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Jin Z, Wang Z, Gong L, Yi L, Liu N, Luo L, Gong W. Molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae among children in China. AMB Express 2022; 12:89. [PMID: 35829853 PMCID: PMC9279541 DOI: 10.1186/s13568-022-01437-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Klebsiella pneumoniae infection and antimicrobial resistance among children are major concerns. The occurrence of hypervirulent K. pneumoniae (hvKp) infections is gradually increasing worldwide, and disinfectant resistance is also being reported. Carbapenem- and disinfectant-resistant hvKp infection has made clinical treatment and nosocomial infection control among children increasingly challenging. In this study, whole-genome sequencing was conducted among 34 Carba NP-positive carbapenem-resistant K. pneumoniae (CRKP) strains, and the distribution of antibiotic resistance genes, virulence genes and disinfectant resistance genes was determined. Eleven distinct STs were identified, and most of them were ST11 (58.8%). Among the carbapenem resistance genes, KPC-2 was predominant (61.8%), followed by NDM-1 (26.5%) and IPM-4 (11.8%), and no other carbapenemase genes were found. Twelve virulence genes were investigated. All 34 CRKP strains carried the following virulence genes: rcsA/B, entA, fimA/H and mrkA/D. The gene iucB was present in only 3 (8.9%) CRKP strains. The positive detection rates of the iroN and ybtA genes were 94.1% and 64.7%, respectively. None of the strains was found to carry the rmpA and iroB genes. Two disinfectant resistance genes were investigated in this study. Twenty-one (61.8%) strains carried both the qacE and cepA disinfectant resistance genes, 13 (38.2%) CRKP strains carried only the cepA gene, and no strains with only the qacE gene was detected. The correlations among virulence, drug resistance and disinfectant tolerance showed that the virulence and disinfectant resistance genes were distinct among several types of carbapenemase-producing CRKP strains.
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Affiliation(s)
- Zhengjiang Jin
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, China
| | - Zhenhui Wang
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, China
| | - Lin Gong
- Department of Disinfection and Pest Control, Wuhan Center for Disease Control & Prevention, Wuhan, 430000, China
| | - Lu Yi
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, China
| | - Nian Liu
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, China
| | - Lan Luo
- Department of Child Health, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, China.
| | - Wenting Gong
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, China
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Hammer-Dedet F, Aujoulat F, Jumas-Bilak E, Licznar-Fajardo P. Persistence and Dissemination Capacities of a BlaNDM-5-Harboring IncX-3 Plasmid in Escherichia coli Isolated from an Urban River in Montpellier, France. Antibiotics (Basel) 2022; 11:antibiotics11020196. [PMID: 35203799 PMCID: PMC8868147 DOI: 10.3390/antibiotics11020196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
To investigate the capacities of persistence and dissemination of blaNDM-5 within Escherichia coli and in aquatic environment, we characterized E. coli (sequence type 636) strains B26 and B28 isolated one month apart from the same urban river in Montpellier, France. The two isolates carried a pTsB26 plasmid, which sized 45,495 Kb, harbored blaNDM-5 gene and belonged to IncX-3 incompatibility group. pTsB26 was conjugative in vitro at high frequency, it was highly stable after 400 generations and it exerted no fitness cost on its host. blaNDM-5harboring plasmids are widely dispersed in E. coli all around the world, with no lineage specialization. The genomic comparison between B26 and B28 stated that the two isolates probably originated from the same clone, suggesting the persistence of pTsB26 in an E. coli host in aquatic environment.
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Affiliation(s)
- Florence Hammer-Dedet
- HSM, University Montpellier, CNRS, IRD, 34090 Montpellier, France; (F.H.-D.); (F.A.)
| | - Fabien Aujoulat
- HSM, University Montpellier, CNRS, IRD, 34090 Montpellier, France; (F.H.-D.); (F.A.)
| | - Estelle Jumas-Bilak
- HSM, University of Montpellier, CNRS, IRD, CHU Montpellier, 34090 Montpellier, France;
| | - Patricia Licznar-Fajardo
- HSM, University of Montpellier, CNRS, IRD, CHU Montpellier, 34090 Montpellier, France;
- Correspondence:
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Pressure response of carbapenems Klebsiella pneumoniae under antibiotic stress. INFECTION GENETICS AND EVOLUTION 2021; 92:104915. [PMID: 34000446 DOI: 10.1016/j.meegid.2021.104915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/17/2021] [Accepted: 05/11/2021] [Indexed: 11/21/2022]
Abstract
To analyze the drug-resistant phenotype and genetic characteristics of Carbapenem resistant Klebsiella pneumoniae (CRKP) in this region, and to study its different expression profiles in RNA level under the pressure of low levels of antibiotics. Trace dilution method and PCR method were used to detect the antibiotic resistance phenotype and antibiotic resistance gene carrying of CRKP strain, simulate the antibiotic stress process, and RNAseq was used to analyze the transcriptomic changes of CRKP strain. 37 CRKP strains, 27 Carbapenem sensitive Klebsiella pneumoniae (CSKP) CSKP strains and 42 sensitive strains were detected. The antibiotic resistance rate of CRKP strain was significantly higher than that of other drug-resistant strains, and there were many kinds of antibiotic resistance genes. Transcriptomic analysis showed that CRKP strain showed compensatory rise under meropenem stress at low concentration, and the expression of genes related to biofilm formation, pressure induction, pressure tolerance and transcriptional regulation was significantly changed. It was speculated that mrkAB, fimDH, phoHP and pspABCD clusters significantly altered their expression under the antibiotics stress response in CRKP strain. The detection rate of CRKP strain is high in this area. Under low levels of antibiotic stress, CRKP strain can not only survive by synthesizing antibiotic modified enzyme, but also respond by transcriptional regulation and biofilm changes, resulting in stress compensation. The discovery of this phenomenon explains the failure of treatment due to improper use of higher-order antibiotics from the perspective of genetic interaction.
