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Shen M, Chen X, He J, Xiong L, Tian R, Yang G, Zha H, Wu K. Antimicrobial Resistance Patterns, Sequence Types, Virulence and Carbapenemase Genes of Carbapenem-Resistant Klebsiella pneumoniae Clinical Isolates from a Tertiary Care Teaching Hospital in Zunyi, China. Infect Drug Resist 2023; 16:637-649. [PMID: 36743338 PMCID: PMC9893843 DOI: 10.2147/idr.s398304] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 01/30/2023] Open
Abstract
Purpose Carbapenem-resistant Klebsiella pneumoniae (CRKP) has seriously threatened public health worldwide. This study aimed to investigate the antimicrobial resistance patterns, sequence types (STs), virulence and carbapenemase genes of CRKP isolates from patients in Zunyi, China. Methods CRKP isolates were collected from the First People's Hospital of Zunyi between January 2018 and December 2020. Antimicrobial susceptibility was determined using a VITEK®2 analyzer and confirmed using either the broth dilution method, Kirby-Bauer method, or E-test assays. Carbapenemase production was examined using a modified carbapenem inactivation method. STs of the studied isolates were determined by multilocus sequence typing, and the presence of carbapenemase and virulence genes was examined using polymerase chain reaction assays. Results In total, 94 CRKP isolates were collected. All studied isolates produced carbapenemase, and the most common carbapenemase gene was New Delhi metallo-β-lactamase (NDM; 72.3%), followed by Klebsiella pneumoniae carbapenemase (KPC; 24.5%), and Verona integron-encoded metallo-β-lactamase (VIM; 3.2%). Of the studied isolates, 74.3% exhibited multidrug-resistant (MDR) phenotype, and 25.7% were either pandrug-resistant (PDR) or extensively drug-resistant (XDR) phenotypes. The most prevalent sequence type was ST2407 (37.2%), followed by ST76 (21.3%) and ST11 (11.7%). The NDM gene was present in 97.1% of ST2407 isolates and 90.0% of ST76 isolates, whereas the KPC gene was present in 90.9% of ST11 isolates. The majority of the isolates carried wabG, uge, and fimH virulence genes, with prevalence rates of 94.7%, 92.6%, and 94.7%, respectively. Conclusion This study describes NDM-producing ST2407 and ST76, as well as KPC-producing ST11, as the major clonal types of CRKP isolates in Zunyi, China. All CRKP isolates were resistant to multiple types of antibiotics, and the majority of isolates carried carbapenemase and virulence genes. Clonal spread of NDM-producing CRKP ST2407 and ST76, and KPC-producing CRKP ST11 should be strictly monitored.
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Affiliation(s)
- Meijing Shen
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - Xianghao Chen
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - Jingyue He
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - Lin Xiong
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - Rengui Tian
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - Guangwu Yang
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - He Zha
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China
| | - Kaifeng Wu
- Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China,Correspondence: Kaifeng Wu; He Zha, Department of Laboratory Medicine, the First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, People’s Republic of China, Email ;
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OXA-48-Like β-Lactamases: Global Epidemiology, Treatment Options, and Development Pipeline. Antimicrob Agents Chemother 2022; 66:e0021622. [PMID: 35856662 PMCID: PMC9380527 DOI: 10.1128/aac.00216-22] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Modern medicine is threatened by the rising tide of antimicrobial resistance, especially among Gram-negative bacteria, where resistance to β-lactams is most often mediated by β-lactamases. The penicillin and cephalosporin ascendancies were, in their turn, ended by the proliferation of TEM penicillinases and CTX-M extended-spectrum β-lactamases. These class A β-lactamases have long been considered the most important. For carbapenems, however, the threat is increasingly from the insidious rise of a class D carbapenemase, OXA-48, and its close relatives. Over the past 20 years, OXA-48 and "OXA-48-like" enzymes have proliferated to become the most prevalent enterobacterial carbapenemases across much of Europe, Northern Africa, and the Middle East. OXA-48-like enzymes are notoriously difficult to detect because they often cause only low-level in vitro resistance to carbapenems, meaning that the true burden is likely underestimated. Despite this, they are associated with carbapenem treatment failures. A highly conserved incompatibility complex IncL plasmid scaffold often carries blaOXA-48 and may carry other antimicrobial resistance genes, leaving limited treatment options. High conjugation efficiency means that this plasmid is sometimes carried by multiple Enterobacterales in a single patient. Producers evade most β-lactam-β-lactamase inhibitor combinations, though promising agents have recently been licensed, notably ceftazidime-avibactam and cefiderocol. The molecular machinery enabling global spread, current treatment options, and the development pipeline of potential new therapies for Enterobacterales that produce OXA-48-like β-lactamases form the focus of this review.
