Molecular characterization of carbapenem-resistant Enterobacteriaceae and emergence of tigecycline non-susceptible strains in the Henan province in China: a multicentrer study

Yan, Wen; Jiang, Nan; Wang, Shan Mei; Xu, Jindong; Yuan, You Hua; Qi, Zhang; Li, A Li; Chen, Li Hao; Zhang, Jiang Feng; Ma, Bing; Ma, Qi; Li, Yang

doi:10.1099/jmm.0.001325

Cited by 18 publications

(17 citation statements)

References 35 publications

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“…The problem of AMR is increasing globally with the spread frequently striking healthcare settings due to the improper use of antimicrobials and inappropriate infection control practices. AMR risk is especially in low- and middle-income countries [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Carbapenems have been the drugs of choice to cure critical VAP infections, although illogical and very common use of carbapenems has given rise to the emergence of CR-GNB strains. Resistance to carbapenems is mediated by a variety of mechanisms [ 4 ]. Carbapenemase enzymes, the most significant of these mechanisms, are β-lactamases that inactivate many β-lactam antibiotics.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Carbapenem-Resistant Gram-Negative Bacilli in Patients with Ventilator-Associated Pneumonia

et al. 2021

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Carbapenem-resistant Gram-negative bacilli (CR-GNB) has become a global threat. In hospital settings, the association of CR-GNB with ventilator-associated pneumonia (VAP) is a critical public health concern owing to their high resistance rate to most antibiotics. The present study aims to identify the frequency of carbapenem-resistance and to determine the rate of multidrug resistance (MDR), extensive drug resistance (XDR) and pan-drug resistance (PDR) among CR-GNB infections in VAP. Antimicrobial susceptibility testing was carried out using the disk diffusion method and the detection of carbapenemases was screened using the imipenem-E test and the modified carbapenem-inactivation method (mCIM). The isolates were verified by polymerase chain reaction (PCR) for the presence of blaNDM, blaSPM, blaVIM, blaIMP and blaGIM genes. 89.5%, 14%, 17.5%, 10.5%, 3.5% of isolates exhibited the presence of blaNDM, blaVIM, blaSPM, blaIMP and blaGIM, respectively. 76%, 17% and 7% of isolates were PDR, XDR, and MDR, respectively. Carbapenem-resistance genes were identified in a significant percentage and blaNDM was the most predominant gene. All isolates were highly resistant to most antibiotics. This health concern has proven to be a big challenge in developing countries such as Egypt, as it is associated with high morbidity, high mortality, and raised healthcare costs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics of Carbapenem-Resistant Gram-Negative Bacilli in Patients with Ventilator-Associated Pneumonia

et al. 2021

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“…28,29 Other STs, such as ST37, ST3627, ST2593, and ST2601, were also detected in 34 TNSKP strains, which was different from previous reports in Henan. 30 Our study is the first to report of ST3627, ST2593, and ST2601 K. pneumoniae with tigecycline-non-susceptible caused by clinical infection. PFGE results showed that the most prevalent clone type ST11-K14K64 (28/34, 82.4%) belongs to cluster A.…”

mentioning

confidence: 65%

Molecular Analysis and Antimicrobial Resistance Pattern of Tigecycline-Non-Susceptible K. pneumoniae Isolated from a Tertiary Care Hospital of East Asia