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Qamar MU, Lopes BS, Hassan B, Khurshid M, Shafique M, Atif Nisar M, Mohsin M, Nawaz Z, Muzammil S, Aslam B, Ejaz H, Toleman MA. The present danger of New Delhi metallo-β-lactamase: a threat to public health. Future Microbiol 2020; 15:1759-1778. [PMID: 33404261 DOI: 10.2217/fmb-2020-0069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The evolution of antimicrobial-resistant Gram-negative pathogens is a substantial menace to public health sectors, notably in developing countries because of the scarcity of healthcare facilities. New Delhi metallo-β-lactamase (NDM) is a potent β-lactam enzyme able to hydrolyze several available antibiotics. NDM was identified from the clinical isolates of Klebsiella pneumoniae and Escherichia coli from a Swedish patient in New Delhi, India. This enzyme horizontally passed on to various Gram-negative bacteria developing resistance against a variety of antibiotics which cause treatment crucial. These bacteria increase fatality rates and play an integral role in the economic burden. The efficient management of NDM-producing isolates requires the coordination between each healthcare setting in a region. In this review, we present the prevalence of NDM in children, fatality and the economic burden of resistant bacteria, the clonal spread of NDM harboring bacteria and modern techniques for the detection of NDM producing pathogens.
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Affiliation(s)
- Muhammad Usman Qamar
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
| | - Bruno S Lopes
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, AB24 3DR, Scotland, UK
| | - Brekhna Hassan
- Department of Medical Microbiology & Infectious Diseases, Institute of Infection & Immunity, School of Medicine, Cardiff University, CF10 3AT, Cardiff, UK
| | - Mohsin Khurshid
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
| | - Muhammad Shafique
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
| | - Muhammad Atif Nisar
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
- College of Science and Engineering, Flinders University, 5042, Australia
| | - Mashkoor Mohsin
- Institute of Microbiology, University of Agriculture Faisalabad, 38000, Pakistan
| | - Zeeshan Nawaz
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
| | - Saima Muzammil
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
| | - Bilal Aslam
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, 38000, Pakistan
| | - Hasan Ejaz
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Al Jouf, 72388, Saudi Arabia
| | - Mark A Toleman
- Department of Medical Microbiology & Infectious Diseases, Institute of Infection & Immunity, School of Medicine, Cardiff University, CF10 3AT, Cardiff, UK
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Huang C, Liu LZ, Kong HK, Law COK, Hoa PQ, Ho PL, Lau TCK. A novel incompatibility group X3 plasmid carrying bla NDM-1 encodes a small RNA that regulates host fucose metabolism and biofilm formation. RNA Biol 2020; 17:1767-1776. [PMID: 32594845 DOI: 10.1080/15476286.2020.1780040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The emergence of New Delhi metallo-beta-lactamase (NDM-1) has become a major health threat to clinical managements of gram-negative bacteria infections. A novel incompatibility group X3 plasmid (IncX3) pNDM-HN380 carrying bla NDM-1 has recently been found to epidemiologically link with multiple geographical areas in China. In this paper, we studied the metabolic responses of host bacteria E. coli J53 upon introduction of pNDM-HN380. A reduction of bacterial motility was observed in J53/pNDM-HN380. We profiled the RNA repertoires of the transconjugants and found a downregulation of genes involved in flagella and chemotaxis metabolic pathways at logarithmic (log) phase. We also identified a novel intragenic region (IGR) small RNA plas2. The plasmid-transcribed sRNA IGR plas2 was further characterized as a regulator of fucRwhich controls the fucose metabolism. By knockdown of IGR plas2 using an antisense decoy, we managed to inhibit the formation of bacterial biofilm of the host. Our study demonstrated a potential way of utilizing plasmid-transcribed sRNA against infectious bacteria.
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Affiliation(s)
- Chuan Huang
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Science, City University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
| | - Liang-Zhe Liu
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Science, City University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
| | - Hoi-Kuan Kong
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Science, City University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
| | - Carmen O K Law
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Science, City University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
| | - Pham Quynh Hoa
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Science, City University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
| | - Pak-Leung Ho
- Department of Microbiology, The University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
| | - Terrence C K Lau
- Department of Biomedical Sciences, College of Veterinary Medicine and Life Science, City University of Hong Kong , Hong Kong, Hong Kong Special Administrative Region
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Wang Y, Tong MK, Chow KH, Cheng VCC, Tse CWS, Wu AKL, Lai RWM, Luk WK, Tsang DNC, Ho PL. Occurrence of Highly Conjugative IncX3 Epidemic Plasmid Carrying bla NDM in Enterobacteriaceae Isolates in Geographically Widespread Areas. Front Microbiol 2018; 9:2272. [PMID: 30294321 PMCID: PMC6158458 DOI: 10.3389/fmicb.2018.02272] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
The emergence of New Delhi metallo-β-lactamase (NDM) in common enterobacterial species is a major concern for healthcare. Early reports have revealed that the spread of NDM involved diverse and heterogeneous plasmids. Recently, the involvement of a rare, IncX3 subtype plasmid has been increasingly recognized. Here, we studied the prevalence of IncX plasmid subtypes in 198 carbapenem-resistant Enterobacteriaceae, originating from a territory-wide active surveillance in Hong Kong in 2016. The complete sequences and biological features of the bla NDM-carrying plasmids were investigated. A total of 62 NDM-type, 21 OXA-48 type, 14 IMP-type, 8 KPC-type, 4 IMI-type producers, and 89 non-carbapenemase-producers were tested for presence of IncX subtypes. IncX3 (n = 60) was the most common subtype, followed by IncX4 (n = 6) and IncX1 (n = 2). The prevalence of IncX3 subtype in isolates producing NDM, other carbapenemase types and non-carbapenemase producers were 75.8, 21.3, and 3.4%, respectively (P < 0.001). An IncX3 plasmid (size ∼50 kb) was confirmed to carry bla NDM in 47 isolates of different enterobacterial species. Thirteen IncX3 plasmids originating from six healthcare regions in Hong Kong were completely sequenced. The results showed that the IncX3 plasmids carrying bla NDM share a high degree of sequence identity with a previously reported plasmid, pNDM-HN380 (GenBank accession JX104760), over the backbone and genetic load regions. A blast search further revealed the occurrence of identical or nearly identical IncX3 plasmids carrying bla NDM in other part of China, Korea, Myanmar, India, Oman, Kuwait, Italy, and Canada. Two IncX3 carrying bla NDM were investigated further. Conjugation experiments demonstrated that the IncX3 plasmids could be efficiently transferred to multiple enterobacterial species at frequencies that are comparable or higher than the epidemic IncFII plasmid carrying bla CTX-M (pHK01). In addition, efficient transfer of the NDM plasmids occurred over a range of temperatures. In conclusion, this study demonstrated the important role played by IncX3 in the dissemination of NDM and the occurrence of pNDM-HN380-like plasmids in geographically widespread areas. The high mobility of IncX3 plasmid across different enterobacterial species highlights the ability of this plasmid replicon to be an important vehicle in worldwide dissemination of NDM.
