Carbapenemase-Producing <i>Enterobacteriaceae</i> and Nonfermentative Bacteria, the Philippines, 2013–2016

Velasco, John Mark; Valderama, Maria Theresa; Peacock, Trent J; Nirdnoy, Warawadee; Nogrado, Kathyleen; Navarro, Fatima Claire; Chua, Domingo; Srijan, Apichai; Ruekit, Sirigade; Macareo, Louis; Swierczewski, Brett E.

doi:10.3201/eid2309.161237

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…Many CPE, including E. coli and other species, possessed different types of carbapenemase. The most prevalent carbapenemase gene type was NDM (n ϭ 39; Table 2); NDM-1 and NDM-7 producers are endemic in clinical settings in the Philippines (14). We found that CPE isolates that are often found in clinical settings were also present in the environment.…”

Section: Resultsmentioning

confidence: 72%

“…We found that CPE isolates that are often found in clinical settings were also present in the environment. KPC, GES, and OXA-48 producers, which have not yet been detected in clinical settings in the Philippines (14,15,17), were detected in both hospital sewage and river water. Although it is unclear whether these CPE isolates originated from humans or the natural environment, it is possible that they may spread from the natural environment to clinical settings in the future.…”

Section: Resultsmentioning

confidence: 94%

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Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines

Suzuki

Nazareno

Nakano

et al. 2020

Appl Environ Microbiol

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This study aimed to evaluate the prevalence and genetic characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in hospital sewage and river water in the Philippines, which has a typical tropical maritime climate. We collected 83 water samples from 7 hospital sewage and 10 river water sites. CPE were identified using CHROMagar mSuperCARBA, and Gram-negative strains were identified using matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) or 16S rRNA gene sequencing. Resistance genes in Enterobacteriaceae strains were identified using PCR and DNA sequencing, and transferability of carbapenemase genes from the CPE was investigated with conjugation experiments. Genotyping was performed using multilocus sequence typing (MLST) for Escherichia coli and Klebsiella pneumoniae. Out of 124 Enterobacteriaceae isolates, we identified 51 strains as CPE and divided these into 7 species, 11 E. coli, 14 Klebsiella spp., 15 Enterobacter spp., and 11 others, including 4 additional species. Conjugation experiments via broth mating and using E. coli J53 revealed that 24 isolates can transfer carbapenemase-encoding plasmids. MLST analysis showed that 6 of 11 E. coli isolates belonged to clonal complex 10 (CC10). Of 11 K. pneumoniae strains, 9 unique sequence types (STs) were identified, including ST147. Five types of carbapenemase genes were identified, with the most prevalent being NDM (n = 39), which is epidemic in clinical settings in the Philippines. E. coli CC10 and K. pneumoniae ST147, which are often detected in clinical settings, were the dominant strains. In summary, our results indicate that hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups. IMPORTANCE Carbapenemase-producing Enterobacteriaceae (CPE) cause severe health care-associated infections, and their increasing prevalence is a serious concern. Recently, natural ecosystems have been recognized as important reservoirs of antibiotic resistance genes. We investigated the prevalence and genetic characteristics of CPE isolated from the environment (hospital sewage and river water) in the Philippines and found several CPE, including Escherichia coli and other species, with different carbapenemases. The most prevalent carbapenemase gene type was NDM, which is endemic in clinical settings. This study revealed that isolates belonging to carbapenemase-producing E. coli CC10 and K. pneumoniae sequence type 147 (ST147), which are often detected in clinical settings, were dominant in the natural environment. Our work here provides a report on the presence and characteristics of CPE in the environment in the Philippines and demonstrates that both hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.

