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The dissemination of multidrug-resistant Enterobacter cloacae throughout the UK and Ireland

Nature Microbiology volume 1, Article number: 16173 (2016) | Download Citation

Abstract

Enterobacter cloacae is a clinically important Gram-negative member of the Enterobacteriaceae, which has increasingly been recognized as a major pathogen in nosocomial infections. Despite this, knowledge about the population structure and the distribution of virulence factors and antibiotic-resistance determinants of this species is scarce. In this study, we analysed a systematic collection of multidrug-resistant E. cloacae isolated between 2001 and 2011 from bloodstream infections across hospitals in the UK and Ireland. We found that the population is characterized by the presence of multiple clones formed at widely different time periods in the past. The clones exhibit a high degree of geographical heterogeneity, which indicates extensive dissemination of these E. cloacae clones across the UK and Ireland. These findings suggest that a diverse, community-based, commensal population underlies multidrug-resistant E. cloacae infections within hospitals.

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Acknowledgements

The authors thank H. Brodrick and K. Judge for their laboratory assistance, and the library construction, sequencing and core informatics teams at the Wellcome Trust Sanger Institute. The authors acknowledge the British Society for Antimicrobial Chemotherapy (BSAC) for allowing the use of isolates from the BSAC Resistance Surveillance Project. This publication presents independent research supported by the Health Innovation Challenge Fund (HICF-T5-342 and WT098600), a parallel funding partnership between the UK Department of Health and the Wellcome Trust. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health, Public Health England or the Wellcome Trust. This project was also funded by a grant awarded to the Wellcome Trust Sanger Institute (098051).

Author information

Affiliations

  1. Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, UK

    • Danesh Moradigaravand
    • , Sharon J. Peacock
    •  & Julian Parkhill
  2. Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK

    • Sandra Reuter
    •  & Sharon J. Peacock
  3. British Society for Antimicrobial Chemotherapy, Griffin House, 53 Regent Place, Birmingham B1 3NJ, UK

    • Veronique Martin
  4. London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

    • Sharon J. Peacock

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Contributions

S.J.P., D.M. and J.P. designed the study. D.M. analysed the data. S.R. performed the in silico rpoB and hsp60 typing. V.M., S.J.P. and J.P. contributed materials and data. S.J.P and J.P. completed ethical approvals. J.P. and S.J.P. were responsible for management of the study.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Julian Parkhill.

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DOI

https://doi.org/10.1038/nmicrobiol.2016.173

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