AUTHOR=Solgi Hamid , Nematzadeh Shoeib , Giske Christian G. , Badmasti Farzad , Westerlund Fredrik , Lin Yii-Lih , Goyal Gaurav , Nikbin Vajihe Sadat , Nemati Amir Hesam , Shahcheraghi Fereshteh 

TITLE=Molecular Epidemiology of OXA-48 and NDM-1 Producing Enterobacterales Species at a University Hospital in Tehran, Iran, Between 2015 and 2016

JOURNAL=Frontiers in Microbiology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2020.00936

DOI=10.3389/fmicb.2020.00936

ISSN=1664-302X

ABSTRACT=<p>Carbapenem-resistant <italic>Enterobacterales</italic> (CRE) is an increasing problem worldwide. Here, we examined the clonal relatedness of 71 non-repetitive CRE isolates collected in a university hospital in Tehran, Iran, between February 2015 and March 2016. Pulsed-field gel electrophoresis (PFGE) and MLST were used for epidemiological analysis. Screening for antibiotic resistance genes, PCR-based replicon typing, conjugation experiments, and optical DNA mapping were also performed. Among all 71 isolates, 47 isolates of <italic>Klebsiella pneumoniae</italic> (66.2%), eight <italic>Escherichia coli</italic> (11.2%), five <italic>Serratia marcescens</italic> (7%), and two <italic>Enterobacter cloacae</italic> (2.8%) harbored <italic>bla</italic><sub>NDM–1</sub> and <italic>bla</italic><sub>OXA–48</sub> genes together or alone. PFGE analysis revealed that most of the OXA-48- and NDM-1-producing <italic>K. pneumoniae</italic> and all of OXA-48-producing <italic>S. marcescens</italic> were clonally related, while all eight <italic>E. coli</italic> and two <italic>E</italic>. <italic>cloacae</italic> isolates were clonally unrelated. The predominant clones of carbapenemase-producing <italic>K. pneumoniae</italic> associated with outbreaks within the hospital were ST147 (<italic>n</italic> = 13) and ST893 (<italic>n</italic> = 10). Plasmids carrying <italic>bla</italic><sub>NDM–1</sub> and <italic>bla</italic><sub>OXA–48</sub> were successfully transferred to an <italic>E. coli</italic> K12-recipient strain. The <italic>bla</italic><sub>OXA–48</sub> gene was located on an IncL/M conjugative plasmid, while the <italic>bla</italic><sub>NDM–1</sub> gene was located on both IncFII ∼86-kb to ∼140-kb and IncA/C conjugative plasmids. Our findings provide novel epidemiologic data on carbapenemase-producing <italic>Enterobacterales</italic> (CPE) in Iran and highlight the importance of horizontal gene transfer in the dissemination of <italic>bla</italic><sub>NDM–1</sub> and <italic>bla</italic><sub>OXA–48</sub> genes. The occurrence and transmission of distinct <italic>K. pneumoniae</italic> clones call for improved infection control to prevent further spread of these pathogens in Iran.</p>