Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou, China
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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.
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