1887

Abstract

Carbapenem-resistant (CRE) have been responsible for nosocomial outbreaks worldwide and have become endemic in several countries.

To better understand the epidemiological trends and characteristics of CRE in the Henan province.

We assessed the molecular epidemiological characteristics of 305 CRE strains isolated from patients in 19 secondary or tertiary hospitals in ten areas of the Henan province in China.

A total of 305 CRE isolates were subjected to multiple tests, including antimicrobial susceptibility testing, PCR for carbapenemase genes , , , , -. Tigecycline-resistant genes , , , A, , X, M, L were analysed in five tigecycline non-susceptible carbapenem-resistant isolates (TNSCRKP). Additionally, multilocus sequence typing (MLST) was performed for carbapenem-resistant (CRKP).

The most common CRE species were (234, 77 %), (36, 12 %) and (13, 4 %). All strains exhibited multi-drug resistance. Overall, 97 % (295/305) and 97 % (297/305) of the isolates were susceptible to polymyxin B and tigecycline, respectively. A total of 89 % (271/305) of the CRE isolates were carbapenemase gene-positive, including 70 % , 13 % , 6 % , and 1 % combined / genes. carbapenemase (KPC) was the predominant carbapenemase in (87 %), whereas NDM and IMP were frequent in (53 %) and (69 %), respectively. Mutations in the , and genes were detected in five TNSCRKP. Moreover, 15 unique sequence types were detected, with ST11 (74 %), ST15 (9 %) and ST2237 (5 %) being dominant among strains.

A high proportion of CRE strains were carbapenemase-positive, and five carbapenem-resistant isolates were tigecycline non-susceptible, indicating a need for the ongoing surveillance of CRE and effective measures for the prevention of CRE infections.

Funding
This study was supported by the:
  • Science and Technology Department, Henan Province (Award SBGJ2018084)
    • Principle Award Recipient: YiLi
  • Science and Technology Department of Henan Province (Award 182102311241)
    • Principle Award Recipient: WenjuanYan
  • This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial License.
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2021-02-15
2021-10-25
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References