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Wang L, Guo L, Ye K, Yang J. Genetic characteristics of OXA-48-producing Enterobacterales from China. J Glob Antimicrob Resist 2021; 26:285-291. [PMID: 34284128 DOI: 10.1016/j.jgar.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In China, OXA-48-producing Enterobacterales have been identified sporadically, causing small-scale regional outbreaks. This study investigated the molecular epidemiology, transmission and evolution of OXA-48-producing Enterobacterales and pOXA48 from mainland China. METHODS We conducted a multicentre resistance monitoring project from 2013-2018. Genome sequencing of OXA-48-produicng isolates was performed. SNPs were analysed. Eleven isolates were selected for subsequent SMRT sequencing. Genome sequences were annotated, and alignment of the complete sequences of blaOXA-48-carrying plasmids from a subset of isolates that underwent long-read sequencing was performed. RESULTS In total, 41 OXA-48-producing Enterobacterales were included in this study (34 Klebsiella pneumoniae, 3 Escherichia coli, 3 Enterobacter cloacae complex and 1 Klebsiella oxytoca). OXA-48-produicng K. pneumoniae (OXAKp) ST383, ST147 and ST11 caused outbreaks of different scales in our hospital. OXA-48-producing E. coli ST156 and ST648, E. cloacae complex ST414 and ST418, and K. oxytoca ST34 were also identified. blaOXA-48 was embedded in a Tn1999.2 structure located in IncL plasmids with different sizes (63.58-109.14 kb). Importantly, K. pneumoniae ST11 co-producing KPC-2 and OXA-48 was identified in our hospital and it is possible that KPC-2-producing K. pneumoniae ST11 obtained the blaOXA-48-carrying plasmid during its spread. A novel 109-kb blaOXA-48-carrying IncL plasmid was identified from OXAKp ST11. Possibly, two plasmids in OXAKp ST383 were integrated to form this larger plasmid. CONCLUSION OXA-48-produicng Enterobacterales were sporadic in China. Importantly, K. pneumoniae ST11 co-producing KPC-2 and OXA-48 has emerged causing an outbreak in China. This high-risk multidrug-resistant clone exhibited high compatibility and strong integration ability with foreign resistance plasmids.
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Affiliation(s)
- Lifeng Wang
- Department of Laboratory Medicine, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ling Guo
- Department of Laboratory Medicine, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Kun Ye
- Department of Laboratory Medicine, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jiyong Yang
- Department of Laboratory Medicine, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
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Mora-Guzmán I, Rubio-Perez I, Domingo-Garcia D, Martin-Perez E. Intra-Abdominal Infections by Carbapenemase-Producing Enterobacteriaceae in a Surgical Unit: Counting Mortality, Stay, and Costs. Surg Infect (Larchmt) 2020; 22:266-273. [PMID: 32598237 DOI: 10.1089/sur.2020.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Carbapenemase-producing Enterobacteriaceae (CPE)-related infections are a problem in public health at present, including intra-abdominal infections (IAI) and surgical populations. The aim of this study was to determine mortality and related risk factors, length of stay (LOS,) and costs for CPE-IAI in surgical patients. Patients and Methods: Review of CPE-related IAI acquired during admission in a general surgery department from January 2013 to December 2018. A mortality analysis was performed specifically in patients with CPE-IAI, and a global analysis of IAI including patients with CPE-IAI (cases) and matched patients with IAI by non-resistant bacteria (controls). Results: Forty patients with CPE-IAI were included, OXA-48-producing Klebsiella pneumoniae was present in 85%. Global mortality rate at 30 days for CPE-IAI was 17.5%; mortality-related factors were: solid tumor (p = 0.009), metastatic disease (p = 0.005), immunodeficiency (p = 0.039), blood transfusion (p = 0.009), and septic shock (p = 0.011). Predictors related to mortality for IAI in the global analysis included age (p = 0.046), Charlson index (p = 0.036), CPE isolation (p = 0.003), and septic shock (p < 0.001). Median global LOS was 43 days (IQR 27-64) in patients with CPE-IAI, and 27 days (IQR 18-35) in controls (p < 0.001). Median global cost of admission was $31,671 (IQR 14,006-55,745) for patients with CPE-IAI and $20,306 (IQR 11,974-27,947) for controls (p = 0.064). The most relevant locations of underlying disease for CPE-IAI were: colorectal (32.5%) with 57-day LOS (IQR 34-65) and cost of $42,877 (IQR 18,780-92,607), and pancreas (25%) with 60-day LOS (IQR 32-99) and cost of $56,371 (IQR 32,590-113,979). Conclusion: Carbapenemase-producing Enterobacteriaceae-related IAI is associated with substantial mortality, LOS, and costs. Factors related to CPE-IAI mortality are solid tumor, metastatic disease, immunodeficiency, blood transfusion, and septic shock. Carbapenemase-producing Enterobacteriaceae isolation in IAI implies higher risk of mortality.
