Carbapenem-Resistant E. cloacae in Southwest China: Molecular Analysis of Resistance and Risk Factors for Infections Caused by NDM-1-Producers

Jia, Xiaojiong; Dai, Wei; Ma, Weijia; Yan, Jinrong; He, Jiaxun; Li, Shuang; Li, Congya; Ss, Yang; Xu, Xun; Sun, Shujuan; Shi, Jing; Zhang, Liping

doi:10.3389/fmicb.2018.00658

Cited by 26 publications

(25 citation statements)

References 24 publications

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“…Previous studies have shown the emergence of bla NDM-1 in China, with most of them being carried on the IncFIIAs-type plasmids. 17 In this study, plasmids from all the bla NDM-1carrying strains (including those in the donors and the transconjugants) also belonged to the plasmid replicon type IncFIIAs. In addition, the plasmids containing bla KPC-2 were un-typable.…”

Section: Discussionmentioning

confidence: 80%

Carbapenem-Resistant Klebsiella aerogenes Clinical Isolates from a Teaching Hospital in Southwestern China: Detailed Molecular Epidemiology, Resistance Determinants, Risk Factors and Clinical Outcomes

Ma¹,

Huang²,

Zhang³

et al. 2020

IDR

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Little is known about the epidemiology and carbapenem-resistance determinants of carbapenem-resistant K. aerogenes (CRKA) isolated from a single medical center. The present study was initiated to characterize the molecular epidemiology and the carbapenemresistance mechanisms of CRKA isolated during 2012-2018 from a teaching hospital in southwest China, and to investigate the risk factors and clinical outcomes of CRKA infections as well. Methods: Pulsed-field gel electrophoresis (PFGE) was employed for epidemiological analysis. PCR amplification and DNA sequencing were used to examine the antibiotic-resistance determinants. Plasmids were extracted and characterized by PCR-based replicon typing and conjugation assays. In order to further investigate the risk factors and clinical outcomes of CRKA infections, a retrospective case-control study was also performed. Results: PFGE analysis showed 32 different PFGE patterns among the 36 non-duplicated CRKA strains collected. Most of the isolates harbored multi-drug resistance (MDR) genes, including 2 (5.6%) carrying bla NDM-1 , 1 (2.8%) harboring bla KPC-2 , 13 (36.1%) carrying ESBL genes, 23 (63.9%) carrying ampC genes, 34 (94.4%) carrying quinolone resistance determinants (QRD) genes and 9 (25%) carrying aminoglycoside resistance determinants (ARD) genes. The outer membrane porins, OmpE35 and OmpE36, were, respectively, lost in 4 and 2 isolates. The efflux pump inhibition experiments were positive in 25 (69.4%) of the CRKA strains. Multivariate analysis indicated that hypo-albuminaemia, invasive procedures, and carbapenem exposure were independent risk factors for acquiring CRKA infections. Conclusion: No clonality relationship was identified among most of the 36 CRKA isolates. The over-expression of ESBLs and AmpC coupled with the efflux pumps contributed to carbapenem resistance in K. aerogenes. Additionally, this is the first report of CRKA isolate co-harboring bla NDM-1 , bla CTX-M-15 , bla EBC , bla ACC , acc (6ʹ)-Ib, armA, qnrD and loss of OmpE36 in China. Hypo-albuminaemia, invasive procedures and carbapenem exposure were associated with acquisition of CRKA infections.

