Simon Garinet1, Vincent Fihman2, Hervé Jacquier3, Stéphane Corvec4, Alban Le Monnier5, Thomas Guillard6, Vincent Cattoir7, Jean-Ralph Zahar8, Paul-Louis Woerther9, Etienne Carbonnelle10, Alain Wargnier11, Solen Kernéis12, Philippe C Morand13. 1. Service de Bactériologie, Hôpitaux Universitaires Paris Centre, site Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. 2. Service de Microbiologie-Hygiène, Unité de Bactériologie-Hygiène, Hôpitaux Universitaires Paris Val de Seine, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Paris, France. 3. Service de Bactériologie-Virologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. 4. Service de Bactériologie-Hygiène hospitalière, Centre Hospitalo-Universitaire de Nantes, Nantes, France. 5. Laboratoire de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France. 6. Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU de Reims, Reims, France. 7. Service de Microbiologie, Centre Hospitalo-Universitaire de Caen; Université de Caen Basse-Normandie, Caen, France. 8. Laboratoire de Microbiologie-Hygiène, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. 9. Laboratoire de Microbiologie, Institut Gustave Roussy, Villejuif, France. 10. Laboratoire de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris; Université Paris Descartes, Paris, France. 11. Laboratoire de Microbiologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France. 12. Equipe Mobile d'Infectiologie, Hôpitaux Universitaires Paris Centre, site Cochin, Assistance Publique-Hôpitaux de Paris; Université Paris Descartes, Paris, France. 13. Service de Bactériologie, Hôpitaux Universitaires Paris Centre, site Cochin, Assistance Publique-Hôpitaux de Paris; Université Paris Descartes, Paris, France. Electronic address: philippe.morand@aphp.fr.
Abstract
OBJECTIVES: The Enterobacter cloacae complex (Ecc), routinely referred to as "E. cloacae" in clinical microbiology, encompasses several species with 12 genetic clusters and one sequence crowd that can be identified based on hsp60 sequencing. Little is known about the pathogenicity and distribution of resistance to antibiotics among the Ecc. METHODS AND RESULTS: In this prospective multicentre study, a total of 193 Ecc clinical isolates were collected from 10 academic hospitals distributed nationally across France and identified at the genetic cluster level on the basis of hsp60 sequencing. E. hormaechei isolates, which belong to clusters VI-VIII, were the largest group (53%), followed by cluster III that accounted for 28% of clinical isolates. All other Ecc clusters were present except cluster VII (E. hormaechei subsp. hormaechei). Cephalosporinase overproduction and ESBL were significantly more present in E. hormaechei (33% and 20%) than in other clusters (19% and 3%, respectively). CONCLUSIONS: These results suggest that rapid identification of "E. cloacae" at the genetic cluster level could improve adequacy of empirical antibiotic treatment and reduce the unnecessary use of broad spectrum antibiotics.
OBJECTIVES: The Enterobacter cloacae complex (Ecc), routinely referred to as "E. cloacae" in clinical microbiology, encompasses several species with 12 genetic clusters and one sequence crowd that can be identified based on hsp60 sequencing. Little is known about the pathogenicity and distribution of resistance to antibiotics among the Ecc. METHODS AND RESULTS: In this prospective multicentre study, a total of 193 Ecc clinical isolates were collected from 10 academic hospitals distributed nationally across France and identified at the genetic cluster level on the basis of hsp60 sequencing. E. hormaechei isolates, which belong to clusters VI-VIII, were the largest group (53%), followed by cluster III that accounted for 28% of clinical isolates. All other Ecc clusters were present except cluster VII (E. hormaechei subsp. hormaechei). Cephalosporinase overproduction and ESBL were significantly more present in E. hormaechei (33% and 20%) than in other clusters (19% and 3%, respectively). CONCLUSIONS: These results suggest that rapid identification of "E. cloacae" at the genetic cluster level could improve adequacy of empirical antibiotic treatment and reduce the unnecessary use of broad spectrum antibiotics.