Hu¹,

Wang

Lin³

et al. 2021

IDR

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Introduction: Tigecycline is one of the last resorts for carbapenem-resistant K. pneumoniae (CRKP) infections. Indeed, tigecycline-non-susceptible K. pneumoniae (TNSKP) strains are increasingly treated with the use of tigecycline. In this study, we attempted to better understand their epidemiological trends and characteristics. K. pneumoniae were collected from 2017 to 2020 at the First Affiliated Hospital of Nanchang University. Methods: Thirty-four TNSKP strains were selected during the study period, all of which were analyzed using antimicrobial susceptibility testing, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). PCR and DNA sequencing were performed for the detection of β-lactamase genes and carbapenemase genes, and the mutation analysis of tet(A), tet(X), tet(L), tet(M), rpsJ, ramR, and oqxR, which are related to tigecycline resistance. Virulence gene and capsular genotype testing were conducted to identify whether the TNSKP strains were hypervirulent Klebsiella pneumoniae. Results: An epidemiology analysis showed that Klebsiella pneumoniae carbapenemase-2 (KPC-2) was the predominant carbapenemase in tigecycline non-susceptible carbapenemresistant K. pneumoniae (TNSCRKP) (96.7%), and the dominant clone type was ST11-K14K64 (82.4%). Among them, 55.9% (19/34) of strains were from each department of ICU, particularly EICU and neurosurgery ICU. In order to further understand the molecular mechanisms of the TNSKP, a polymerase chain reaction of the resistant determinants was carried out. The results detected many tigecycline-resistant genes, such as tet(A) (97.1%), tet (X) (17.6%), rpsJ (97.1%), and ramR (8.8%). Conclusion:As the results of this study reveal, we should take effective measures to control the increase in TNSKP.

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“…CRKP is resistant to most of the commonly used antimicrobial agents, thus limiting treatment options and posing a serious threat to the global public health [8]. Carbapenemases are the main causes of multidrug resistance in CRKP and are classified into class A (KPC), class B (NDM, IMP, and VIM), and class D (OXA-48-like) [9]. In China and elsewhere, KPCs are major contributors to carbapenem resistance in K. pneumoniae and more than 70% of carbapenemase-producing K. pneumoniae produces KPCs [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Carbapenemases are the main causes of multidrug resistance in CRKP and are classified into class A (KPC), class B (NDM, IMP, and VIM), and class D (OXA-48-like) [ 9 ]. In China and elsewhere, KPCs are major contributors to carbapenem resistance in K. pneumoniae and more than 70% of carbapenemase-producing K. pneumoniae produces KPCs [ 9–11 ].…”

Section: Introductionmentioning

confidence: 99%

Mutations in porin LamB contribute to ceftazidime-avibactam resistance in KPC-producing Klebsiella pneumoniae

Guo

Liu

Wang³

et al. 2021

Emerging Microbes & Infections

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Ceftazidime-avibactam (CAZ-AVI) shows promising activity against carbapenem-resistant Klebsiella pneumoniae (CRKP), however, CAZ-AVI resistance have emerged recently. Mutations in KPCs, porins OmpK35 and/or OmpK36, and PBPs are known to contribute to the resistance to CAZ-AVI in CRKP. To identify novel CAZ-AVI resistance mechanism, we generated 10 CAZ-AVI-resistant strains from 14 CAZ-AVI susceptible KPC-producing K. pneumoniae (KPC-Kp) strains through in vitro multipassage resistance selection using low concentrations of CAZ-AVI. Comparative genomic analysis for the original and derived mutants identified CAZ-AVI resistance-associated mutations in KPCs, PBP3 (encoded by ftsI), and LamB, an outer membrane maltoporin. CAZ-AVI susceptible KPC-Kp strains became resistant when complemented with mutated blaKPC genes. Complementation experiments also showed that a plasmid borne copy of wild-type lamB or ftsI gene reduced the MIC value of CAZ-AVI in the induced resistant strains. In addition, blaKPC expression level increased in four of the six CAZ-AVI-resistant strains without KPC mutations, indicating a probable association between increased blaKPC expression and increased resistance in these strains. In conclusion, we here identified a novel mechanism of CAZ-AVI resistance associated with mutations in porin LamB in KPC-Kp.

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Molecular characterization of carbapenem-resistant Enterobacteriaceae and emergence of tigecycline non-susceptible strains in the Henan province in China: a multicentrer study

Cited by 18 publications

References 35 publications

Characteristics of Carbapenem-Resistant Gram-Negative Bacilli in Patients with Ventilator-Associated Pneumonia

Characteristics of Carbapenem-Resistant Gram-Negative Bacilli in Patients with Ventilator-Associated Pneumonia

Molecular Analysis and Antimicrobial Resistance Pattern of Tigecycline-Non-Susceptible K. pneumoniae Isolated from a Tertiary Care Hospital of East Asia

Mutations in porin LamB contribute to ceftazidime-avibactam resistance in KPC-producing Klebsiella pneumoniae

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