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Section: Discussionmentioning

confidence: 80%

Carbapenem-Resistant Klebsiella aerogenes Clinical Isolates from a Teaching Hospital in Southwestern China: Detailed Molecular Epidemiology, Resistance Determinants, Risk Factors and Clinical Outcomes

Ma¹,

Huang²,

Zhang³

et al. 2020

IDR

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“…For conjugative assays, the rifampin-resistant E. coli EC600 strain was use as the recipient, and the transconjugants were selected on Mueller-Hinton agar plates supplemented with a combination of 32 µg/ml ampicillin and 512 µg/ml rifampin. For transformation assays, the transformants were selected on Mueller-Hinton agar plates containing 2 µg/ml MEM (Jia et al, 2018). Both the transconjugants and transformants were tested for antimicrobial susceptibilities by the VITEK2 compact system, and MICs for ETP, IPM, MEM, colistin (CS), and tigecycline (TGC) were further determined by the broth microdilution method.…”

Section: Conjugation Transformation and Plasmid Analysismentioning

confidence: 99%

Emergence of NDM-5-Producing Escherichia coli in a Teaching Hospital in Chongqing, China: IncF-Type Plasmids May Contribute to the Prevalence of blaNDM–5

et al. 2020

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The newly emerging NDM-5 confers increased antibiotic resistance and attracts extensive global attention, but the prevalence, dissemination mechanism, and clinical significance of NDM-5 among clinical Escherichia coli (E. coli) infections have not been thoroughly characterized to date. In the present study, 109 unique carbapenemresistant E. coli (CR-EC) isolates were collected in Southwest China, from 2013 to 2017, among which 41 (37.61%) CR-EC isolates were identified as NDM-5-producers, with most isolates carrying the IncF-type plasmids. Molecular epidemiological studies revealed ST167 being the most common sequence type (ST). Moreover, we described the first report of a clinical CR-EC isolate co-harboring bla KPC−2 and bla NDM−5 , which showed a higher level of resistance to carbapenems. In addition, bla NDM−5 plasmid transformation and conjugation indicated that bla NDM−5 itself did confer resistance to carbapenems. Complete sequencing of the bla NDM−5-harboring IncF plasmid revealed highly conserved regions (ble MBL-trpF-tat) and some transposons around bla NDM−5. Our findings revealed a new potential threat of NDM-5-postive CR-EC in mainland China and emphasized an urgent need to control their further spread.

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“…The most alarming data was that none of these cases had a history of traveling outside Brazil, which might represent local acquisition. Our cases present common characteristics, such as low socioeconomic class, low educational background, severe clinical conditions and poor functional status, already described as risk factors for infection by co-resistant agents (6,13,14).…”

Section: Discussionmentioning

confidence: 59%

Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2.

Bes

Nagano

Martins

et al. 2020

Preprint

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Carbapenem-resistant Enterobacteriaceae is a worldwide health problem, however isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe microbiological and clinical characteristics of five cases of bloodstream infection (BSI) caused by carbapenem-resistant K lebsiella pneumoniae and Serratia marcescens co-harboring blaKPC-2 and blaNDM-1.Of the five blood culture isolates, three from are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a soft tissue surgical patient. All patients lived in low-income neighborhoods and had no travel history. Despite antibiotic treatment, four of five patients died. The phenotypic assays showed that Meropenem added with either EDTA, PA or both showed increased zone of inhibition in comparison to Meropenem alone. Molecular tests confirmed blaKPC-2 and blaNDM-1 genes, the K. pneumoniae were assigned as ST258 and ST340 by Whole Genome Sequencing.

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Carbapenem-Resistant E. cloacae in Southwest China: Molecular Analysis of Resistance and Risk Factors for Infections Caused by NDM-1-Producers

Cited by 26 publications

References 24 publications

<p>Carbapenem-Resistant <em>Klebsiella aerogenes</em> Clinical Isolates from a Teaching Hospital in Southwestern China: Detailed Molecular Epidemiology, Resistance Determinants, Risk Factors and Clinical Outcomes</p>

<p>Carbapenem-Resistant <em>Klebsiella aerogenes</em> Clinical Isolates from a Teaching Hospital in Southwestern China: Detailed Molecular Epidemiology, Resistance Determinants, Risk Factors and Clinical Outcomes</p>

Emergence of NDM-5-Producing Escherichia coli in a Teaching Hospital in Chongqing, China: IncF-Type Plasmids May Contribute to the Prevalence of blaNDM–5

Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2.

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