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Affiliation(s)
- Ya Wang
- Department of Microbiology, Queen Mary Hospital, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Man-Ki Tong
- Department of Microbiology, Queen Mary Hospital, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Kin-Hung Chow
- Department of Microbiology, Queen Mary Hospital, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Cindy Wing-Sze Tse
- Department of Clinical Pathology, Kwong Wah Hospital, Hospital Authority, Hong Kong, China
| | - Alan Ka-Lun Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong, China
| | - Raymond Wai-Man Lai
- Department of Microbiology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Wei-Kwang Luk
- Department of Pathology, Tseung Kwan O Hospital, Hospital Authority, Hong Kong, China
| | - Dominic Ngai-Chong Tsang
- Department of Clinical Pathology, Queen Elizabeth Hospital, Hospital Authority, Hong Kong, China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
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Potential Dissemination of ARB and ARGs into Soil Through the Use of Treated Wastewater for Agricultural Irrigation: Is It a True Cause for Concern? ACTA ACUST UNITED AC 2017. [DOI: 10.1007/978-3-319-66260-2_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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8
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Lung DC, Tsang OTY, Choi KW, Hung IFN, Chan KM, Wu AKL, Tso EYK, Wu TC, Lam TS, Wong AWY, Ng KHL, Lui SSY, Hsu EK, Wong ATY. Review of first 36 cases of New Delhi metallo-β-lactamase-producing Enterobacteriaceae in Hong Kong. J Glob Antimicrob Resist 2017; 8:199-201. [PMID: 28192211 DOI: 10.1016/j.jgar.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- David C Lung
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong SAR, China.
| | - Owen T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hospital Authority, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - K W Choi
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, 11 Chuen On Road, Tai Po, NY, Hong Kong SAR, China
| | - Ivan F N Hung
- Department of Medicine, University of Hong Kong, Room 405B, 4/F Professorial Block, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong SAR, China
| | - K M Chan
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong SAR, China
| | - Alan K L Wu
- Department of Clinical Microbiology, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China
| | - Eugene Y K Tso
- Department of Medicine and Geriatrics, United Christian Hospital, Hospital Authority, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, China
| | - T C Wu
- Department of Medicine, Queen Elizabeth Hospital, Hospital Authority, 30 Gascoigne Road, Kowloon, Hong Kong SAR, China
| | - T S Lam
- Surveillance and Epidemiology Branch, Centre for Health Protection, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Ada W Y Wong
- Infection Control Branch, Centre for Health Protection, G/F, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Ken H L Ng
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong SAR, China
| | - Steffi S Y Lui
- Infection Control Branch, Centre for Health Protection, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Enoch K Hsu
- Infection Control Branch, Centre for Health Protection, G/F, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Andrew T Y Wong
- Infection Control Branch, Centre for Health Protection, G/F, 147C Argyle Street, Kowloon, Hong Kong SAR, China
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Shi Z, Zhao H, Li G, Jia W. Molecular Characteristics of Carbapenem-Resistant Enterobacter cloacae in Ningxia Province, China. Front Microbiol 2017; 8:94. [PMID: 28197140 PMCID: PMC5281609 DOI: 10.3389/fmicb.2017.00094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 01/13/2017] [Indexed: 12/21/2022] Open
Abstract
The emergence of carbapenem-resistant Enterobacteriaceae (CRE) has become a major public health concern worldwide and a new challenge in the treatment of infectious diseases. The molecular characteristics of Enterobacter cloacae in Ningxia China are unknown. In this study, we reported 10 carbapenem-resistant E. cloacae isolates from the General Hospital of Ningxia Medical University, the largest university hospital in Ningxia between January 2012 and December 2013. Bacteria isolates were identified by Vitek2 compact and the identity of non-duplicate E. cloacae isolates was further confirmed by PCR and sequencing. The drug susceptibility and phenotype identification of these isolates were analyzed by agar dilution method, modified Hodge test (MHT), and EDTA synergy test. Beta-lactamase (bla) genes blaNDM−1 was found in 8 out of 10 isolates. Most isolates harbored multiple resistance genes including blaESBL, blaAmpC, quinolones, aminoglycosides, and disinfectant resistance genes. Pulsed field gel electrophoresis (PFGE) showed that these E. cloacae isolates were grouped into 6 clusters based on a cutoff of 80% genetic similarity. In conjugative assay, 9 out of 10 isolates transferred carbapenem-resistant genes to Escherichia coli. Our study has revealed that NDM-1-producing isolates are the most prevalent carbapenem-resistant E. cloacae in Ningxia. These isolates also carry several other carbapenem-resistant genes and can transfer these genes to other bacteria through conjugation. These findings highlight an urgent need to monitor these isolates to prevent their further spread in this region.
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Affiliation(s)
- Zhiyun Shi
- Medical Experimental Center, General Hospital of Ningxia Medical UniversityYinchuan, China; Key Laboratory of Ningxia Clinical Pathogenic MicroorganismsYinchuan, China
| | - Huizheng Zhao
- Department of Laboratory, Institute of Clinical Medicine, Ningxia Medical UniversityYinchuan, China; Hematology and Oncology Center, Yanda Hospital of Hebei ProvinceLangfang, China
| | - Gang Li
- Medical Experimental Center, General Hospital of Ningxia Medical UniversityYinchuan, China; Key Laboratory of Ningxia Clinical Pathogenic MicroorganismsYinchuan, China
| | - Wei Jia
- Medical Experimental Center, General Hospital of Ningxia Medical UniversityYinchuan, China; Key Laboratory of Ningxia Clinical Pathogenic MicroorganismsYinchuan, China
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A Novel Risk Factor Associated With Colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in Addition to Antimicrobial Treatment. Infect Control Hosp Epidemiol 2016; 37:1418-1425. [DOI: 10.1017/ice.2016.202] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVETo study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).METHODSWe analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.RESULTSOf 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).CONCLUSIONSConcomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.Infect Control Hosp Epidemiol 2016;1418–1425
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Aitken SL, Tarrand JJ, Deshpande LM, Tverdek FP, Jones AL, Shelburne SA, Prince RA, Bhatti MM, Rolston KVI, Jones RN, Castanheira M, Chemaly RF. High Rates of Nonsusceptibility to Ceftazidime-avibactam and Identification of New Delhi Metallo-β-lactamase Production inEnterobacteriaceaeBloodstream Infections at a Major Cancer Center: Table 1. Clin Infect Dis 2016; 63:954-958. [DOI: 10.1093/cid/ciw398] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/08/2016] [Indexed: 11/13/2022] Open
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12
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Yang Q, Fang L, Fu Y, Du X, Shen Y, Yu Y. Dissemination of NDM-1-Producing Enterobacteriaceae Mediated by the IncX3-Type Plasmid. PLoS One 2015; 10:e0129454. [PMID: 26047502 PMCID: PMC4457825 DOI: 10.1371/journal.pone.0129454] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/10/2015] [Indexed: 01/14/2023] Open
Abstract
The emergence and spread of NDM-1-producing Enterobacteriaceae have resulted in a worldwide public health risk that has affected some provinces of China. China is an exceptionally large country, and there is a crucial need to investigate the epidemic of blaNDM-1-positive Enterobacteriaceae in our province. A total of 186 carbapenem-resistant Enterobacteriaceae isolates (CRE) were collected in a grade-3 hospital in Zhejiang province. Carbapenem-resistant genes, including blaKPC, blaIMP, blaVIM, blaOXA-48 and blaNDM-1 were screened and sequenced. Ninety isolates were identified as harboring the blaKPC-2 genes, and five blaNDM-1-positive isolates were uncovered. XbaI-PFGE revealed that three blaNDM-1-positive K. pneumoniae isolates belonged to two different clones. S1-PFGE and southern blot suggested that the blaNDM-1 genes were located on IncX3-type plasmids with two different sizes ranging from 33.3 to 54.7 kb (n=4) and 104.5 to 138.9 kb (n=1), respectively, all of which could easily transfer to Escherichia coli by conjugation and electrotransformation. The high-throughput sequencing of two plasmids was performed leading to the identification of a smaller 54-kb plasmid, which had high sequence similarity with a previously reported pCFNDM-CN, and a larger plasmid in which only a 7.8-kb sequence of a common gene environment around blaNDM-1 (blaNDM-1-trpF- dsbC-cutA1-groEL-ΔInsE,) was detected. PCR mapping and sequencing demonstrated that four smaller blaNDM-1 plasmids contained a common gene environment around blaNDM-1 (IS5-blaNDM-1-trpF- dsbC-cutA1-groEL). We monitored the CRE epidemic in our hospital and determined that KPC-2 carbapenemase was a major risk to patient health and the IncX3-type plasmid played a vital role in the spread of the blaNDM-1 gene among the CRE.
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Affiliation(s)
- Qing Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lanfang Fang
- Department of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying Fu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoxing Du
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuqin Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yunsong Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- * E-mail:
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Chen Z, Li H, Feng J, Li Y, Chen X, Guo X, Chen W, Wang L, Lin L, Yang H, Yang W, Wang J, Zhou D, Liu C, Yin Z. NDM-1 encoded by a pNDM-BJ01-like plasmid p3SP-NDM in clinical Enterobacter aerogenes. Front Microbiol 2015; 6:294. [PMID: 25926823 PMCID: PMC4396501 DOI: 10.3389/fmicb.2015.00294] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
A carbapenem-nonsusceptible Enterobacter aerogenes strain named 3-SP was isolated from a human case of pneumonia in a Chinese teaching hospital. NDM-1 carbapenemase is produced by a pNDM-BJ01-like conjugative plasmid designated p3SP-NDM to account for carbapenem resistance of 3-SP. p3SP-NDM was fully sequenced and compared with all publically available pNDM-BJ01-like plasmids. The genetic differences between p3SP-NDM and pNDM-BJ01 include only 18 single nucleotide polymorphisms, a 1 bp deletion and a 706 bp deletion. p3SP-NDM and pNDM-BJ01 harbor an identical Tn125 element organized as ISAba125, blaNDM−1, bleMBL, ΔtrpF, dsbC, cutA, ΔgroES, groEL, ISCR27, and ISAba125. The blaNDM−1 surrounding regions in these pNDM-BJ01-like plasmids have a conserved linear organization ISAba14-aphA6-Tn125-unknown IS, with considerable genetic differences identified within or immediately downstream of Tn125. All reported pNDM-BJ01-like plasmids are exclusively found in Acinetobacter, whereas this is the first report of identification of a pNDM-BJ01-like plasmid in Enterobacteriaceae.
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Affiliation(s)
- Zhenhong Chen
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Hongxia Li
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Jiao Feng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Yuxue Li
- The First Hospital of Shijiazhuang City Shijiazhuang, China
| | - Xin Chen
- Zhongshan School of Medicine, Sun Yat-Sen University Guangzhou, China
| | - Xuemin Guo
- Zhongshan School of Medicine, Sun Yat-Sen University Guangzhou, China
| | - Weijun Chen
- Beijing Institute of Genomics, Chinese Academy of Sciences Beijing, China
| | - Li Wang
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Lei Lin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Huiying Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Wenhui Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Jie Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Changting Liu
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Zhe Yin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
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Sidjabat HE, Paterson DL. Multidrug-resistantEscherichia coliin Asia: epidemiology and management. Expert Rev Anti Infect Ther 2015; 13:575-91. [DOI: 10.1586/14787210.2015.1028365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li P, Yang C, Xie J, Liu N, Wang H, Zhang L, Wang X, Wang Y, Qiu S, Song H. Acinetobacter calcoaceticus from a fatal case of pneumonia harboring bla(NDM-1) on a widely distributed plasmid. BMC Infect Dis 2015; 15:131. [PMID: 25881070 PMCID: PMC4373515 DOI: 10.1186/s12879-015-0870-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have recovered one bla(NDM-1)-harboring bacterial strain, designated as XM1570, from a sputum sample obtained from a fatal case of pneumonia in China. METHODS Biochemical profiling, 16S rRNA sequencing and antimicrobial susceptibility testing were performed. Conjugation experiments were conducted to determine transmissibility of resistance. Pulsed-field gel electrophoresis and whole genome sequencing were performed to identify strain-specific features. RESULTS The isolate XM1570 was identified as Acinetobacter calcoaceticus. Whole genome sequencing identified two plasmids, pXM1 and pXM2. Comparative analysis showed >99% similarity between XM1570 and A. calcoaceticus PHEA-2. Plasmid pXM1 carried the carbapenemase gene bla(NDM-1) and displayed high homology with previously described plasmids isolated from different Acinetobacter spp., which were collected from human or livestock distributed in China and worldwide. The bla(NDM-1) gene was located on this conjugative plasmid in a transposon-like region flanked by two copies of the insertion sequence ISAba125; and resistance to all tested β-lactams was observed. Transferability of resistance from pXM1 to the transconjugants was identified. Plasmid pXM2 had an insertion sequence ISAba125 and a -35 region of the bla NDM-1 gene promoter but the bla NDM-1 gene was not present. A chromosomally located carbapenemase-encoding gene bla OXA-75 was detected; however, this gene was interrupted by an insertion sequence ISAba22 belonging to IS3 family. CONCLUSIONS Location of bla(NDM-1) on different self-transmissible plasmids could facilitate geographically broad dissemination and host range expansion of the bla(NDM-1) gene via horizontal gene transfer. Our findings of this normally environmental species A. calcoaceticus XM1570 further underline the significant clinical challenge and the essential need for surveillance including molecular methods and plasmid analyses.
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Affiliation(s)
- Peng Li
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | - Chaojie Yang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | - Jing Xie
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | - Nan Liu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | | | - Ling Zhang
- 174th Hospital of PLA, Xiamen, Fujian, China.
| | - Xu Wang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | - Yong Wang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | - Shaofu Qiu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
| | - Hongbin Song
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, 20 DongDa Street, Fengtai District, Beijing, 100071, China.
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Cheng VCC, Wong SCY, Ho PL, Yuen KY. Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China. Emerg Microbes Infect 2015; 4:e8. [PMID: 26038766 PMCID: PMC4345289 DOI: 10.1038/emi.2015.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 01/23/2023]
Abstract
Antimicrobial-resistant bacteria are either highly prevalent or increasing rapidly in Hong Kong and China. Treatment options for these bacteria are generally limited, less effective and more expensive. The emergence and dynamics of antimicrobial resistance genes in bacteria circulating between animals, the environment and humans are not entirely known. Nonetheless, selective pressure by antibiotics on the microbiomes of animal and human, and their associated environments (especially farms and healthcare institutions), sewage systems and soil are likely to confer survival advantages upon bacteria with antimicrobial-resistance genes, which may be further disseminated through plasmids or transposons with integrons. Therefore, antibiotic use must be tightly regulated to eliminate such selective pressure, including the illegalization of antibiotics as growth promoters in animal feed and regulation of antibiotic use in veterinary practice and human medicine. Heightened awareness of infection control measures to reduce the risk of acquiring resistant bacteria is essential, especially during antimicrobial use or institutionalization in healthcare facilities. The transmission cycle must be interrupted by proper hand hygiene, environmental cleaning, avoidance of undercooked or raw food and compliance with infection control measures by healthcare workers, visitors and patients, especially during treatment with antibiotics. In addition to these routine measures, proactive microbiological screening of hospitalized patients with risk factors for carrying resistant bacteria, including history of travel to endemic countries, transfer from other hospitals, and prolonged hospitalization; directly observed hand hygiene before oral intake of drugs, food and drinks; and targeted disinfection of high-touch or mutual-touch items, such as bed rails and bed curtains, are important. Transparency of surveillance data from each institute for public scrutiny provides an incentive for controlling antimicrobial resistance in healthcare settings at an administrative level.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China ; Infection Control Team, Queen Mary Hospital , Hong Kong, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China ; Department of Clinical Microbiology and Infection Control, Hong Kong University-Shenzhen Hospital , Shenzhen 518053, Guangdong province, China
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Nesme J, Simonet P. The soil resistome: a critical review on antibiotic resistance origins, ecology and dissemination potential in telluric bacteria. Environ Microbiol 2014; 17:913-30. [DOI: 10.1111/1462-2920.12631] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Joseph Nesme
- Environmental Microbial Genomics, Bioengineering Departement, Laboratoire Ampère, CNRS UMR5005, Ecole Centrale de Lyon; Université de Lyon; 36 Avenue Guy de Collongue Ecully 69134 France
| | - Pascal Simonet
- Environmental Microbial Genomics, Bioengineering Departement, Laboratoire Ampère, CNRS UMR5005, Ecole Centrale de Lyon; Université de Lyon; 36 Avenue Guy de Collongue Ecully 69134 France
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Epidemiological characteristics of blaNDM-1 in Enterobacteriaceae and the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in China from 2011 to 2012. PLoS One 2014; 9:e113852. [PMID: 25469701 PMCID: PMC4254649 DOI: 10.1371/journal.pone.0113852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/01/2014] [Indexed: 12/04/2022] Open
Abstract
Objectives The study aimed to investigate the prevalence and epidemiological characteristics of blaNDM-1 (encoding New Delhi metallo-β-lactamase 1) in Enterobacteriaceae and the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ABC) in China from July 2011 to June 2012. Methods PCR was used to screen for the presence of blaNDM-1 in all organisms studied. For blaNDM-1-positive strains, 16S rRNA analysis and Analytical Profile Index (API) strips were used to identify the bacterial genus and species. The ABCs were reconfirmed by PCR detection of blaOXA-51-like. Antibiotic susceptibilities of the bacteria were assessed by determining minimum inhibitory concentration (MIC) of them using two-fold agar dilution test, as recommended by the Clinical and Laboratory Standards Institute (CLSI). Molecular typing was performed using pulsed-field gel electrophoresis (PFGE). S1 nuclease-pulsed-field gel electrophoresis (S1-PFGE) and Southern blot hybridization were conducted to ascertain the gene location of blaNDM-1. Conjugation experiments were conducted to determine the transmission of blaNDM-1-positive strains. Results Among 2,170 Enterobacteriaceae and 600 ABCs, seven Enterobacteriaceae strains and two A. calcoaceticus isolates from five different cities carried the blaNDM-1 gene. The seven Enterobacteriaceae strains comprised four Klebsiella pneumoniae, one Enterobacter cloacae, one Enterobacter aerogen and one Citrobacter freundii. All seven were non-susceptible to imipenem, meropenem or ertapenem. Two A. calcoaceticus species were resistant to imipenem and meropenem. Three K. pneumoniae showed the same PFGE profiles. The blaNDM-1 genes of eight strains were localized on plasmids, while one was chromosomal. Conclusions Compared with previous reports, the numbers and species containing the blaNDM-1 in Enterobacteriaceae have significantly increased in China. Most of them are able to disseminate the gene, which is cause for concern. Consecutive surveillance should be implemented and should also focus on the dissemination of blaNDM-1 among gram-negative clinical isolates.
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Characterization of plasmids in extensively drug-resistant acinetobacter strains isolated in India and Pakistan. Antimicrob Agents Chemother 2014; 59:923-9. [PMID: 25421466 DOI: 10.1128/aac.03242-14] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The blaNDM-1 gene is associated with extensive drug resistance in Gram-negative bacteria. This probably spread to Enterobacteriaceae from Acinetobacter spp., and we characterized plasmids associated with blaNDM-1 in Acinetobacter spp. to gain insight into their role in this dissemination. Four clinical NDM-1-producing Acinetobacter species strains from India and Pakistan were investigated. A plasmid harboring blaNDM-1, pNDM-40-1, was characterized by whole-genome sequencing of Acinetobacter bereziniae CHI-40-1 and comparison with related plasmids. The presence of similar plasmids in strains from Pakistan was sought by PCR and sequencing of amplicons. Conjugation frequency was tested and stability of pNDM-40-1 investigated by real-time PCR of isolates passaged with and without antimicrobial selection pressure. A. bereziniae and Acinetobacter haemolyticus strains contained plasmids similar to the pNDM-BJ01-like plasmids identified in Acinetobacter spp. in China. The backbone of pNDM-40-1 was almost identical to that of pNDM-BJ01-like plasmids, but the transposon harboring blaNDM-1, Tn125, contained two short deletions. Escherichia coli and Acinetobacter pittii transconjugants were readily obtained. Transconjugants retained pNDM-40-1 after a 14-day passage experiment, although stability was greater with meropenem selection. Fragments of pNDM-BJ01-like plasmid backbones are found near blaNDM-1 in some genetic contexts from Enterobacteriaceae, suggesting that cross-genus transfer has occurred. pNDM-BJ01-like plasmids have been described in isolates originating from a wide geographical region in southern Asia. In vitro data on plasmid transfer and stability suggest that these plasmids could have contributed to the spread of blaNDM-1 into Enterobacteriaceae.
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Zhou G, Guo S, Luo Y, Ye L, Song Y, Sun G, Guo L, Chen Y, Han L, Yang J. NDM-1-producing strains, family Enterobacteriaceae, in hospital, Beijing, China. Emerg Infect Dis 2014; 20:340-2. [PMID: 24456600 PMCID: PMC3901461 DOI: 10.3201/eid2002.121263] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Cheng VCC, Tai JWM, Chau PH, Chen JHK, Yan MK, So SYC, To KKW, Chan JFW, Wong SCY, Ho PL, Yuen KY. Minimal intervention for controlling nosocomial transmission of methicillin-resistant staphylococcus aureus in resource limited setting with high endemicity. PLoS One 2014; 9:e100493. [PMID: 24945412 PMCID: PMC4063951 DOI: 10.1371/journal.pone.0100493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity. METHODS Three phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored. RESULTS During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3). CONCLUSIONS Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broad-spectrum antibiotics.
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Affiliation(s)
- Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Josepha Wai-Ming Tai
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Pui-Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jonathan Hon-Kwan Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Mei-Kum Yan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Simon Yung-Chun So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Kelvin Kai-Wang To
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jasper Fuk-Woo Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sally Cheuk-Ying Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
- * E-mail:
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Berrazeg M, Diene SM, Medjahed L, Parola P, Drissi M, Raoult D, Rolain JM. New Delhi Metallo-beta-lactamase around the world: An eReview using Google Maps. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.20.20809] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Gram-negative carbapenem-resistant bacteria, in particular those producing New Delhi Metallo-beta-lactamase-1 (NDM-1), are a major global health problem. To inform the scientific and medical community in real time about worldwide dissemination of isolates of NDM-1-producing bacteria, we used the PubMed database to review all available publications from the first description in 2009 up to 31 December 2012, and created a regularly updated worldwide dissemination map using a web-based mapping application. We retrieved 33 reviews, and 136 case reports describing 950 isolates of NDM-1-producing bacteria. Klebsiella pneumoniae (n= 359) and Escherichia coli (n=268) were the most commonly reported bacteria producing NDM-1 enzyme. Several case reports of infections due to imported NDM-1 producing bacteria have been reported in a number of countries, including the United Kingdom, Italy, and Oman. In most cases (132/153, 86.3%), patients had connections with the Indian subcontinent or Balkan countries. Those infected were originally from these areas, had either spent time and/or been hospitalised there, or were potentially linked to other patients who had been hospitalised in these regions. By using Google Maps, we were able to trace spread of NDM-1-producing bacteria. We strongly encourage epidemiologists to use these types of interactive tools for surveillance purposes and use the information to prevent the spread and outbreaks of such bacteria.
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Affiliation(s)
- M Berrazeg
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine et de Pharmacie, Marseille, France
- Laboratoire Antibiotiques, Antifongiques: physico- chimie, Synthèse et Activité Biologiques, Faculté des Sciences de la Nature, de la Vie, de la Terre et de l’Univers, Université Abou Bekr Belkaid, Tlemcen, Algeria
| | - S M Diene
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine et de Pharmacie, Marseille, France
| | - L Medjahed
- Département d'Informatique, Faculté de technologie, Université Abou Bekr Belkaid, Tlemcen, Algeria
| | - P Parola
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine et de Pharmacie, Marseille, France
| | - M Drissi
- Laboratoire Antibiotiques, Antifongiques: physico- chimie, Synthèse et Activité Biologiques, Faculté des Sciences de la Nature, de la Vie, de la Terre et de l’Univers, Université Abou Bekr Belkaid, Tlemcen, Algeria
| | - D Raoult
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine et de Pharmacie, Marseille, France
| | - J M Rolain
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine et de Pharmacie, Marseille, France
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High incidence and endemic spread of NDM-1-positive Enterobacteriaceae in Henan Province, China. Antimicrob Agents Chemother 2014; 58:4275-82. [PMID: 24777095 DOI: 10.1128/aac.02813-13] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The emergence and spread of New Delhi metallo-β-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla(NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla(NDM-1), and the gene was found to be carried on plasmids of various sizes (∼ 55 to ∼ 360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla(NDM-1)-positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla(NDM-1)-positive CRE isolate, the bla(NDM-1) gene was downstream of an intact ISAba125 element and upstream of the bleMBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla(NDM-1)-containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.
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Wailan AM, Paterson DL. The spread and acquisition of NDM-1: a multifactorial problem. Expert Rev Anti Infect Ther 2013; 12:91-115. [DOI: 10.1586/14787210.2014.856756] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ho PL, Cheung YY, Lo WU, Li Z, Chow KH, Lin CH, Chan JFW, Cheng VCC. Molecular Characterization of an Atypical IncX3 Plasmid pKPC-NY79 Carrying bla KPC-2 in a Klebsiella pneumoniae. Curr Microbiol 2013; 67:493-8. [PMID: 23728748 DOI: 10.1007/s00284-013-0398-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/01/2013] [Indexed: 11/24/2022]
Abstract
The IncX family of plasmids has recently been expanded to include at least four subtypes, IncX1-IncX4. The revised classification provides an opportunity for improving our understanding of the sequence diversity of the IncX plasmids and the resistance genes they carried. We described the complete nucleotide sequence of a novel IncX3 plasmid, pKPC-NY79 (42,447 bp) from a sequence-type 258 Klebsiella pneumoniae strain that was isolated from a patient who was hospitalized in New York, United States. In pKPC-NY79, the plasmid scaffold and genetic load region were highly similar to homologous regions in pIncX-SHV (IncX3, JN247852) and the bla KPC carrying pKpQIL (IncFIIk, GU595196), respectively, indicating that it has possibly arisen through recombination of plasmids. The bla KPC-2 gene, as part of a transposon Tn4401a, was found within the genetic load region. The backbone of pKPC-NY79 differs from pIncX-SHV by a deletion involving the gene tandem hns-topB (encoding H-NS protein and topoisomerase III, respectively) and a putative ATPase gene. Unexpectedly, the impact of the hns-topB deletion on host fitness and plasmid stability was found to be small. In conclusion, the findings contribute to a better understanding of the plasmid platforms carrying bla KPC and of variations in the backbone of the IncX3 plasmids.
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Affiliation(s)
- Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital and Carol Yu Centre for Infection, The University of Hong Kong, China.
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Emergence of blaNDM-1 among Klebsiella pneumoniae ST15 and novel ST1031 clinical isolates in China. Diagn Microbiol Infect Dis 2013; 75:373-6. [PMID: 23453788 DOI: 10.1016/j.diagmicrobio.2013.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/03/2013] [Accepted: 01/08/2013] [Indexed: 01/29/2023]
Abstract
The emergence of NDM-1 has become established as a major public health threat and represents a new and major challenge in the treatment of infectious diseases. A total of 39 carbapenem-resistant Enterobacteriaceae isolates collected from patients receiving care at 5 teaching hospitals in Jiangxi province, central China, were analyzed for carriage of resistance genes, including bla(NDM-1). Two carbapenem-resistant Klebsiella pneumoniae isolates (NC12 and NC18) were found to harbor bla(NDM-1). In addition to bla(NDM-1), NC12 also carried bla(SHV-1), while NC18 harbored additional resistance genes, including bla(SHV-12), bla(CTX-M-14), armA and bla(TEM-1). NC12 and NC18 belonged to ST15 and novel ST1031 and were clonally unrelated. Carbapenem resistance for NC12 could be transferred to Escherichia coli recipients through conjugation and chemical transformation, while carbapenem resistance for NC18 was only transferred to E. coli recipients by chemical transformation. The EcoR1-digested DNA pattern of plasmids from the transformants of NC12 was identical to that for NC18. Taken together, this is the first report of bla(NDM-1) carriage by K. pneumoniae clinical isolates in mainland China, indicating that bla(NDM-1) is disseminated among Enterobacteriaceae in China. Systemic surveillance should focus on the dissemination of bla(NDM-1) among Gram-negative clinical isolates, especially some major clones, such as K. pneumoniae ST15 which is a major clone among CTX-M-15-producing isolates.
