&lt;p&gt;Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant &lt;em&gt;Enterobacteriaceae&lt;/em&gt; from Inpatient Children in a Pediatric Hospital of Shanghai&lt;/p&gt;

Xu, Qi; Pan, Fang; Sun, Yi-Ming; Chun, Wu; Shi, Yingying; Zhang, Tiandong; Yu, Fangyuan; Zhang, Hong

doi:10.2147/idr.s275549

Cited by 16 publications

(13 citation statements)

References 51 publications

(53 reference statements)

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“…The carriage rate of CRE among pediatric patients varies in different geographic areas ( 23 ). In this study, the fecal CRE carriage rate in pediatric inpatients was 3.92%, which is lower than that of three other hospitals in Hunan (8.5%), Fujian (6.6%), and Shanghai (8.6%) ( 23 – 25 ). There are several possible reasons that could contribute to this phenomenon.…”

Section: Discussioncontrasting

confidence: 63%

Clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients in South China

Xiong,

Zhang,

Sarbandi

et al. 2023

Microbiol Spectr

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Carbapenem-resistant Enterobacteriaceae (CRE) are a substantial health burden. Existing management guidelines are primarily based on clonal evidence. Therefore, epidemiological data are required. We evaluated the risk factors for CRE colonization and described the molecular and clinical characteristics of CRE colonization in pediatric inpatients in Guangzhou, China. Pediatric inpatients from three hospitals in Guangzhou, China, between July 2019 and January 2021 were included. Fecal samples were collected and screened for CRE. Microbiological cultures were grown on MacConkey agar plates, and bacteria were identified with a mass spectrometry microbial identification system. Antimicrobial susceptibility was tested with a VITEK2 system, and carbapenemase genes were amplified. A case-control study was conducted to evaluate the risk factors for fecal CRE colonization in pediatric inpatients. Of 4,033 patients screened, 158 (3.92%) were positive for CRE, including Escherichia coli (51.27%), Klebsiella pneumoniae (37.97%), and Enterobacter cloacae (6.96%). The most common carbapenemase genes were blaNDM-5 (51.89%), blaNDM-1 (15.19%), and blaIMP-4 (7.60%) and blaKPC-2 (3.80%). Hematological malignancies, respiratory diseases, otolaryngological diseases, nervous system diseases, oral administration of third-generation cephalosporins, and the combined use of two or more antibiotics were independently associated with CRE colonization. The most prevalent carbapenem-resistant K. pneumoniae sequence types (STs) were ST11 (8.06%), ST37 (8.06%), and ST76 (8.06%), and the most prevalent carbapenem-resistant E. coli STs were ST10 (9.88%), ST48 (13.58%), and ST58 (8.64%). Pediatric inpatients were colonized by a diversity of CRE strains. Infection control and prevention measures should be implemented to reduce CRE colonization. IMPORTANCE This study assessed the clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients at three hospitals in South China by means of screening stool samples for carbapenem-resistant genes and a nested case-control study to determine risk factors for carriage of carbapenem-resistant Enterobacteriaceae. Of 4,033 fecal samples screened, 158 (3.92%) were positive for CRE, including Escherichia coli (51.27 %), Klebsiella pneumoniae (37.97%), and Enterobacter cloacae (6.96%). The most common carbapenemase genes harbored by gastrointestinal CRE strains were blaNDM-5, blaNDM-1, and blaIMP-4. Hematological malignancies, respiratory diseases, otolaryngological diseases, nervous system diseases, oral administration of third-generation cephalosporins, and the combined use of two or more antibiotics were independently associated with CRE colonization.

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Section: Discussioncontrasting

confidence: 63%

Clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients in South China

Xiong,

Zhang,

Sarbandi

et al. 2023

Microbiol Spectr

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“… 31 In addition, the carriage of CP-EC in the present study was 0.9%, which is lower than that of outpatient (1.4%) and inpatient children (1.9%) in Shanghai, China. 20 , 32 Although few countries have reported CP-EC carriage among community healthy children to date, a report from Pakistan showed that a quarter of infants in their research harbored CP-EC, indicating that the intestine of healthy children may be a reservoir of CP-EC and should be considered as a serious health issue. 29 …”

Section: Discussionmentioning

confidence: 99%

Community Fecal Carriage and Molecular Epidemiology of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Escherichia coli from Healthy Children in the Central South China

Yang

et al. 2022

IDR

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Background Fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) and carbapenemase-producing E. coli (CP-EC) is well reported among hospitalized adults and children. However, there are few studies on the carriage prevalence and ESBL-EC and CP-EC genotypes among healthy children in China. Patients and Methods Stool samples were collected from 330 students in 2021 from three randomly selected primary schools in Changsha, China. ESBL-EC and CP-EC were screened using CHROMagar TM chromogenic plates. ESBL and carbapenemase production was confirmed using the double-disc synergy test and a modified carbapenem inactivation method, respectively. Antimicrobial susceptibility was tested using the broth microdilution method. Resistance determinants, virulence factors, and phylogenetic groups were determined by PCR and sequencing. Multi-locus sequence typing (MLST) was performed (seven housekeeping genes were amplified and sequenced) on the phylogenic group B2 E. coli to detect high-risk clonal strains such as ST131 E. coli . Then, ST131 E. coli were characterized based on ST131 clades, O-type, and fimH alleles. Results In total, 118 (35.8%) ESBL-EC and 3 (0.9%) CP-EC were isolated. bla CTX-M was the most common genotype (27.1%), identified in all ESBL-EC, except one, which carried bla SHV-12 . One isolate with mcr-1 was found amongst ESBL-EC, whereas all three CP-EC carried bla NDM-1 . The predominant sequence type (ST) clones in group B2 were ST131 and ST1193. The prevalence of ST131 E. coli was 9.9%, displaying serotypes O16 and O25b, fimH alleles 30, 41, and 89, and ST131 clades A and C1-M27. Conclusion In this study, high carriage rate of ESBL-EC was found among healthy children, and the dominant ESBL was CTX-M-14. In addition, high-risk clones (ST131 and ST1193) were also detected. This emphasizes the importance of monitoring ESBL-EC in community settings.

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“…In a study from Morocco (2013–2015), up to 59.4% and 12.5% of the neonatal ICU (NICU)-patients were colonized with ESBL- Ent and CPE, respectively [ 69 ]. CPE carriage was also observed in 8.6% of inpatients in a pediatric hospital in China (2019), with those colonized having a history of invasive procedures and antibiotic exposures [ 70 ].…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

Campos-Madueno

Moradi

Eddoubaji

et al. 2023

Eur J Clin Microbiol Infect Dis

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The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens—especially Escherichia coli and Klebsiella pneumoniae—may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.

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<p>Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> from Inpatient Children in a Pediatric Hospital of Shanghai</p>

Cited by 16 publications

References 51 publications

Clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients in South China

Clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients in South China

Community Fecal Carriage and Molecular Epidemiology of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Escherichia coli from Healthy Children in the Central South China

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

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