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Antimicrob Agents Chemother. 2014 Aug;58(8):4275-82. doi: 10.1128/AAC.02813-13. Epub 2014 Apr 28.

High incidence and endemic spread of NDM-1-positive Enterobacteriaceae in Henan Province, China.

Author information

1
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
2
Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
3
Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA.
4
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
5
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China xjfeng62688@163.com liuhm@zzu.edu.cn.
6
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China xjfeng62688@163.com liuhm@zzu.edu.cn.

Abstract

The emergence and spread of New Delhi metallo-β-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla(NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla(NDM-1), and the gene was found to be carried on plasmids of various sizes (∼ 55 to ∼ 360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla(NDM-1)-positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla(NDM-1)-positive CRE isolate, the bla(NDM-1) gene was downstream of an intact ISAba125 element and upstream of the bleMBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla(NDM-1)-containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.

PMID:
24777095
PMCID:
PMC4136005
DOI:
10.1128/AAC.02813-13
[Indexed for MEDLINE]
Free PMC Article
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