What question did this study set out to answer?

To investigate the clonal outbreak of KPC-2-producing Enterobacter roggenkampii in pediatric patients and its associated resistance mechanisms.

April 27, 2026International Journal of Infectious Diseases0 citationsOpen Access

Fatal Clonal Outbreak of KPC-2–Producing Enterobacter roggenkampii in Paediatric Patients: Cefiderocol Resistance and a Novel IncU Plasmid

LNLetícia da Silva NascimentoFundação Oswaldo Cruz DRDaiana Cristina Silva RodriguesFundação Oswaldo Cruz BSBruna Ribeiro Sued-KaramFundação Oswaldo Cruz

Key Points

To investigate the clonal outbreak of KPC-2-producing Enterobacter roggenkampii in pediatric patients and its associated resistance mechanisms.
Identified clonal dissemination of KPC-2-E. roggenkampii ST516 in a pediatric ICU.
Analyzed cefiderocol resistance and genetic elements including the blaKPC-2 gene on a novel plasmid.
Assessed clinical outcomes and diagnostic challenges during the outbreak.
50% mortality rate among affected patients with severe complications.
Detection of cefiderocol resistance in XDR isolates despite no prior exposure.
Automated systems misidentified isolates, contributing to the outbreak.

Abstract

Clonal dissemination of KPC-2-E.roggenkampii ST516 in a paediatric ICU. Automated systems misidentified the isolates, masking a fatal nosocomial outbreak. The blaKPC-2 gene was located on a novel, streamlined IncU plasmid backbone. XDR isolates showed cefiderocol resistance despite no prior drug exposure.Graphical abstract of the fatal E. roggenkampii ST516 outbreak.The study highlights: (i) 50% mortality and severe clinical complications; (ii) diagnostic misidentification by automated systems; (iii) a novel ~30 kb IncU plasmid carrying blaKPC-2; and (iv) an XDR phenotype with cefiderocol resistance despite no prior drug exposure.Created in PowerPoint and Canva using royalty-free icons.

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