  1. Potter RF, D’Souza AW, Dantas G. The rapid spread of carbapenem-resistant Enterobacteriaceae . Drug Resist Updat 2016; 29:30–46 [View Article]
    [Google Scholar]
  2. Sivalingam P, Poté J, Prabakar K. Environmental prevalence of carbapenem resistance Enterobacteriaceae (CRE) in a tropical ecosystem in India: human health perspectives and future directives. Pathogens 2019; 8:174 [View Article]
    [Google Scholar]
  3. Durante-Mangoni E, Andini R, Zampino R. Management of carbapenem-resistant Enterobacteriaceae infections. Clin Microbiol Infect 2019; 25:943–950 [View Article]
    [Google Scholar]
  4. Cui X, Zhang H, Du H. Carbapenemases in Enterobacteriaceae: detection and antimicrobial therapy. Front Microbiol 1823; 2019:10
    [Google Scholar]
  5. Kopotsa K, Osei Sekyere J, Mbelle NM. Plasmid evolution in carbapenemase‐producing Enterobacteriaceae : a review. Ann N Y Acad Sci 2019; 1457:61–91 [View Article]
    [Google Scholar]
  6. Wang Q, Wang X, Wang J, Ouyang P, Jin C et al. Phenotypic and genotypic characterization of carbapenem-resistant Enterobacteriaceae: data from a longitudinal large-scale CRE study in China (2012–2016). Clin Infect Dis 2018; 67:S196–S205 [View Article]
    [Google Scholar]
  7. Liu C, Qin S, Xu H, Xu L, Zhao D et al. New Delhi Metallo-β-Lactamase 1(NDM-1), the dominant carbapenemase detected in carbapenem-resistant Enterobacter cloacae from Henan Province, China. PLoS One 2015; 10:e0135044 [View Article]
    [Google Scholar]
  8. Liang W-juan, Liu H-ying, Duan G-C, Zhao Y-xin, Chen S-yin et al. Emergence and mechanism of carbapenem-resistant Escherichia coli in Henan, China, 2014. J Infect Public Health 2018; 11:347–351 [View Article]
    [Google Scholar]
  9. Li Y, Sun Q-ling, Shen Y, Zhang Y, Yang J-wen et al. Rapid increase in prevalence of carbapenem-resistant Enterobacteriaceae (CRE) and emergence of colistin resistance Gene mcr-1 in CRE in a hospital in Henan, China. J Clin Microbiol 2018; 56:e01932–17 [View Article]
    [Google Scholar]
  10. He T, Wang R, Liu D, Walsh TR, Zhang R et al. Emergence of plasmid-mediated high-level tigecycline resistance genes in animals and humans. Nat Microbiol 2019; 4:1450–1456 [View Article]
    [Google Scholar]
  11. Chiu S-K, Huang L-Y, Chen H, Tsai Y-K, Liou C-H et al. Roles of ramR and tet(A) mutations in conferring Tigecycline resistance in carbapenem-resistant Klebsiella pneumoniae clinical isolates. Antimicrob Agents Chemother 2017; 61:e00391–17 [View Article]
    [Google Scholar]
  12. Park Y, Choi Q, Kwon GC, Koo SH. Molecular epidemiology and mechanisms of tigecycline resistance in carbapenem‐resistant Klebsiella pneumoniae isolates. J Clin Lab Anal 2020; 34:e23506 [View Article]
    [Google Scholar]
  13. Elgendy SG, Abdel Hameed MR, El-Mokhtar MA. Tigecycline resistance among Klebsiella pneumoniae isolated from febrile neutropenic patients. J Med Microbiol 2018; 67:972–975 [View Article]
    [Google Scholar]
  14. Veleba M, Higgins PG, Gonzalez G, Seifert H, Schneiders T. Characterization of RaRA, a novel AraC family multidrug resistance regulator in Klebsiella pneumoniae. Antimicrob Agents Chemother 2012; 56:4450–4458 [View Article]
    [Google Scholar]
  15. He F, Shi Q, Fu Y, Xu J, Yu Y et al. Tigecycline resistance caused by rpsJ evolution in a 59-year-old male patient infected with KPC-producing Klebsiella pneumoniae during tigecycline treatment. Infect Genet Evol 2018; 66:188–191 [View Article]
    [Google Scholar]
  16. Du X, He F, Shi Q, Zhao F, Xu J et al. The rapid emergence of tigecycline resistance in blaKPC–2 harboring Klebsiella pneumoniae, as mediated in vivo by mutation in tetA during tigecycline treatment. Front Microbiol 2018; 9:648 [View Article]
    [Google Scholar]
  17. Sun J, Chen C, Cui C-Y, Zhang Y, Liu X et al. Plasmid-encoded tet(X) genes that confer high-level tigecycline resistance in Escherichia coli. Nat Microbiol 2019; 4:1457–1464 [View Article]
    [Google Scholar]
  18. Chen D, Zhao Y, Qiu Y, Xiao L, He H et al. CusS-CusR two-component system mediates tigecycline resistance in carbapenem-resistant Klebsiella pneumoniae. Front Microbiol 2019; 10:3159 [View Article]
    [Google Scholar]
  19. Fiedler S, Bender JK, Klare I, Halbedel S, Grohmann E et al. Tigecycline resistance in clinical isolates of Enterococcus faecium is mediated by an upregulation of plasmid-encoded tetracycline determinants tet (L) and tet (M). J Antimicrob Chemother 2016; 71:871–881 [View Article]