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Affiliation(s)
- Ismael Mora-Guzmán
- Department of General Surgery, Hospital Santa Bárbara, Puertollano, Spain
| | - Inés Rubio-Perez
- Department of General Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Diego Domingo-Garcia
- Department of Clinical Microbiology, Hospital Universitario La Princesa, Madrid, Spain
| | - Elena Martin-Perez
- Department of General Surgery, Hospital Universitario La Princesa, Madrid, Spain
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Chen CM, Guo MK, Ke SC, Lin YP, Li CR, Vy Nguyen HT, Wu LT. Emergence and nosocomial spread of ST11 carbapenem-resistant Klebsiella pneumoniae co-producing OXA-48 and KPC-2 in a regional hospital in Taiwan. J Med Microbiol 2019; 67:957-964. [PMID: 29873627 DOI: 10.1099/jmm.0.000771] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose. Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a major challenge for global healthcare systems. The objectives of this study were to determine the nosocomial spread of CRKP clones and analyse the molecular characteristics of CRKP in our hospital.Methodology. Ninety-eight non-duplicated clinical CRKP isolates were collected from March 2014-June 2015. Clinical, demographic and microbiological data of patients with CRKP were reviewed. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing were applied to investigate the genetic relationship between the 98 isolates. Antibiotic resistance genes were identified by conventional PCR-sequencing.Results. PFGE patterns were grouped into 26 clusters. Two main PFGE clusters were identified: L (53 isolates, belonging to ST11) and N (11 isolates, belonging to ST11). The most dominant ST was ST11 (79 %, 77/98), followed by ST273 (5 %, 5/98). KPC-2 (n=82) was the predominant carbapenemase followed by OXA-48 (n=64). Fifty isolates (51 %, 50/98) harboured bla KPC-2 and bla OXA-48 simultaneously, and three of these isolates were detected with the third carbapenemase genes (bla IMP-8 or bla VIM-1).Conclusion. The clonal spread of K. pneumoniae ST11 expressing OXA-48, KPC-2 and CTX-M-14 β-lactamases was the cause of an outbreak of CRKP. To the best of our knowledge, a single strain harbouring A-, B- and D-class carbapenemase genes has not previously been identified. There is a high prevalence of plasmid-encoded KPC-2- and OXA-48-producing CRKP in our hospital; most isolates were members of ST11, which may be representative of a high-risk CRKP clone disseminating in central Taiwan.
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Affiliation(s)
- Chih-Ming Chen
- Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.,Department of Health Food, Chung Chou University of Science and Technology, Changhua, Taiwan, ROC
| | - Ming-Kai Guo
- The Institute of Medical Science and Department of Microbiology, China Medical University, Taichung, Taiwan, ROC
| | - Se-Chin Ke
- Infection Control Office, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.,Department of Medical Technology, Jen-The Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
| | - Yi-Pei Lin
- Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
| | - Chia-Ru Li
- Section of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hong Thuy Vy Nguyen
- The Institute of Biomedical Sciences College of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Lii-Tzu Wu
- The Institute of Medical Science and Department of Microbiology, China Medical University, Taichung, Taiwan, ROC
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Wang Q, Wang X, Wang J, Ouyang P, Jin C, Wang R, Zhang Y, Jin L, Chen H, Wang Z, Zhang F, Cao B, Xie L, Liao K, Gu B, Yang C, Liu Z, Ma X, Jin L, Zhang X, Man S, Li W, Pei F, Xu X, Jin Y, Ji P, Wang H. Phenotypic and Genotypic Characterization of Carbapenem-resistant Enterobacteriaceae: Data From a Longitudinal Large-scale CRE Study in China (2012-2016). Clin Infect Dis 2019; 67:S196-S205. [PMID: 30423057 DOI: 10.1093/cid/ciy660] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Carbapenem-resistant Enterobacteriaceae (CRE) strains are a major threat to global health. The development of effective control measures requires more detailed phenotypic and genotypic characterization of CRE. Methods CRE isolates were collected from 65 hospitals in 25 provinces across China between January 1, 2012, and December 31, 2016. The isolates were characterized by antimicrobial susceptibility testing and multilocus sequence typing. Genes encoding carbapenemases, mobilized colistin resistance (mcr-1), and β-lactamases were detected by polymerase chain reaction and DNA sequencing. Results A total of 1801 independent CRE isolates (1201 Klebsiella pneumoniae, 282 Escherichia coli, and 179 Enterobacter cloacae) were collected during the study period. Overall, 96.9%, 89.7%, 54.5%, 49.9%, and 40% of CRE strains were susceptible to colistin, tigecycline, amikacin, minocycline, and fosfomycin, respectively. Notably, 1091/1201 (91%) K. pneumoniae, 225/282 (80%) E. coli, and 129/179 (72%) E. cloacae harbored carbapenemase gene. K. pneumoniae carbapenemase (KPC) was predominant in K. pneumoniae (77%), whereas New Delhi metallo-β-lactamase (NDM) was predominant in E. coli (75%) and E. cloacae (53%). The mcr-1 gene was detected in 13 NDM-carrying E. coli isolates (4.6%). Sequence type (ST)11 and ST167 were predominant among the 100 K. pneumoniae and 47 E. coli STs, respectively. KPC-ST11, which accounted for 64% of K. pneumoniae isolates, had higher levels of resistance than non-ST11 strains to aztreonam, fosfomycin, and amikacin (P < .001). The proportions of KPC and NDM enzymes in CRE increased from 2012 to 2016 (54%-59% and 12%-28%, respectively). Conclusions The number of CRE strains harboring carbapenemase is increasing. KPC-ST11 K. pneumoniae, the predominant strain, shows a reduced susceptibility to most available antibiotics.
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Affiliation(s)
- Qi Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Xiaojuan Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Juan Wang
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, Changsha, Hunan
| | - Pengwen Ouyang
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, Changsha, Hunan
| | - Chunmei Jin
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji
| | - Ruobing Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Yawei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Longyang Jin
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Zhanwei Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, and National Clinical Research Center for Respiratory Diseases, Beijing
| | - Liangyi Xie
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, Changsha, Hunan
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong
| | - Bing Gu
- Department of Clinical Laboratory, Medical Technology Institute of Xuzhou Medical University, The Affiliated Hospital of Xuzhou Medical University, Jiangsu
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University
| | - Zhiwu Liu
- Department of Medical Laboratory center, the First Hospital of Lanzhou University, Gansu
| | - Xiaobo Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Fujian
| | - Liang Jin
- Department of Clinical Laboratory, First Hospital of Qinhuangdao, Hebei
| | - Xiaoqian Zhang
- Department of Clinical Laboratory, Henan Province Hospital of TCM, Zhengzhou
| | - Sijin Man
- Department of Clinical Laboratory, Tengzhou Central People's Hospital, Shandong
| | - Wei Li
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan
| | - Fengyan Pei
- Department of Clinical Microbiology, Jinan Central Hospital, Shandong
| | - Xiuli Xu
- Department of Clinical Laboratory Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi
| | - Yan Jin
- Department of Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan
| | - Ping Ji
- Department of Laboratory Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumchi, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing
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Li X, Ma W, Qin Q, Liu S, Ye L, Yang J, Li B. Nosocomial spread of OXA-232-producing Klebsiella pneumoniae ST15 in a teaching hospital, Shanghai, China. BMC Microbiol 2019; 19:235. [PMID: 31660869 PMCID: PMC6819465 DOI: 10.1186/s12866-019-1609-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
Background The spread and outbreak of Enterobacteriaceae producing OXA-48-like carbapenemases have become more and more prevalent in China. Results A total of 62 non-duplicated OXA-232-producing K. pneumoniae (OXA232Kp) were isolated between 2015 and 2017. An outbreak of OXA232Kp was observed in burn ICU. The 62 OXA232Kp isolates were all belongs to ST15 and categorized into two PFGE types (A and B). Type A was dominated of the isolates, which contained 61 clinical isolates and divided into 10 subtypes (A1-A10). In addition, most of OXA232Kp strains exhibited low-level carbapenems resistance. All strains carried a 6141 bp ColKP3 plasmid harboring the blaOXA-232 gene which is highly homologous to other blaOXA-232-bearing plasmids involved in other studies in eastern China. Conclusions In this study, clone transmission of OXA232Kp ST15was observed. Highly significant homology among the blaOXA-232-bearing plasmids indicated the important role of the 6.1 kb ColE-like plasmid on the prevalence of blaOXA-232 gene in China.
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Affiliation(s)
| | | | - Qin Qin
- Department of Laboratory Diagnosis, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Shanrong Liu
- Department of Laboratory Diagnosis, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Liyan Ye
- Center for Clinical Laboratory Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiyong Yang
- Center for Clinical Laboratory Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Boan Li
- Center for Clinical Laboratory, the 302 Hospital of Chinese PLA, Beijing, 100039, China.
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Zhuang Z, Lv L, Lu J, Lin J, Liu JH. Emergence of Klebsiella pneumoniae and Enterobacter cloacae producing OXA-48 carbapenemases from retail meats in China, 2018. J Antimicrob Chemother 2019; 74:3632-3634. [DOI: 10.1093/jac/dkz394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Zilin Zhuang
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, Key Laboratory of Zoonoses of Ministry of Agriculture, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Luchao Lv
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, Key Laboratory of Zoonoses of Ministry of Agriculture, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Jiaxun Lu
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, Key Laboratory of Zoonoses of Ministry of Agriculture, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Jinhang Lin
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, Key Laboratory of Zoonoses of Ministry of Agriculture, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Jian-Hua Liu
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, Key Laboratory of Zoonoses of Ministry of Agriculture, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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Gomez-Gamboa L, Barrios-Camacho H, Duran-Bedolla J, Sánchez-Perez A, Reyna-Flores F, Perozo-Mena A, Zabala I, Rodriguez-Medina N, Martínez-Barnetche J, Téllez-Sosa J, Valdovinos-Torres H, Garza-Ramos U. Molecular and genetic characterization of carbapenemase-producing bacteria in Venezuela. J Chemother 2019; 31:349-353. [PMID: 31046636 DOI: 10.1080/1120009x.2019.1607452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Carbapenem-resistant Gram-negative bacteria isolated in Venezuela have been poorly characterized. The present study characterized a total of 34 isolates obtained from 27 patients; five of these patients were multi-infected. The bacterial species identified were Klebsiella pneumoniae (17), Pseudomonas aeruginosa (9), and Acinetobacter baumannii (8). From these isolates, 85% were identified as carbapenemase-producing bacteria, and the identified carbapenemase genes were blaKPC-2 (10/29 [34.4%]), blaVIM-type (7/29 [24.1%]), blaOXA-23 (7/29 [24.1%]), blaNDM-1 (8/29 [27.5%]), and the coexistence of blaOXA-23/blaNDM-1 (2/29 [6.8%]). Patient 1 was multi-infected by K. pneumoniae ST11 and ST2413 isolates harbouring the blaNDM-1 and blaKPC-2 genes, respectively. The other patients were multi-infected by two or three different bacterial species such as ESBL-producing K. pneumoniae isolates, P. aeruginosa harbouring the blaVIM-type gene, K. pneumoniae ST147 harbouring the blaKPC-2 gene and by A. baumannii harbouring the blaOXA-23 gene. The blaNDM-1 gene in A. baumannii is flanked by an uncommon genetic structure, whereas blaNDM-1 gene in K. pneumoniae revealed a common structure described in different plasmids from Enterobacteriaceae isolates. This study provides new information about the epidemiology of carbapenemase-producing bacteria in clinical setting in Venezuela.