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Section: Resultsmentioning

confidence: 72%

Section: Resultsmentioning

confidence: 94%

Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines

Suzuki

Nazareno

Nakano

et al. 2020

Appl Environ Microbiol

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“…In contrast to North America and Europe, NDM and other MBLs (eg, IMP, VIM), and OXA-48–type, rather than KPC, were the predominant carbapenemases in CRE in Southeast Asia [60]. A 2013–2016 study of 130 carbapenem-resistant isolates in the Philippines identified 45 (35%) carbapenemase-producing bacterial isolates with 43 (33%) testing positive for NDM and 2 (1.5%) for VIM, both of which were P. aeruginosa [61]. Surveillance reports in India and surrounding countries reveal that the most frequent carbapenemase enzymes remain NDM in Enterobacteriaceae and OXA-23 in A. baumannii [26].…”

Section: Geographic Distribution Of Carbapenem Resistance Mechanismsmentioning

confidence: 99%

Epidemiology and Diagnostics of Carbapenem Resistance in Gram-negative Bacteria

Nordmann

Poirel

2019

Clinical Infectious Diseases

499

373

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Carbapenem resistance in gram-negative bacteria has caused a global epidemic that continues to grow. Although carbapenemase-producing Enterobacteriaceae have received the most attention because resistance was first reported in these pathogens in the early 1990s, there is increased awareness of the impact of carbapenem-resistant nonfermenting gram-negative bacteria, such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Moreover, evaluating the problem of carbapenem resistance requires the consideration of both carbapenemase-producing bacteria as well as bacteria with other carbapenem resistance mechanisms. Advances in rapid diagnostic tests to improve the detection of carbapenem resistance and the use of large, population-based datasets to capture a greater proportion of carbapenem-resistant organisms can help us gain a better understanding of this urgent threat and enable physicians to select the most appropriate antibiotics.

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“…This correlates with previous studies, in which most resistant organisms were identified as Klebsiella species. [ 20 22 23 24 ] Klebsiella species are known to be the most common carbapenemase-producing Enterobacterales in the health-care settings and have become a significant cause of morbidity and mortality in the admitted patient. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy and Agreement between Four Phenotypic Carbapenemase Detection Tests among Enterobacterales

Farooqui¹,

Irfan²,

Laiq³

2021

Journal of Global Infectious Diseases

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Introduction: Carbapenem-resistant Enterobacterales (CREs) are becoming increasingly popular as a cause of hospital-acquired infections that are difficult to treat and are frequently reported as causes of outbreaks in various hospitals. Conventional culturing techniques take at least 2 days to report a case as carbapenem resistant, and it is therefore important to detect such resistance mechanisms as early as possible. Methods: This study aimed to compare the diagnostic performance of Carba NP, modified Hodge test (MHT), ethylenediaminetetraacetic acid (EDTA) disk synergy test (DST), and the modified carbapenem inactivation method (mCIM). This study was done at Microbiology Laboratory, Aga Khan University Hospital, Karachi. It was an observational study. Carba NP, MHT, EDTA DST, and the mCIM were performed on consecutive isolates of Enterobacterales. Sensitivity, specificity, and agreement between the four tests were calculated. Results: Of 207 Enterobacterales isolated, 127 were resistant to carbapenems. One hundred and fourteen of these were tested by a polymerase chain reaction, and the sensitivities of the Carba NP, MHT, EDTA DST, and the mCIM were found to be 94.34%, 75.47%, 79.25%, and 98.11%, respectively. Conclusions: Due to increased rates of carbapenem resistance, there is a need to employ mechanisms in hospitals that can identify such organisms as early as possible, both from clinical and epidemiological standpoints. The Carba NP test is a rapid, cost–effective, and reliable method and mCIM is more accurate but time consuming and both can be safely used for the screening of CREs.

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Carbapenemase-Producing Enterobacteriaceae and Nonfermentative Bacteria, the Philippines, 2013–2016

Cited by 11 publications

References 9 publications

Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines

Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines

Epidemiology and Diagnostics of Carbapenem Resistance in Gram-negative Bacteria

Diagnostic Accuracy and Agreement between Four Phenotypic Carbapenemase Detection Tests among Enterobacterales

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