First report of a carbapenemase OXA-48-producing Hafnia alvei clinical isolate
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Introduction. Carbapenems are usually used in the treatment of infections caused by cephalosporin-resistant Enterobacterales ; however, the increase in carbapenem-resistant Enterobacterales (CRE) has become one of the most important problems in public health. Hafnia alvei is associated with intestinal and extraintestinal infections, especially in patients with any chronic disease or some type of immunosupression. H. alvei is resistant to first-generation aminopenicillins and cephalosporins owing to the β-lactamase (Amp C) in their chromosome; the only carbapenem-resistant Hafnia strain described until now was due to a lack of the OmpK36 protein that plays an important role in permeability to carbapenems.
Case presentation. We present the case of a 65-year-old male diagnosed with acute lithiasic cholecystitis. Culture of the biliary prosthesis yielded a OXA-48-producing H. alvei that was identified by MALDI-TOF (matrix-assisted laser desorption/ionization-time of flight) MS. Carbapenemase production was detected by immunochromatography and confirmed by sequencing.
Conclusion. To our knowledge, this is the first report of OXA-48-producing H. alvei probably obtained by horizontal transfer from Enterobacter cloacae OXA-48 isolated in previous samples.
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This is a study that would be of interest to the field and community.
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Comments to Author
Dear authors It is ok Just DAA in line 59 is direct antiviral drug Regards
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
Dear authors The manuscript is well-written, discuss important topic and organized. There are some points that need correction: - Line 59: DAA; the complete name should be mentioned first - Line 59: virologic sustained response (SVR); complete name needs rearrangement of words. - Lines 84-86: Minimum Inhibitory concentrations (MIC)…..; reference should be written - Table 2: Table 2: MIC distribution…. (measuring unit should be mentioned (
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential …
Comments to Author
Dear authors The manuscript is well-written, discuss important topic and organized. There are some points that need correction: - Line 59: DAA; the complete name should be mentioned first - Line 59: virologic sustained response (SVR); complete name needs rearrangement of words. - Lines 84-86: Minimum Inhibitory concentrations (MIC)…..; reference should be written - Table 2: Table 2: MIC distribution…. (measuring unit should be mentioned (
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
No: ethical approval is not mentioned nor informed consent
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Comments to Author
This is a good case report overall and is the first case I have ever come across that Hafnia as being a confirmed Carbapenamase producer. This highlights the need of further testing if expected clinical response is not achieved and showed reduced susceptibility is seen in initial analysis. The fact that possible within-host interspecies spreading of resistance pattern is an interesting point. The case was well presented. The only additional thing that would be interesting to add was to describe a bit more on the patient's clinical response before and after changing antibiotics after finding out Hafnia is the carbapenamase producer. Can the author provide that information please? In many of the intra-abdominal/surgical infections, it is very important to distinguish between real pathogens and …
Comments to Author
This is a good case report overall and is the first case I have ever come across that Hafnia as being a confirmed Carbapenamase producer. This highlights the need of further testing if expected clinical response is not achieved and showed reduced susceptibility is seen in initial analysis. The fact that possible within-host interspecies spreading of resistance pattern is an interesting point. The case was well presented. The only additional thing that would be interesting to add was to describe a bit more on the patient's clinical response before and after changing antibiotics after finding out Hafnia is the carbapenamase producer. Can the author provide that information please? In many of the intra-abdominal/surgical infections, it is very important to distinguish between real pathogens and colonisers, so it is good to know the difference in patients' condition before and after new treatment.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes