Rapid Increase in Prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) and Emergence of Colistin Resistance Gene mcr-1 in CRE in a Hospital in Henan, China

Abstract

The global spread of carbapenem-resistant (CRE) is one of the most severe threats to human health in a clinical setting. The recent emergence of plasmid-mediated colistin resistance gene among CRE strains greatly compromises the use of colistin as a last resort for the treatment of infections caused by CRE. This study aimed to understand the current epidemiological trends and characteristics of CRE from a large hospital in Henan, the most populous province in China. From 2014 to 2016, a total of 7,249 isolates were collected from clinical samples, among which 18.1% (1,311/7,249) were carbapenem resistant. Carbapenem-resistant and carbapenem-resistant were the two most common CRE species, with carbapenemases (KPC) and New Delhi metallo-β-lactamases (NDM), respectively, responsible for the carbapenem resistance of the two species. Notably, >57.0% ( = 589) of the isolates from the intensive care unit were carbapenem resistant. Furthermore, and were found to coexist in one isolate, which exhibited resistance to almost all tested antibiotics. Overall, we observed a significant increase in the prevalence of CRE isolates during the study period and suggest that carbapenems may no longer be considered to be an effective treatment for infections caused by in the studied hospital.

<p>Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant <em>Klebsiella pneumoniae</em> in Wenzhou, China from 2003 to 2016</p>

“…The emergence of carbapenem-resistant Enterobacteriaceae (CRE) strains is a major burden for public health-care systems, 39,40 with long-term surveillance studies identifying emerging high-risk strains of CRKP. 41,42 Here, we analyzed a 14-year time-window for trends in resistance phenotypes, virulence factors and sequence profiles of CRKP isolates from a major hospital in Wenzhou.…”

Prevalence and antibiotics susceptibility patterns of carbapenem resistant Enterobacteriaceae

“…In Asia, the prevalence of CRE among clinical samples was determined in many studies includes Rao A et al 17 (India), Amjad A et al 18 (Pakistan), Jamal WY et al 19 (Kuwait), Li Y et al 20 (China), Kandeel A et al 21 (Saudi Arabia), Nair PK et al 22 (India), Zaidah A et al 23 (Malaysia), Jan R et al 24 (South India) and Khare V et al 25 (India) which reported the prevalence of CRE were 13.95%, 69%, 8%, 18.1%, 1.77% ,12.26%, 5.76%, 8% and 37.9% respectively. 17−25 Europe, Australia, and America (North and South)…”

Comparison of clinical characteristics and outcomes of bloodstream infections due to multidrug-resistant Acinetobacter baumannii and other Gram-negative bacteria in ICU patients

“…Carbapenems and tigacycline were rarely used in E. coli group when admitted to hospital, thus, the resistance rate was significantly lower in this group. However, with drug-resistant genes resulting in drug-resistant bacteria, they can widely spread in hospitals and communities, consequently resulting in an increased incidence of carbapenem-resistant E. coli and CR K. pneumoniae infections in China [42]. In China, ST11 has been considered as the dominant CR K. pneumoniae strain, but new ST11 CR A. baumannii is emerging [43], which is hypervirulent, multidrug resistant, and transmissible, potentially resulting a real superbacteria that could pose a serious threat to public health.…”

“…In China, ST11 has been considered as the dominant CR K. pneumoniae strain, but new ST11 CR A. baumannii is emerging [43], which is hypervirulent, multidrug resistant, and transmissible, potentially resulting a real superbacteria that could pose a serious threat to public health. The polycolisin-resistant E. coli has been found in China [42], which undoubtedly adds to the current sad situation.…”