NDLI: War Wound Treatment Complications Due to Transfer of an IncN Plasmid Harboring bla OXA-181 from Morganella morganii to CTX-M-27-Producing Sequence Type 131 Escherichia coli

Content Provider	PubMed Central
Author	Mcgann, Patrick Erik, Snesrud Ong, Ana C. Lakshmi, Appalla Koren, Michael Kwak, Yoon I. Waterman, Paige E. Lesho, Emil P.
Copyright Year	2015
Abstract	A 22-year-old male developed a recurrent sacral abscess associated with embedded shrapnel following a blast injury. Cultures grew extended-spectrum β-lactamase (ESBL)-producing, carbapenem-susceptible Escherichia coli. Ertapenem was administered, but the infection recurred after each course of antibiotics. Initial surgical interventions were unsuccessful, and subsequent cultures yielded E. coli and Morganella morganii, both nonsusceptible to carbapenems. The isolates were Carba NP test negative, gave ambiguous results with the modified Hodge test, and amplified the bla OXA48-like gene by real-time PCR. All E. coli isolates were sequence type 131 (ST131), carried nine resistance genes (including bla CTX-M-27) on an IncF plasmid, and were identical by genome sequencing, except for 150 kb of plasmid DNA in carbapenem-nonsusceptible isolates only. Sixty kilobases of this was shared by M. morganii and represented an IncN plasmid harboring bla OXA-181. In M. morganii, the gene was flanked by IS3000 and ISKpn19, but in all but one of the E. coli isolates containing bla OXA-181, a second copy of ISKpn19 had inserted adjacent to IS3000. To the best of our knowledge, this is the first report of bla OXA-181 in the virulent ST131 clonal group and carried by the promiscuous IncN family of plasmids. The tendency of M. morganii to have high MICs of imipenem, a bla OXA-181 substrate profile that includes penicillins but not extended-spectrum cephalosporins, and weak carbapenemase activity almost resulted in the presence of bla OXA-181 being overlooked. We highlight the importance of surveillance for carbapenem resistance in all species, even those with intrinsic resistances, and the value of advanced molecular techniques in detecting subtle genetic changes.
Related Links	http://dx.doi.org/10.1128/aac.04442-14
Ending Page	3562
Page Count	7
Starting Page	3556
File Format	PDF
ISSN	00664804
e-ISSN	10986596
Journal	Antimicrobial Agents and Chemotherapy
Issue Number	6
Volume Number	59
Language	English
Publisher	American Society for Microbiology
Publisher Date	2015-06-01
Access Restriction	Open
Rights Holder	American Society for Microbiology
Subject Keyword	Pharmacology (medical) Pharmacology Infectious Diseases Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology Pharmacology (medical)

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