Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital
ABSTRACT Carbapenem-resistant Enterobacter cloacae complex (ECC) has become a clinically important pathogen with increased incidence worldwide in recent years. In Taiwan, IMP-8 accounted for most carbapenemase produced by ECC in earlier studies. Clinical ECC isolates resistant to ertapenem, imipenem...
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American Society for Microbiology
2025-07-01
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| Series: | Microbiology Spectrum |
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| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.00234-25 |
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| author | Cong-Tat Cia Shu-Li Su Pei-Fang Tsai Yu-Cheng Su Nan-Yao Lee Wen-Chien Ko Po-Lin Chen |
| author_facet | Cong-Tat Cia Shu-Li Su Pei-Fang Tsai Yu-Cheng Su Nan-Yao Lee Wen-Chien Ko Po-Lin Chen |
| author_sort | Cong-Tat Cia |
| collection | DOAJ |
| description | ABSTRACT Carbapenem-resistant Enterobacter cloacae complex (ECC) has become a clinically important pathogen with increased incidence worldwide in recent years. In Taiwan, IMP-8 accounted for most carbapenemase produced by ECC in earlier studies. Clinical ECC isolates resistant to ertapenem, imipenem, and meropenem at the study hospital between 2014 and 2022 were collected at a medical center in southern Taiwan. The isolates were subjected to multilocus sequence typing, species identification by hsp60 sequencing, polymerase chain reaction detection of beta-lactamase genes, antimicrobial susceptibility tests, and whole genome sequencing analysis. Fifty-four ECC isolates causing infections were included. Bloodstream (20 episodes, 37.0%) and lower respiratory tract infections (14, 25.9%) were the common infection types. The crude in-hospital mortality was 51.8%. Carbapenemase genes were detected among 90.7% of the isolates, and blaIMP-8 remained to be the most common gene. The amikacin and colistin resistance rates were lower than 20%, while other agents were less active in vitro. Infections caused by ECC with extensive carbapenem resistance herald a poor prognosis and have limited treatment options. Clonal spread of blaNDM-1 harboring E. hormaechei subsp. xiangfangensis ST171 and blaVIM-1 harboring E. hormaechei subsp. hoffmannii ST78, which have not been reported in Taiwan, was responsible for the increased incidence of ECC with complete resistance to tested carbapenems since 2019.IMPORTANCEThis study reported the increase of carbapenemase-producing Enterobacter cloacae complex (ECC) isolates at a medical center in southern Taiwan during 2014 and 2022. The emergence of NDM-1-producing E. hormaechei subsp. xiangfangensis ST171 and VIM-1-producing E. hormaechei subsp. hoffmannii ST78, contrary to widely reported IMP-8-producing carbapenem-resistant E. cloacae complex, accounts for the increased incidence of health care-associated infections with few remaining treatment options and poor clinical outcomes. Our findings highlighted the changing antimicrobial resistance of carbapenem resistance among Enterobacterales, leading to clinical difficulties in Taiwan. |
| format | Article |
| id | doaj-art-f4bf4123f4784ce3bc7d08059d2cf439 |
| institution | Kabale University |
| issn | 2165-0497 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | American Society for Microbiology |
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| series | Microbiology Spectrum |
| spelling | doaj-art-f4bf4123f4784ce3bc7d08059d2cf4392025-08-20T03:30:56ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972025-07-0113710.1128/spectrum.00234-25Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospitalCong-Tat Cia0Shu-Li Su1Pei-Fang Tsai2Yu-Cheng Su3Nan-Yao Lee4Wen-Chien Ko5Po-Lin Chen6Department of Internal Medicine, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Pathology, National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Tainan, TaiwanInstitute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Internal Medicine, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, Tainan, TaiwanABSTRACT Carbapenem-resistant Enterobacter cloacae complex (ECC) has become a clinically important pathogen with increased incidence worldwide in recent years. In Taiwan, IMP-8 accounted for most carbapenemase produced by ECC in earlier studies. Clinical ECC isolates resistant to ertapenem, imipenem, and meropenem at the study hospital between 2014 and 2022 were collected at a medical center in southern Taiwan. The isolates were subjected to multilocus sequence typing, species identification by hsp60 sequencing, polymerase chain reaction detection of beta-lactamase genes, antimicrobial susceptibility tests, and whole genome sequencing analysis. Fifty-four ECC isolates causing infections were included. Bloodstream (20 episodes, 37.0%) and lower respiratory tract infections (14, 25.9%) were the common infection types. The crude in-hospital mortality was 51.8%. Carbapenemase genes were detected among 90.7% of the isolates, and blaIMP-8 remained to be the most common gene. The amikacin and colistin resistance rates were lower than 20%, while other agents were less active in vitro. Infections caused by ECC with extensive carbapenem resistance herald a poor prognosis and have limited treatment options. Clonal spread of blaNDM-1 harboring E. hormaechei subsp. xiangfangensis ST171 and blaVIM-1 harboring E. hormaechei subsp. hoffmannii ST78, which have not been reported in Taiwan, was responsible for the increased incidence of ECC with complete resistance to tested carbapenems since 2019.IMPORTANCEThis study reported the increase of carbapenemase-producing Enterobacter cloacae complex (ECC) isolates at a medical center in southern Taiwan during 2014 and 2022. The emergence of NDM-1-producing E. hormaechei subsp. xiangfangensis ST171 and VIM-1-producing E. hormaechei subsp. hoffmannii ST78, contrary to widely reported IMP-8-producing carbapenem-resistant E. cloacae complex, accounts for the increased incidence of health care-associated infections with few remaining treatment options and poor clinical outcomes. Our findings highlighted the changing antimicrobial resistance of carbapenem resistance among Enterobacterales, leading to clinical difficulties in Taiwan.https://journals.asm.org/doi/10.1128/spectrum.00234-25carbapenem-resistant EnterobacteralescarbapenemasesEnterobacter cloacae complexTaiwan |
| spellingShingle | Cong-Tat Cia Shu-Li Su Pei-Fang Tsai Yu-Cheng Su Nan-Yao Lee Wen-Chien Ko Po-Lin Chen Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital Microbiology Spectrum carbapenem-resistant Enterobacterales carbapenemases Enterobacter cloacae complex Taiwan |
| title | Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital |
| title_full | Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital |
| title_fullStr | Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital |
| title_full_unstemmed | Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital |
| title_short | Infections caused by clonal spread of metallo-beta-lactamase-producing Enterobacter cloacae complex isolates at a southern Taiwan hospital |
| title_sort | infections caused by clonal spread of metallo beta lactamase producing enterobacter cloacae complex isolates at a southern taiwan hospital |
| topic | carbapenem-resistant Enterobacterales carbapenemases Enterobacter cloacae complex Taiwan |
| url | https://journals.asm.org/doi/10.1128/spectrum.00234-25 |
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