Gram-negative bacteria harboring carbapenemases are rapidly spreading worldwide and are a significant public health concern, resulting in mortality upwards of 60%. Carbapenemase-producing organisms (CPO) are considered a triple threat due to their increasing prevalence, their multidrug-resistant (MDR) profile, and their ease of transmission from species to species and even among different genera of Gram-negative bacteria through transmissible genetic elements (i.e. transposons, insertion sequences, and plasmids). Knowledge gaps: Studies of CPO transmission in the US have generally been limited to outbreak settings; data regarding transmission in endemic settings are largely unknown. Additionally, studies evaluating transmission of carbapenemases have generally been restricted to Enterobacteriaceae; The role of glucose non-fermenters (e.g., Pseudomonas and Acinetobacter spp.) has mostly been ignored. We propose to fill these gaps in knowledge by understanding the molecular mechanisms of antibiotic resistance and spread amongst all CPO (Enterobacteriaceae and glucose non-fermenters) in a region of the US endemic for CPO. These data will be critical in determining how best to limit CPO transmission between patients and to guide therapeutic decisions. To accomplish these goals, we have assembled a team of clinician-scientists, biomedical engineers, and bioinformaticians with expertise in clinical microbiology, epidemiology, infectious diseases, antibiotic stewardship, and in applications of the novel MinION technology.
Aim 1 : Determine the molecular mechanisms of spread involved in the dissemination of CPO in a non-outbreak setting using whole genome sequencing (WGS).
Aim 2 : Identify all antibiotic-resistance genes harbored by the CPO isolates to link the resistance genes to the circulating clones or plasmids harboring carbapenemases.
Aim 3 : Determine if the association of resistance genes with particular plasmids or clones can be used to accurately predict antibiotic susceptibility profiles of CPO clinical isolates. Significance and Impact: By gaining a better understanding of the complexity of the molecular mechanisms of resistance and spread among CPO, we can help guide therapy and appropriate prevention strategies to halt the spread of these important pathogens within the clinical setting.

Public Health Relevance

Gram-negative bacteria harboring carbapenemases are rapidly spreading worldwide and are a significant public health concern, resulting in mortality upwards of 60%. We propose to conduct experiments to help us understand the molecular mechanisms of antibiotic resistance and spread amongst all CPO in a region of the US endemic for CPO. By gaining a better understanding of the complexity of the molecular mechanisms of resistance and spread amongst CPO, we can help guide therapy and appropriate prevention strategies to halt the spread of these important pathogens within the clinical setting.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21AI130608-01
Application #
9297426
Study Section
Special Emphasis Panel (ZRG1-IDM-T (82)S)
Program Officer
Ernst, Nancy Lewis
Project Start
2017-02-15
Project End
2019-01-31
Budget Start
2017-02-15
Budget End
2018-01-31
Support Year
1
Fiscal Year
2017
Total Cost
$285,761
Indirect Cost
$110,761
Name
Johns Hopkins University
Department
Pathology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Simner, Patricia J; Goodman, Katherine E; Carroll, Karen C et al. (2018) Using Patient Risk Factors to Identify Whether Carbapenem-Resistant Enterobacteriaceae Infections Are Caused by Carbapenemase-Producing Organisms. Open Forum Infect Dis 5:ofy094
Tamma, Pranita D; Simner, Patricia J (2018) Phenotypic Detection of Carbapenemase-Producing Organisms from Clinical Isolates. J Clin Microbiol 56:
Simner, Patricia J; Antar, Annukka A R; Hao, Stephanie et al. (2018) Antibiotic pressure on the acquisition and loss of antibiotic resistance genes in Klebsiella pneumoniae. J Antimicrob Chemother :
Rock, Clare; Anderson, Michael; Lewis, Shawna et al. (2018) Comparison of nylon-flocked swab and cellulose sponge methods for carbapenem-resistant Enterobacteriaceae and gram-negative organism recovery from high-touch surfaces in patient rooms. Infect Control Hosp Epidemiol 39:1257-1261
Tamma, Pranita D; Fan, Yunfan; Bergman, Yehudit et al. (2018) Successful Treatment of Persistent Burkholderia cepacia Complex Bacteremia with Ceftazidime-Avibactam. Antimicrob Agents Chemother 62:
Simner, Patricia J; Opene, Belita N A; Chambers, Krizia K et al. (2017) Carbapenemase Detection among Carbapenem-Resistant Glucose-Nonfermenting Gram-Negative Bacilli. J Clin Microbiol 55:2858-2864
Tamma, Pranita D; Wang, Ruibin; Lewis, Shawna et al. (2017) Is There a Carbapenem MIC Cutoff Value That Distinguishes Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem Non-Susceptible Pseudomonas and Acinetobacter Isolates? Infect Control Hosp Epidemiol 38:1378-1379