Clonal and Horizontal Transmission of
            <i>bla</i>
            <sub>NDM</sub>
            among Klebsiella pneumoniae in Children’s Intensive Care Units

Fu, Bo; Yin, Daqiang; Sun, Chengtao; Shen, Yingbo; Liu, Dejun; Bai, Rina; Zhang, Rong; Shen, Jianzhong; Hu, Fupin; Wang, Yang

doi:10.1128/spectrum.01574-21

Cited by 17 publications

(11 citation statements)

References 47 publications

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“…However, although ceftazidime-avibactam is effective for most KPC- and OXA-48-producing Enterobacteriaceae , it has a narrow antibacterial spectrum which is not available against metallo-beta-lactamase (MBL)-producing Enterobacteriaceae , 31 which is playing an increasingly important role in infections caused by CRE, especially in children. 32 These findings in children require confirmation by randomized controlled trials in the future.…”

Section: Discussionmentioning

confidence: 94%

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Liu¹,

Mai²,

Wang³

et al. 2022

IDR

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Purpose Limited data are available on the characteristics, risk factors, and antimicrobial treatment of critically ill pediatric patients with carbapenem-resistant Enterobacteriaceae (CRE) infections. This study was to identify the risk factors for 30-day mortality in pediatric intensive care unit (PICU) patients with CRE infections and compare the clinical outcomes of different antimicrobial regimens. Methods A retrospective, observational cohort study was performed on patients admitted to the PICU with positive CRE cultures between January 2016 and December 2021. Results For the 56 patients, the overall 30-day mortality was 50% (n=28). Multivariable logistic regression analysis revealed that pediatric critical illness score (PCIS; HR = 0.879; 95% CI, 0.827–0.935; P < 0.001) and serum albumin levels (HR = 0.921; 95% CI, 0.860–0.987; P = 0.019) were independently associated with 30-day mortality. At the same time, there was no significant difference in 30-day mortality (42.9% versus 45.5%, P = 0.854) or clinical efficiency rate (53.4% versus 40.9%, P = 0.374) between with and without polymyxin B therapy. Conclusion The study revealed PCIS and serum albumin levels were the independent mortality-related risk factors of CRE infections in critically ill pediatric patients. Treatment with polymyxin B could not reduce 30-day mortality. Future prospective cohort studies are needed to investigate the optimal antimicrobial regimens for CRE infection in PICU patients.

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Section: Discussionmentioning

confidence: 94%

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Liu¹,

Mai²,

Wang³

et al. 2022

IDR

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“…It is very concerning that almost identical plasmids could be isolated from epidemiologically unrelated sources. Previous studies also reported the identification of genetically closely related plasmids between those from humans and those from environments, such as hospitals, farm yards, and aquatic environments ( 14 , 26 – 28 ). Therefore, the use of measures other than antimicrobials, e.g., hand hygiene, patient isolation, minimization of physical contact with animals, and disinfection of the environment, may decrease the spread of bla NDM and bla IMP genes among children.…”

Section: Discussionmentioning

confidence: 98%

Genomic Analysis Revealed the International and Domestic Transmission of Carbapenem-Resistant Klebsiella pneumoniae in Chinese Pediatric Patients

Jiang

Liu

et al. 2023

Microbiol Spectr

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in pediatric patients differs from that in adults patients in terms of both genetic and phenotypic features, which remain to be elucidated. We present a summary of prevalent CRKP isolates from Chinese pediatric patients over 8 years, demonstrating the prevalence and clinical importance of New Delhi metallo-β-lactamase genes in pediatric patients, mainly describing the genomic features of two predominant CRKP clones (ST11 and ST14) in Chinese children, and identifying four carbapenemase-encoding plasmids that contribute to the transmission of most carbapenemase genes in hospitals.

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“…Carbapenems are among the most effective antimicrobial agents for treating human infections caused by extensively drug-resistant Enterobacterales, mainly E. coli and K. pneumoniae [ 1 ]. However, the intensive use of carbapenems in clinical settings has led to a gradual increase in carbapenem-resistant Enterobacterales (CRE), posing a significant threat to anti-infective treatment, especially among children [ 2 , 3 ]. Notably, carbapenems are not yet approved for use in the livestock industry; however, CRE was prevalent in these sectors [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Transmission of bla _NDM in Enterobacteriaceae among animals, food and human

Fu,

Xu,

Yin

et al. 2024

Emerging Microbes & Infections

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Despite carbapenems not being used in animals, carbapenem-resistant Enterobacterales (CRE), particularly New Delhi metallo-β-lactamase-producing CRE (NDM-CRE), are prevalent in livestock. Concurrently, the incidence of human infections caused by NDM-CRE is rising, particularly in children. Although a positive association between livestock production and human NDM-CRE infections at the national level was identified, the evidence of direct transmission of NDM originating from livestock to humans remains largely unknown. Here, we conducted a cross-sectional study in Chengdu, Sichuan Province, to examine the prevalence of NDM-CRE in chickens and pigs along the breeding–slaughtering–retail chains, in pork in cafeterias of schools, and in colonizations and infections from children's hospital and examined the correlation of NDM-CRE among animals, foods and humans. Overall, the bla NDM increases gradually along the chicken and pig breeding (4.70%/2.0%) –slaughtering (7.60%/22.40%) –retail (65.56%/34.26%) chains. The slaughterhouse has become a hotspot for cross-contamination and amplifier of bla NDM . Notably, 63.11% of pork from the school cafeteria was positive for bla NDM . The prevalence of bla NDM in intestinal and infection samples from children's hospitals was 21.68% and 19.80%, respectively. whole genome sequencing (WGS) analysis revealed the sporadic, not large-scale, clonal spread of NDM-CRE along the chicken and pig breeding–slaughtering–retail chain, with further spreading via IncX3- bla NDM plasmid within each stage of whole chains. Clonal transmission of NDM-CRE is predominant in children's hospitals. The IncX3- bla NDM plasmid was highly prevalent among animals and humans and accounted for 57.7% of Escherichia coli and 91.3% of Klebsiella pneumoniae . Attention should be directed towards the IncX3 plasmid to control the transmission of bla NDM between animals and humans.

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Clonal and Horizontal Transmission of bla _NDM among Klebsiella pneumoniae in Children’s Intensive Care Units

Abstract: The bla NDM gene is playing an increasingly important role in infections caused by CR-KP, especially in children. However, systematic detection and bioinformatics analysis of NDM-KP in children's hospitals are lacking in China.

Cited by 17 publications

References 47 publications

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Genomic Analysis Revealed the International and Domestic Transmission of Carbapenem-Resistant Klebsiella pneumoniae in Chinese Pediatric Patients

Transmission of bla _NDM in Enterobacteriaceae among animals, food and human

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Clonal and Horizontal Transmission of bla NDM among Klebsiella pneumoniae in Children’s Intensive Care Units

Abstract: The bla NDM gene is playing an increasingly important role in infections caused by CR-KP, especially in children. However, systematic detection and bioinformatics analysis of NDM-KP in children's hospitals are lacking in China.

Cited by 17 publications

References 47 publications

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Genomic Analysis Revealed the International and Domestic Transmission of Carbapenem-Resistant Klebsiella pneumoniae in Chinese Pediatric Patients

Transmission of bla NDM in Enterobacteriaceae among animals, food and human

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Resources

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Clonal and Horizontal Transmission of bla _NDM among Klebsiella pneumoniae in Children’s Intensive Care Units

Transmission of bla _NDM in Enterobacteriaceae among animals, food and human