Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou, China
With the abuse of antimicrobial agents in developing countries, increasing number of carbapenem-resistant Enterobacteriaceae (CRE) attracted considerable public concern. A retrospective study was conducted based on 242 CRE strains from a tertiary hospital in Hangzhou, China to investigate prevalence and drug resistance characteristics of CRE in southeast China. Bacterial species were identified. Antimicrobial susceptibility was examined by broth microdilution method or epsilometer test. Resistant β-lactamase genes were identified by polymerase chain reaction and sequencing. Genotypes were investigated by phylogenetic analysis. Klebsiella pneumoniae and Escherichia coli were the most prevalent types of species, with occurrence in 71.9% and 21.9% of the strains, respectively. All strains exhibited high resistance (> 70%) against β-lactam antibiotics, ciprofloxacin, trimethoprim–sulfamethoxazole, and nitrofurantoin but exhibited low resistance against tigecycline (0.8%) and minocycline (8.3%). A total of 123 strains harbored more than two kinds of β-lactamase genes. blaKPC-2, blaSHV-11, blaTEM-1, and blaCTX-M-14 were the predominant genotypes, with detection rates of 60.3%, 61.6%, 43.4%, and 16.5%, respectively, and were highly identical with reference sequences in different countries, indicating potential horizontal dissemination. IMP-4 was the most frequent class B metallo-lactamases in this study. In conclusion, continuous surveillance and effective prevention should be emphasized to reduce spread of CRE.
KeywordsEnterobacteriaceae carbapenem β-lactamase genes phylogenetic analysis
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This work was supported by a grant from the Medical Science Foundation of Nanjing Military Command (No. 10Z037). The authors are grateful to Prof. A.A. Medeiros (The Miriam Hospital, Providence, RI, USA) for the Enterobacter cloacae IMI-1 strain, Prof. G. A. Jacoby (Massachusetts General Hospital, Boston, MA, USA) for the Klebsiella pneumoniae IMP-4 strain, and Prof. Rong Zhang (Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China) for the Klebsiella pneumoniae KPC-2 strain.
- 3.Pollett S, Miller S, Hindler J, Uslan D, Carvalho M, Humphries RM. Phenotypic and molecular characteristics of carbapenem-resistant Enterobacteriaceae in a health care system in Los Angeles, California, from 2011 to 2013. J Clin Microbiol 2014; 52(11): 4003–4009CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Schwaber MJ, Lev B, Israeli A, Solter E, Smollan G, Rubinovitch B, Shalit I, Carmeli Y. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011; 52(7): 848–855CrossRefPubMedGoogle Scholar
- 7.Hu FP, Zhu DM, Wang F, Jiang XF, Yang Q, Huang WX, Jia B, Xu YH, Shen JL, Xu YC, Zhang XJ, Hu YJ, Ai XM, Zhang ZX, Ji P, Shan B, Du Y, Zhuo C, Su DH, Wang CQ, Wang AJ, Ni YX, Sun JY, Sun ZY, Chen ZJ, Wei LH, Wu L, Zhang H, Kong Q. CHINET surveillance of distribution and susceptibility of carbapenemresistant Enterobacteriaceae isolates in 2010. Chin J Infect Chemother (Zhongguo Gan Ran Yu Hua Liao Za Zhi) 2013; 13(1): 1–7 (in Chinese)Google Scholar
- 10.Clinical and Laboratory Standards Institute. Performance standards for antimiembial susceptibility testing; twenty-fourth informational supplement. CLSI document M100–S25. Wayne, PA: CLSI, 2015Google Scholar
- 11.Zowawi HM, Sartor AL, Balkhy HH, Walsh TR, Al Johani SM, AlJindan RY, Alfaresi M, Ibrahim E, Al-Jardani A, Al-Abri S, Al Salman J, Dashti AA, Kutbi AH, Schlebusch S, Sidjabat HE, Paterson DL. Molecular characterization of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in the countries of the Gulf cooperation council: dominance of OXA-48 and NDM producers. Antimicrob Agents Chemother 2014; 58(6): 3085–3090CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Castanheira M, Sader HS, Deshpande LM, Fritsche TR, Jones RN. Antimicrobial activities of tigecycline and other broad-spectrum antimicrobials tested against serine carbapenemase- and metallo-β- lactamase-producing Enterobacteriaceae: report from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother 2008; 52(2): 570–573CrossRefPubMedGoogle Scholar
- 18.Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant Gram-negative organisms: extended-spectrum β- lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc 2011; 86(3): 250–259CrossRefPubMedPubMedCentralGoogle Scholar
- 22.An S, Chen J, Wang Z, Wang X, Yan X, Li J, Chen Y, Wang Q, Xu X, Li J, Yang J, Wang H, Gao Z. Predominant characteristics of CTX-M-producing Klebsiella pneumoniae isolates from patients with lower respiratory tract infection in multiple medical centers in China. FEMS Microbiol Lett 2012; 332(2): 137–145CrossRefPubMedGoogle Scholar
- 23.Abdallah HM, Wintermans BB, Reuland EA, Koek A, al Naiemi N, Ammar AM, Mohamed AA, Vandenbroucke-Grauls CM. Extendedspectrum β-lactamase- and carbapenemase-producing enterobacteriaceae isolated from Egyptian patients with suspected blood stream infection. PLoS One 2015; 10(5): e0128120CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Giske CG, Fröding I, Hasan CM, Turlej-Rogacka A, Toleman M, Livermore D, Woodford N, Walsh TR. Diverse sequence types of Klebsiella pneumoniae contribute to the dissemination of blaNDM-1 in India, Sweden, and the United Kingdom. Antimicrob Agents Chemother 2012; 56(5): 2735–2738CrossRefPubMedPubMedCentralGoogle Scholar