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Affiliation(s)
- Liliana Gomez-Gamboa
- Department of Tropical and Infectious Diseases School of Medicine, University of Zulia , Maracaibo , Venezuela
| | - Humberto Barrios-Camacho
- Instituto Nacional de Salud Pública (INSP), CISEI Laboratorio de Resistencia Bacteriana , Cuernavaca , Morelos , Mexico
| | - Josefina Duran-Bedolla
- Instituto Nacional de Salud Pública (INSP), CISEI Laboratorio de Resistencia Bacteriana , Cuernavaca , Morelos , Mexico
| | - Alejandro Sánchez-Perez
- Instituto Nacional de Salud Pública (INSP), CISEI Laboratorio de Resistencia Bacteriana , Cuernavaca , Morelos , Mexico
| | - Fernando Reyna-Flores
- Instituto Nacional de Salud Pública (INSP), CISEI Laboratorio de Resistencia Bacteriana , Cuernavaca , Morelos , Mexico
| | - Armindo Perozo-Mena
- Laboratory of Bacteriology Department of Microbiology Faculty of Medicine. University of Zulia, Maracaibo , Venezuela
| | - Irene Zabala
- Genetics and Molecular Biology Laboratory Faculty of Science, University of Zulia , Maracaibo , Venezuela
| | - Nadia Rodriguez-Medina
- Instituto Nacional de Salud Pública (INSP), CISEI Laboratorio de Resistencia Bacteriana , Cuernavaca , Morelos , Mexico
| | - Jesús Martínez-Barnetche
- Instituto Nacional de Salud Pública (INSP), CISEI, Departamento de Inmunología , Cuernavaca , Morelos , Mexico
| | - Juan Téllez-Sosa
- Instituto Nacional de Salud Pública (INSP), CISEI, Departamento de Inmunología , Cuernavaca , Morelos , Mexico
| | - Humberto Valdovinos-Torres
- Instituto Nacional de Salud Pública (INSP), CISEI, Departamento de Inmunología , Cuernavaca , Morelos , Mexico
| | - Ulises Garza-Ramos
- Instituto Nacional de Salud Pública (INSP), CISEI Laboratorio de Resistencia Bacteriana , Cuernavaca , Morelos , Mexico
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Mairi A, Pantel A, Ousalem F, Sotto A, Touati A, Lavigne JP. OXA-48-producing Enterobacterales in different ecological niches in Algeria: clonal expansion, plasmid characteristics and virulence traits. J Antimicrob Chemother 2019; 74:1848-1855. [DOI: 10.1093/jac/dkz146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Assia Mairi
- Laboratoire d’Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algeria
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, Nîmes, France
| | - Alix Pantel
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, Nîmes, France
- Department of Microbiology, University Hospital Nîmes, Nîmes, France
| | - Farès Ousalem
- Institut de Biologie et de Physico-chimie, UMR826, Université de Paris Diderot, Paris, France
| | - Albert Sotto
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, Nîmes, France
- Department of Infectious Diseases, University Hospital Nîmes, Nîmes, France
| | - Abdelaziz Touati
- Laboratoire d’Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algeria
| | - Jean-Philippe Lavigne
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, Nîmes, France
- Department of Microbiology, University Hospital Nîmes, Nîmes, France
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11
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Emergence of OXA-232 Carbapenemase-Producing Klebsiella pneumoniae That Carries a pLVPK-Like Virulence Plasmid among Elderly Patients in China. Antimicrob Agents Chemother 2019; 63:AAC.02246-18. [PMID: 30559135 DOI: 10.1128/aac.02246-18] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/08/2018] [Indexed: 12/15/2022] Open
Abstract
This study reported the clonal dissemination of OXA-232-producing sequence type 15 (ST15) carbapenem-resistant Klebsiella pneumoniae among elderly patients in China. All patients were immunocompromised, suffered from multiple underlying diseases, and were hospitalized for a prolonged period; however, they slowly recovered on antimicrobial therapy. The bla OXA-232 gene was in a 6.1-kb ColKP3-type nonconjugative plasmid. The strains displayed a multidrug resistance phenotype and were not hypervirulent despite harboring a virulence plasmid. Active surveillance should be enforced to control further transmission.
