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Clin Infect Dis. 2018 Nov 13;67(suppl_2):S196-S205. doi: 10.1093/cid/ciy660.

Phenotypic and Genotypic Characterization of Carbapenem-resistant Enterobacteriaceae: Data From a Longitudinal Large-scale CRE Study in China (2012-2016).

Author information

1
Department of Clinical Laboratory, Peking University People's Hospital, Beijing.
2
Department of Clinical Laboratory, Hunan Provincial People's Hospital, Changsha, Hunan.
3
Department of Clinical Laboratory, Yanbian University Hospital, Yanji.
4
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, and National Clinical Research Center for Respiratory Diseases, Beijing.
5
Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong.
6
Department of Clinical Laboratory, Medical Technology Institute of Xuzhou Medical University, The Affiliated Hospital of Xuzhou Medical University, Jiangsu.
7
Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University.
8
Department of Medical Laboratory center, the First Hospital of Lanzhou University, Gansu.
9
Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Fujian.
10
Department of Clinical Laboratory, First Hospital of Qinhuangdao, Hebei.
11
Department of Clinical Laboratory, Henan Province Hospital of TCM, Zhengzhou.
12
Department of Clinical Laboratory, Tengzhou Central People's Hospital, Shandong.
13
Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan.
14
Department of Clinical Microbiology, Jinan Central Hospital, Shandong.
15
Department of Clinical Laboratory Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi.
16
Department of Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan.
17
Department of Laboratory Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumchi, China.

Abstract

Background:

Carbapenem-resistant Enterobacteriaceae (CRE) strains are a major threat to global health. The development of effective control measures requires more detailed phenotypic and genotypic characterization of CRE.

Methods:

CRE isolates were collected from 65 hospitals in 25 provinces across China between January 1, 2012, and December 31, 2016. The isolates were characterized by antimicrobial susceptibility testing and multilocus sequence typing. Genes encoding carbapenemases, mobilized colistin resistance (mcr-1), and β-lactamases were detected by polymerase chain reaction and DNA sequencing.

Results:

A total of 1801 independent CRE isolates (1201 Klebsiella pneumoniae, 282 Escherichia coli, and 179 Enterobacter cloacae) were collected during the study period. Overall, 96.9%, 89.7%, 54.5%, 49.9%, and 40% of CRE strains were susceptible to colistin, tigecycline, amikacin, minocycline, and fosfomycin, respectively. Notably, 1091/1201 (91%) K. pneumoniae, 225/282 (80%) E. coli, and 129/179 (72%) E. cloacae harbored carbapenemase gene. K. pneumoniae carbapenemase (KPC) was predominant in K. pneumoniae (77%), whereas New Delhi metallo-β-lactamase (NDM) was predominant in E. coli (75%) and E. cloacae (53%). The mcr-1 gene was detected in 13 NDM-carrying E. coli isolates (4.6%). Sequence type (ST)11 and ST167 were predominant among the 100 K. pneumoniae and 47 E. coli STs, respectively. KPC-ST11, which accounted for 64% of K. pneumoniae isolates, had higher levels of resistance than non-ST11 strains to aztreonam, fosfomycin, and amikacin (P < .001). The proportions of KPC and NDM enzymes in CRE increased from 2012 to 2016 (54%-59% and 12%-28%, respectively).

Conclusions:

The number of CRE strains harboring carbapenemase is increasing. KPC-ST11 K. pneumoniae, the predominant strain, shows a reduced susceptibility to most available antibiotics.

PMID:
30423057
DOI:
10.1093/cid/ciy660

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