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Johnson AP, Woodford N. Global spread of antibiotic resistance: the example of New Delhi metallo-β-lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol 2013; 62:499-513. [PMID: 23329317 DOI: 10.1099/jmm.0.052555-0] [Citation(s) in RCA: 303] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The rapidity with which new types of antibiotic resistance can disseminate globally following their initial emergence or recognition is exemplified by the novel carbapenemase New Delhi metallo-β-lactamase (NDM). The first documented case of infection caused by bacteria producing NDM occurred in 2008, although retrospective analyses of stored cultures have identified the gene encoding this enzyme (blaNDM) in Enterobacteriaceae isolated in 2006. Since its first description, NDM carbapenemase has been reported from 40 countries worldwide, encompassing all continents except South America and Antarctica. The spread of NDM has a complex epidemiology involving the spread of a variety of species of NDM-positive bacteria and the inter-strain, inter-species and inter-genus transmission of diverse plasmids containing blaNDM, with the latter mechanism having played a more prominent role to date. The spread of NDM illustrates that antibiotic resistance is a public health problem that transcends national borders and will require international cooperation between health authorities if it is to be controlled.
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Affiliation(s)
- Alan P Johnson
- Department of Healthcare Associated Infection & Antimicrobial Resistance, HPA Health Protection Services Colindale, NW9 5EQ, London, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, HPA Microbiology Services Colindale, NW9 5EQ, London, UK
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Abstract
PURPOSE OF REVIEW This review focuses on recent changes in epidemiological aspects of bacteria-induced intra-abdominal infections (IAIs), including the dominant pathogens, antimicrobial susceptibility profiles, and emerging resistance phenotypes. RECENT FINDINGS Enterobacteriaceae species, including Escherichia coli and Klebsiella pneumoniae, remain the major pathogens contributing to abdominal sepsis, although Pseudomonas aeruginosa and Acinetobacter baumannii have recently become common causes of hospital-acquired IAIs. The prevalence of multidrug-resistant Gram-negative bacilli, especially those that produce extended-spectrum β-lactamases (ESBLs), has increased worldwide, although the distribution of those organisms varies from region to region. Furthermore, recent changes in interpretive breakpoints for antimicrobial susceptibility testing recommended by the Clinical Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) have resulted in a marked increase in the reported rates of resistance among Gram-negative bacilli to carbapenems, extended-spectrum cephalosporins, and fluoroquinolones. Besides, routine detection and reporting of ESBL phenotypes for clinical isolates have not been recommended after following new interpretive breakpoints. More studies are needed to investigate the impacts of these changes on therapeutic strategies and epidemiological surveillance. In addition, pathogens carrying New Delhi metallo-β-lactamases (NDMs), K. pneumoniae carbapenemases (KPCs), and other carbapenemases show extended resistance to currently available antibiotics and rapid transfer between species and countries. Although some of these pathogens are still susceptible to tigecycline and colistin, rates of resistance to these two agents are rising. SUMMARY Abdominal sepsis due to multidrug-resistant bacteria, especially ESBL producers, and international and interspecies spreading of metallo-β-lactamase raise key therapeutic problems.
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Ho PL, Li Z, Lo WU, Cheung YY, Lin CH, Sham PC, Cheng VCC, Ng TK, Que TL, Chow KH. Identification and characterization of a novel incompatibility group X3 plasmid carrying bla NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China. Emerg Microbes Infect 2012; 1:e39. [PMID: 26038408 PMCID: PMC3630922 DOI: 10.1038/emi.2012.37] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/18/2012] [Accepted: 09/26/2012] [Indexed: 01/02/2023]
Abstract
The New Delhi metallo-β-lactamase (NDM-1) is one of the most important resistance traits in Enterobacteriaceae. We characterized nine blaNDM-1 producing Enterobacteriaceae recovered from seven patients who have recently travelled or been treated in India (n=1) or mainland China (n=6) during December 2010–May 2012. All the China-linked patients had no links to the Indian subcontinent. The blaNDM-1 carrying plasmids belonged to the novel IncX3 (∼50 kb, in seven isolates including two Escherichia coli, two Klebsiella pneumoniae, one Citrobacter freundii, one Enterobacter aerogenes and one E. cloacae), IncA/C2 (∼140 kb, in one E. coli) or FII-F1B groups (∼110 kb, in one E. coli). Restriction fragment length polymorphism analysis of the seven IncX3 plasmids revealed identical pattern in six and two bands difference in the remaining one. The IncX3 plasmids carrying blaNDM-1 were epidemiologically linked to Guangzhou (n=1), Hunan (n=4), Haifeng (n=1) and Dongguan (n=1) in mainland China. Complete sequencing of the IncX3 plasmid pNDM-HN380 revealed that it was 54 035 bp long and encoded 52 open reading frames. The blaNDM-1 gene was found in a transposon-like structure flanked by ISAba125 and IS26, inserted into the plasmid genetic load region. The sequences of the blaNDM-1 containing module within the two IS elements were identical to those previously described for blaNDM-1-positive Tn125 in the plasmids or chromosome of Acinetobacter isolates. In summary, this is the first description of IncX3 plasmids carrying blaNDM-1. The findings indicate the worrisome involvement of an epidemic plasmid in the dissemination of NDM-1 in China.
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Affiliation(s)
- Pak-Leung Ho
- Department of Microbiology, The University of Hong Kong , Hong Kong, China ; Carol Yu Center for Infection, The University of Hong Kong , Hong Kong, China
| | - Zhen Li
- Department of Microbiology, The University of Hong Kong , Hong Kong, China
| | - Wai-U Lo
- Department of Microbiology, The University of Hong Kong , Hong Kong, China
| | - Yuk-Yam Cheung
- Department of Microbiology, The University of Hong Kong , Hong Kong, China
| | - Chi-Ho Lin
- Centre for Genomic Sciences, The University of Hong Kong , Hong Kong, China
| | - Pak-Chung Sham
- Centre for Genomic Sciences, The University of Hong Kong , Hong Kong, China
| | | | - Tak-Keung Ng
- Department of Clinical Pathology, Princess Margaret Hospital, Hospital Authority , Hong Kong, China
| | - Tak-Lun Que
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority , Hong Kong, China
| | - Kin-Hung Chow
- Department of Microbiology, The University of Hong Kong , Hong Kong, China
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