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An J, Lai K, Ma Y, Guo L, Ye L, Luo Y, Yang J. Emergence of multiple carbapenemase-producing organisms in single patients: an increasing threat to treatment of infection. J Antimicrob Chemother 2019; 73:544-546. [PMID: 29136151 DOI: 10.1093/jac/dkx411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jingna An
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Kaisheng Lai
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Yanning Ma
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Ling Guo
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Liyan Ye
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Yanping Luo
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Jiyong Yang
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
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13
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Jing X, Zhou H, Min X, Zhang X, Yang Q, Du S, Li Y, Yu F, Jia M, Zhan Y, Zeng Y, Yang B, Pan Y, Lu B, Liu R, Zeng J. The Simplified Carbapenem Inactivation Method (sCIM) for Simple and Accurate Detection of Carbapenemase-Producing Gram-Negative Bacilli. Front Microbiol 2018; 9:2391. [PMID: 30425686 PMCID: PMC6218411 DOI: 10.3389/fmicb.2018.02391] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
This study reports the simplified carbapenem inactivation method (sCIM) to detect carbapenemase-producing gram-negative bacilli in a simple and accurate manner. This method is based on the modified carbapenem inactivation method (mCIM) with the improvement of experimental procedures. Instead of incubating the antibiotic disk in the organism culture media, the organism to be tested was smeared directly onto the antibiotic disk in the sCIM. For evaluating the sensitivity and specificity of the method, a total of 196 Enterobacteriaceae, 73 Acinetobacter baumannii, and 158 Pseudomonas aeruginosa isolates were collected. Polymerase chain reaction (PCR) was used to detect the carbapenemase genes. Phenotypic evaluations were performed using both the sCIM and the mCIM. PCR results showed that, of the 196 Enterobacteriaceae strains, 147 expressed the carbapenemase genes blaKPC−2 (58.5%), blaIMP−4 (21.8%), blaIMP−2 (2.0%), blaVIM−1 (6.1%), blaNDM−1 (10.2%), and blaOXA−48 (1.4%). sCIM results had high concordance with PCR results (99.5%) and mCIM results (100%) with the exception of one Klebsiella pneumoniae strain, which had an minimal inhibitory concentration (MIC) for imipenem of 0.25 mg/L. PCR demonstrated that 53 of the 73 A. baumannii isolates expressed the carbapenemase genes blaOXA−23 (98.1%) and blaVIM−2 (1.8%). sCIM and PCR results corresponded but all A. baumannii isolates were carbapenemase negative by the mCIM. PCR demonstrated that 25 of the 158 P. aeruginosa isolates expressed carbapenemase genes blaVIM−1 (52%), blaVIM−2 (8%), blaVIM−4 (36%), and blaIMP−4 (4%). sCIM results had high concordance with PCR results (100%) and the mCIM results (99.4%) with the exception of one P. aeruginosa isolate that expressed the blaVIM−4 gene. The sCIM offers specificity and sensitivity comparable to PCR but has the advantage of being more user-friendly. This method is suitable for routine use in most clinical microbiology laboratories for the detection of carbapenemase-producing gram-negative bacilli.
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Affiliation(s)
- Xiaopeng Jing
- Department of Clinical Laboratory, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Zhou
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaochun Min
- Department of Clinical Laboratory, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zhang
- Department of Clinical Laboratory, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Yang
- Department of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shuaixian Du
- Department of Clinical Laboratory, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yirong Li
- Department of Clinical Laboratory, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Jia
- Department of Clinical Laboratory, Wuhan First Hospital, Wuhan, China
| | - Yu Zhan
- Department of Clinical Laboratory, The Central Hospital of Wuhan, Wuhan, China
| | - Yi Zeng
- Department of Clinical Laboratory, The Central Hospital of Wuhan, Wuhan, China
| | - Bo Yang
- Department of Clinical Laboratory, The Central Hospital of Wuhan, Wuhan, China
| | - Yunjun Pan
- Department of Clinical Laboratory, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Binghuai Lu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical Medicine, Beijing, China
| | - Rong Liu
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Ministry of Education of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji Zeng
- Department of Clinical Laboratory, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wilson H, Török ME. Extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacteriaceae. Microb Genom 2018; 4:e000197. [PMID: 30035710 PMCID: PMC6113871 DOI: 10.1099/mgen.0.000197] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/19/2018] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public-health emergency, which threatens the advances made by modern medical care over the past century. The World Health Organization has recently published a global priority list of antibiotic-resistant bacteria, which includes extended-spectrum β-lactamase-producing Enterobacteriaceae and carbapenemase-producing Enterobacteriaceae. In this review, we highlight the mechanisms of resistance and the genomic epidemiology of these organisms, and the impact of AMR.
