Fecal carriage and molecular epidemiology of carbapenem-resistant Enterobacteriaceae from outpatient children in Shanghai

Abstract

Background Fecal colonization with carbapenem-resistant Enterobacteriaceae (CRE) is a risk factor for bacterial translocation resulting in subsequent endogenous infections. The purpose of this study is to investigate the prevalence of CRE strains colonization in stool samples of outpatient in a tertiary pediatric hospital of Shanghai, China. Methods In a retrospective study, fecal samples were consecutively obtained from patients in 2016 and screening test for CRE was conducted by using home-made MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and β-lactamases were characterized by polymerase chain reaction (PCR) assays and DNA sequencing. Multilocus sequence typing (MLST) was performed for the genetic relationships of the isolates. Results A total of 880 fecal samples were included for this screening test and 32 CRE strains were identified in 32 non-duplicate fecal samples from 32 children (1.3 ± 1.5 years), with a carriage rate of 3.6%. These strains mainly distributed in Klebsiella pnuemoniae (37.5%) and Escherichia coli (37.5%). All CRE strains showed high resistance to most of the routinely used antibiotics (> 90%) except for polymyxin B and tigecycline. The bla NDM gene was the major carbapenemase gene harbored by gastrointestinal CRE strains, followed by bla KPC- 2 , bla IMP-26 , and bla IMP-4 . Other β-Lactamase genes including bla CTX-M , bla SHV , bla TEM-1 , and bla DHA-1 were also detected. MLST analysis revealed that various sequence types (STs) were detected in these strains, with ST11 and ST37 being more prevalent in K.pneumoniae and ST101 in E.coli . Conclusions This study revealed the prevalence of CRE fecal carriage in children from outpatient and urgent implementation of infection control measure should be conducted to limit the spread of CRE strains.

<p>Emergence of NDM-5-Producing Carbapenem-Resistant <em>Klebsiella pneumoniae</em> and SIM-Producing Hypervirulent <em>Klebsiella pneumoniae</em> Isolated from Aseptic Body Fluid in a Large Tertiary Hospital, 2017–2018: Genetic Traits of <em>bla</em>NDM-Like and <em>bla</em>SIM-Like Genes as Determined by NGS</p>

“…These factors are considered as risk factors in the occurrence of CRKP in previous studies. [30][31][32] In addition, a significant portion of strains were obtained from blood specimens, suggesting that CRKP bloodstream infection was a major problem in this study.…”

“…Conversely, NDM-1-producing CRKP was resistant to them, which were agreed with another report. 32 Interestingly, a study showed that NDM-5-producing KP strains have high resistance to quinolones, 35 while, other studies proposed controversial points. 10,13 Hence, the diversity of carbapenemases among CRKP strengthens the difficulty for infection control.…”

“…This suggests that the resistance to the antibiotics might attribute to new mechanisms and further studies should be conducted. 32 Li et al Dovepress submit your manuscript | www.dovepress.com…”

Global Evolution of Pathogenic Bacteria With Extensive Use of Fluoroquinolone Agents

“…Interestingly fecal carriage of MDR major ST K. pneumoniae strains were reported from various continents in both outpatients and the general population with higher prevalence in developing countries (Zhang et al, 2015;Baraniak et al, 2016;Aghamohammad et al, 2018;Büdel et al, 2019;Pan et al, 2019). In addition, most recently MDR major ST strains of K. pneumoniae were observed to colonize more frequently the respiratory system than the gastrointestinal tract (Shu et al, 2019).…”

Fecal Carriage and Molecular Epidemiology of mcr-1-Harboring Escherichia Coli from Children in Southern China.

“…Colonization of multidrug resistant bacteria in the gastrointestinal tract may be a risk factor for bacterial translocation, leading to endogenous infections in immunocompromised children [6]. Colistin resistance is considered of special clinical signi cance in the Enterobacteriaceae.…”