    [Google Scholar]
  20. Qin S, Fu Y, Zhang Q, Qi H, Wen JG et al. High incidence and endemic spread of NDM-1-positive Enterobacteriaceae in Henan Province, China. Antimicrob Agents Chemother 2014; 58:4275–4282 [View Article]
    [Google Scholar]
  21. Clinical and Laboratory Standards Institute M100‐S30. Performance Standards for Antimicrobial Susceptibility Testing: Thirty Edition [S] Wayne, PA: CLSI; 2020
    [Google Scholar]
  22. U.S. Food and Drug Administration Antibacterial susceptibility test interpretive criteria; 2020-10-13
  23. European Committee on Antimicrobial Susceptibility Testing Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 10.0.2020-01‐01. n.d
    [Google Scholar]
  24. Dallenne C, Da Costa A, Decré D, Favier C, Arlet G. Development of a set of multiplex PCR assays for the detection of genes encoding important β-lactamases in Enterobacteriaceae . J Antimicrob Chemother 2010; 65:490–495 [View Article]
    [Google Scholar]
  25. Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007; 20:440–458 [View Article]
    [Google Scholar]
  26. Rahman M, Shukla SK, Prasad KN, Ovejero CM, Pati BK et al. Prevalence and molecular characterisation of New Delhi metallo-β-lactamases NDM-1, NDM-5, NDM-6 and NDM-7 in multidrug-resistant Enterobacteriaceae from India. Int J Antimicrob Agents 2014; 44:30–37 [View Article]
    [Google Scholar]
  27. Lee C-R, Lee JH, Park KS, Kim YB, Jeong BC et al. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: epidemiology, genetic context, treatment options, and detection methods. Front Microbiol 2016; 7:895 [View Article]
    [Google Scholar]
  28. Fang L, Lu X, Xu H, Ma X, Chen Y et al. Epidemiology and risk factors for carbapenem-resistant Enterobacteriaceae colonisation and infections: case-controlled study from an academic medical center in a southern area of China. Pathog Dis 2019; 77:FTZ034 [View Article]
    [Google Scholar]
  29. Zhang R, Liu L, Zhou H, Chan EW, Li J et al. Nationwide surveillance of clinical carbapenem-resistant Enterobacteriaceae (CRE) strains in China. EBioMedicine 2017; 19:98–106 [View Article]
    [Google Scholar]
  30. Lutgring JD. Carbapenem-resistant Enterobacteriaceae: an emerging bacterial threat. Semin Diagn Pathol 2019; 36:182–186 [View Article]
    [Google Scholar]
  31. Nordmann P, Poirel L. Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria. Clin Infect Dis 2019; 69:S521–S528 [View Article]
    [Google Scholar]
  32. Meletis G. Carbapenem resistance: overview of the problem and future perspectives. Ther Adv Infect Dis 2016; 3:15–21 [View Article]
    [Google Scholar]
  33. Betts JW, Phee LM, Hornsey M, Woodford N, Wareham DW. In vitro and in vivo activities of tigecycline-colistin combination therapies against carbapenem-resistant Enterobacteriaceae . Antimicrob Agents Chemother 2014; 58:3541–3546 [View Article]
    [Google Scholar]
  34. Sheng Z-K, Hu F, Wang W, Guo Q, Chen Z et al. Mechanisms of tigecycline resistance among Klebsiella pneumoniae clinical isolates. Antimicrob Agents Chemother 2014; 58:6982–6985 [View Article]
    [Google Scholar]
  35. Fang L, Chen Q, Shi K, Li X, Shi Q et al. Step-Wise increase in tigecycline resistance in Klebsiella pneumoniae associated with mutations in ramR, Lon and rpsJ. PLoS One 2016; 11:e0165019 [View Article]
    [Google Scholar]
  36. Park S, Lee H, Shin D, Ko KS. Change of Hypermucoviscosity in the development of tigecycline resistance in hypervirulent Klebsiella pneumoniae sequence type 23 strains. Microorganisms 2020; 8:1562 [View Article]
    [Google Scholar]
  37. Park Y, Choi Q, Kwon GC, Koo SH. Molecular epidemiology and mechanisms of tigecycline resistance in carbapenem‐resistant Klebsiella pneumoniae isolates. J Clin Lab Anal 2020; 34:e23506 [View Article]
    [Google Scholar]
  38. Huang Y-H, Chou S-H, Liang S-W, Ni C-E, Lin Y-T et al. Emergence of an XDR and carbapenemase-producing hypervirulent Klebsiella pneumoniae strain in Taiwan. Antimicrob Chemother 2018; 73:2039–2046 [View Article]
    [Google Scholar]
  39. Guo S, Xu J, Wei Y, Xu J, Li Y et al. Clinical and molecular characteristics of Klebsiella pneumoniae ventilator-associated pneumonia in mainland China. BMC Infect Dis 2016; 16:608 [View Article][PubMed]
    [Google Scholar]
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