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Affiliation(s)
- Hayley Wilson
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - M. Estée Török
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, UK
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15
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Liang WJ, Liu HY, Duan GC, Zhao YX, Chen SY, Yang HY, Xi YL. Emergence and mechanism of carbapenem-resistant Escherichia coli in Henan, China, 2014. J Infect Public Health 2017; 11:347-351. [PMID: 29107607 DOI: 10.1016/j.jiph.2017.09.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/12/2017] [Accepted: 09/09/2017] [Indexed: 12/17/2022] Open
Abstract
The emergence and dissemination of carbapenem-resistant Escherichia coli (E. coli) strains is a main risk for global public health, but little is known of carbapenemase producing E. coli in Henan, China. The study was undertaken to investigate the prevalence and mechanism of carbapenem-resistant E. coli strains in a hospital in Xinxiang, Henan, China, 2014. A total of 5 carbapenemase-producing E. coli strains were screened from 1014 isolates. We found that they were all resistant to meropenem and imipenem. Amikacin showed the best sensitivity, with gentamicin coming up next. The positive rate of blaNDM was 80% (4/5). The sequencing results showed that two isolates belonged to blaNDM-1 whereas other 2 isolates carried the blaNDM-5. Other carbapenemase genes including blaIMP,blaVIM, blaKPC and blaOXA-48 were not detected. The blaCTX-M-15,blaTEM-1,sul2, aad, and aac(6")-Ib-cr were also detected. MLST analysis showed that NDM-producing E. coli were sporadic. Conjugation test indicated blaNDM could be transferred. In conclusion, the blaNDM was the principal resistance mechanism of carbapenem-resistant E. coli in the hospital, Henan, China.
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Affiliation(s)
- Wen-Juan Liang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China; Henan Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan 453003, China.
| | - Hui-Ying Liu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Guang-Cai Duan
- College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China; Henan Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan 453003, China.
| | - Yong-Xin Zhao
- Laboratory Department, the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453003, China.
| | - Shuai-Yin Chen
- College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Hai-Yan Yang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Yuan-Lin Xi
- College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
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16
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Mairi A, Pantel A, Sotto A, Lavigne JP, Touati A. OXA-48-like carbapenemases producing Enterobacteriaceae in different niches. Eur J Clin Microbiol Infect Dis 2017; 37:587-604. [PMID: 28990132 DOI: 10.1007/s10096-017-3112-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/26/2022]
Abstract
The emergence of carbapenem-resistant enterobacterial species poses a serious threat to public health worldwide. OXA-48-type carbapenem-hydrolyzing class D β-lactamases are widely distributed among Enterobacteriaceae, with significant geographical differences. To date, 11 OXA-48-like variants have been identified, with classical OXA-48 being the most widespread. These enzymes show high-level hydrolytic activity against penicillins and low-level hydrolysis towards carbapenems. Since the first description of the OXA-48 carbapenemase in Turkey, bacterial strains producing the enzyme have been extensively reported in nosocomial and community outbreaks in many parts of the word, particularly in the Mediterranean area and European countries. The rapid spread of Enterobacteriaceae producing OXA-48-like enzymes in different ecosystems has become a serious issue recently. The number of reservoirs for such organisms is increasing, not only in hospitals, but also in the community, among animals (e.g., livestock, companion animals, and wildlife) and in the environment. This review aims to summarize the main characteristics of the OXA-48-type carbapenemases, covering genetic and enzymatic traits, their epidemiology, clonality and associated genes, correlation with extended-spectrum β-lactamases (ESBLs) or plasmidic AmpC (pAmpC) in different bacterial species worldwide.
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Affiliation(s)
- Assia Mairi
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria.,Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Alix Pantel
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France.,Department of Microbiology, University Hospital of Nîmes, Nîmes, France
| | - Albert Sotto
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Jean-Philippe Lavigne
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France. .,Department of Microbiology, University Hospital of Nîmes, Nîmes, France.
| | - Aziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria
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