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

Nature Microbiology volume 1, Article number: 16173 (2016) Cite this article

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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.

The non-motile bacterium Enterobacter cloacae belongs to the Enterobacteriaceae family and has been recovered from natural environments1–3. It is an opportunistic pathogen that can cause a wide range of infections, in particular in immune-compromised individuals. E. cloacae has been increasingly recognized as a cause of hospital-acquired infections and outbreaks in the past few decades4–6, as reported in hospitals7,8, especially in neonatal settings9. The reservoirs for E. cloacae in hospitals are thought to include equipment, cleaning solutions and healthcare workers9–11. Endogenous infection from an established clone carried by individuals before admission to hospital has also been described. Multi-locus sequencing typing (MLST) has shown that the global E. cloacae population is highly diverse and includes a limited number of clonal complexes that have spread internationally, and have independently acquired antibiotic resistance elements12,13.

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Figure 1: Population diversity of multidrug-resistant E. cloacae.
Figure 2: Population structure of multidrug-resistant E. cloacae.

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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

Authors and Affiliations

  1. Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, Cambridgeshire, 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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  1. Danesh Moradigaravand
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  3. Veronique Martin
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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.

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Correspondence to Julian Parkhill.

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The authors declare no competing financial interests.

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Supplementary Figures 1–18, Supplementary Tables' Legends (PDF 3115 kb)

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Moradigaravand, D., Reuter, S., Martin, V. et al. The dissemination of multidrug-resistant Enterobacter cloacae throughout the UK and Ireland. Nat Microbiol 1, 16173 (2016). https://doi.org/10.1038/nmicrobiol.2016.173

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