. C., Lai E. L., Yam W. C., Tsang K. W., Lai W. M. 2005; Detection and characterization of extended-spectrum β-lactamases among bloodstream isolates of Enterobacter spp. in Hong Kong, 2000–2002. J Antimicrob Chemother 55:326–332
     [Google Scholar]
  17. Hoffmann H., Stindl S., Ludwig W., Stumpf A., Mehlen A., Monget D., Pierard D., Ziesing S., Heesemann J. other authors 2005; Enterobacter hormaechei subsp. oharae subsp. nov., E. hormaechei subsp. hormaechei comb. nov., and E.hormaechei subsp. steigerwaltii subsp. nov., three new subspecies of clinical importance. J Clin Microbiol 43:3297–3303
     [Google Scholar]
  18. Iversen C., Druggan P., Forsythe S. 2004a; A selective differential medium for Enterobacter sakazakii, a preliminary study. Int J Food Microbiol 96:133–139
     [Google Scholar]
  19. Iversen C., Waddington M., Farmer J. J. III, Forsythe S. J. 2004b; Identification and phylogeny of Enterobacter sakazakii relative to Enterobacter and Citrobacter species. J Clin Microbiol 42:5368–5370
     [Google Scholar]
  20. Iversen C., Lancashire L., Waddington M., Forsythe S., Ball G. 2006; Identification of Enterobacter sakazakii from closely related species: the use of Artificial Neural Networks in the analysis of biochemical and 16S rDNA data. BMC Microbiol 6:28
     [Google Scholar]
  21. Iversen C., Mullane M., McCardell B., Tall B. D., Lehner A., Fanning S., Stephan R., Joosten H. 2008; Cronobacter gen. nov., a new genus to accommodate the biogroups of Enterobacter sakazakii, and proposal of Cronobacter sakazakii gen.nov., comb. nov., Cronobacter malonaticus sp. nov., Cronobacter turicensis sp. nov., Cronobacter muytjensii sp. nov.,Cronobacter dublinensis sp. nov., Cronobacter genomospecies 1, and of three subspecies, Cronobacter dublinensis subsp .dublinensis subsp. nov., Cronobacter dublinensis subsp. lausannensis subsp.nov. and Cronobacterdublinensis subsp. lactaridi subsp. nov. Int J Syst Evol Microbiol 58:1442–1447
     [Google Scholar]
  22. Jarvis C. 2005; Fatal Enterobacter sakazakii infection associated with powdered infant formula in a neonatal intensive care unit in New Zealand. Am J Infect Control 33:e19
     [Google Scholar]
  23. Keyser M., Witthuhn R. C., Ronquest L. C., Britz T. J. 2003; Treatment of winery effuent with upflow anaerobic sludge blanket (UASB)-granular sludges enriched with Enterobacter sakazakii . Biotechnol Lett 25:1893–1898
     [Google Scholar]
  24. Mohan Nair M. K., Venkitanarayanan K. S. 2006; Cloning and sequencing of the ompA gene of Enterobacter sakazakii and development of an ompA-targeted PCR for rapid detection of Enterobacter sakazakii in infant formula. Appl Environ Microbiol 72:2539–2546
     [Google Scholar]
  25. Muytjens H. L., Zanen H. C., Sonderkamp H. J., Kollee L. A., Wachsmuth I. K., Farmer J. J. III 1983; Analysis of eight cases of neonatal meningitis and sepsis due to Enterobacter sakazakii . J Clin Microbiol 18:115–120
     [Google Scholar]
  26. Muytjens H. L., Roelofs-Willemse H., Jaspar G. H. 1988; Quality of powdered substitutes for breast milk with regard to members of the family Enterobacteriaceae . J Clin Microbiol 26:743–746
     [Google Scholar]
  27. O'Hara C. M., Steigerwalt A. G., Hill B. C., Farmer J. J. III, Fanning G. R., Brenner D. J. 1989; Enterobacter hormaechei, a new species of the family Enterobacteriaceae formerly known as enteric group 75. J Clin Microbiol 27:2046–2049
     [Google Scholar]
  28. Pagotto F. J., Nazarowec-White M., Bidawid S., Farber J. M. 2003; Enterobacter sakazakii: infectivity and enterotoxin production in vitro and in vivo . J Food Prot 66:370–375
     [Google Scholar]
  29. Pagotto F., Farber J. M., Lenati R. 2007 Mechanisms of pathogenicity of E. sakazakii. Chapter 5 in Emerging Issues in Food Safety. Enterobacter sakazakii Edited by Farber J. M., Forsythe S. Washington, DC: American Society for Microbiology;
     [Google Scholar]
  30. Sundstrom C., Nilsson K. 1976; Establishment and characterization of a human histiocytic lymphoma cell line (U-937. Int J Cancer 17:565–577
     [Google Scholar]
  31. Szymanski C. M., King M., Haardt M., Armstrong G. D. 1995; Campylobacter jejuni motility and invasion of Caco-2 cells. Infect Immun 63:4295–4300
     [Google Scholar]
  32. Tenover F. C., Arbeit R. D., Goering R. V., Mickelsen P. A., Murray B. E., Persing D. H., Swaminathan B. 1995; Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 33:2233–2239
     [Google Scholar]
  33. Townsend S., Caubilla-Barron J., Loc-Carrillo C., Forsythe S. 2007a; The presence of endotoxin in powdered infant formula milk and the influence of endotoxin and Enterobacter sakazakii on bacterial translocation in the infant rat. Food Microbiol 24:67–74
     [Google Scholar]
  34. Townsend S. M., Hurrell E., Gonzalez-Gomez I., Lowe J., Frye J. G., Forsythe S., Badger J. L. 2007b; Enterobacter sakazakii invades brain capillary endothelial cells, persists in human macrophages influencing cytokine secretion and induces severe brain pathology in the neonatal rat. Microbiology 153:3538–3547
     [Google Scholar]
  35. Townsend S., Hurrell E., Caubilla-Barron J., Loc-Carrillo C., Forsythe S. 2008; Virulence studies of Enterobacter sakazakii isolates associated with a neonatal intensive care unit outbreak. BMC Microbiol 8:64
     [Google Scholar]
  36. van Acker J., de Smet F., Muyldermans G., Bougatef A., Naessens A., Lauwers S. 2001; Outbreak of necrotizing enterocolitis associated with Enterobacter sakazakii in powdered milk formula. J Clin Microbiol 39:293–297
     [Google Scholar]
  37. Wenger P. N., Tokars J. I., Brennan P., Samel C., Bland L., Miller M., Carson L., Arduino M., Edelstein P. other authors 1997; An outbreak of Enterobacter hormaechei infection and colonization in an intensive care nursery. Clin Infect Dis 24:1243–1244
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/micro/10.1099/mic.0.2008/021980-0
Loading
Characterization of an extended-spectrum beta-lactamase Enterobacter hormaechei nosocomial outbreak, and other Enterobacter hormaechei misidentified as Cronobacter (Enterobacter) sakazakii
Microbiology 154, 3659 (2008); https://doi.org/10.1099/mic.0.2008/021980-0
/content/journal/micro/10.1099/mic.0.2008/021980-0
/content/journal/micro/10.1099/mic.0.2008/021980-0
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error