Clonal spread of carbapenemase-producing Enterobacteriaceae in a region, China

Abstract

Background The increasing number of carbapenemase-producing Enterobacterales (CPE) has become a serious problem globally. This study aimed to elucidate their geographically epidemiological characteristics. Methods Resistance genes were identified by polymerase chain reaction (PCR) and sequencing. Bacterial genotyping was studied using multilocus sequence typing (MLST) and wzi typing. The transferability of carbapenemase genes was determined by a broth mating method. The relationships between the rates of antimicrobial consumption and the prevalence of CRE were performed by Pearson's or Spearman's correlation analyses. Results A total of 930 phenotypically confirmed carbapenem-resistant Enterobacterales (CRE) isolates collected from 19 hospitals were genotypically characterized. K. pneumoniae (KP) and E. coli isolates were 785 (85.14%) and 96 (10.41%) among 922 CPE isolates. Two major carbapenemase genes blaKPC-2 and blaNDM in CPE isolates accounted for 84.6% (n = 780) and 13.77% (n = 127). ST11 comprised 86.83% (633/729) of KPC-2 KP isolates. Different combinations of extended spectrum-β-lactamase (ESBL) genes of blaSHV, blaCTX, and blaTEM were found in KPC-2 producing KP isolates, and blaCTM-M-14/15, blaSHV-11/12 and blaTEM-1 were common ESBL genotypes. The wzi typing method could further subdivide ST11 KP group into at least five subgroups, among which wzi209 (69.83%, 442/633) was the most frequently isolated, followed by wzi141 (25.28%, 160/633). Conjugation assays showed that high conjugation rates were observed in CPE (15.24%, 32/210) for NDM plasmids, but relatively low (8.1%, 17/210) for KPC-2 plasmids. Different STs, different wzis and temperature could influence plasmid conjugation efficiency. No associations between the rates of antibiotics consumption and CPE prevalence were observed. The number of intra-hospital and inter-hospital transfers of CPE patients increased gradually from 18 (17.82%, 101) and 12 (11.88%, 101) in 2015 to 63 (30.73%, 205) and 51 (24.88%, 205) in 2018 (p = 0.016 and p = 0.008), respectively. Evidence-based measures could effectively reduce the prevalence of ST11-wzi209 clone but failed to control the dissemination of ST11-wzi141 KP clone. Conclusions Clonal spread of CPE, especially KPC-2 ST11 KP was the key factor contributing to the CPE increase in the region. Continued vigilance for the importations should be maintained. Coordinated regional interventions are urgently needed to reduce CPE threat.

Epidemiological and genomic characteristics of global blaNDM-carrying Escherichia coli

“…The most prevalent among these were sul1 and sul2 , encoding an alternative dihydropteroate synthase, emphasizing the need for cautious prescription of sulfonamides targeting CREC. Furthermore, we observed the coexistence of bla ESBL, particularly bla TEM-1b and bla CTX-M-15, with the bla NDM-5 gene, consistent with prior reports [ 12 , 16 ]. This underscores the complexity of resistance profiles and emphasizes the importance of comprehensive antimicrobial stewardship.…”

Carbapenem resistance in West Africa: a systematic review

“…Carbapenems are the last-resort antibiotics used to treat severe infections caused by multidrug-resistant bacteria [1,2]. Unfortunately, the world has been witnessing the spread of carbapenem-resistant bacteria (CRB) for the last two decades [3][4][5]. According to the World Health Organization (WHO), carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa should be considered critical priority pathogens, posing the greatest threat to human health [6].…”

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

“…Carbapenemases usually spread through clonal lineages associated with conjugative plasmids, thus making their dispersal more convenient among nosocomial pathogens [ 31 ]. Carbapenemase-encoding genes are found associated with different sequence types such as the rapid spread of bla KPC–3 -ST384 K. pneumoniae and bla KPC–2 -ST101 among Enterobacterales reported from Spain [ 32 , 33 , 34 ], bla KPC–2 -ST15 K. pneumoniae from China [ 35 ], bla NDM-1 -ST307 K. pneumoniae from France [ 36 ], bla OXA-48 -ST399 E. coli from the UK [ 37 ], bla NDM-1 -ST147 K. pneumoniae from Italy [ 38 ], bla NDM-1 -ST11 K. pneumoniae from Portugal [ 29 ], bla VIM-2 -ST121 Pseudomonas aeruginosa ( P. aeruginosa ) from Netherlands [ 39 ] and bla NDM-1 -ST11 K. pneumoniae from Pakistan [ 40 ]. This heterogeneous clonal background showed its importance for global dissemination of carbapenemases among Enterobacterales .…”