Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou, China

Abstract

With the abuse of antimicrobial agents in developing countries, increasing number of carbapenem-resistant Enterobacteriaceae (CRE) attracted considerable public concern. A retrospective study was conducted based on 242 CRE strains from a tertiary hospital in Hangzhou, China to investigate prevalence and drug resistance characteristics of CRE in southeast China. Bacterial species were identified. Antimicrobial susceptibility was examined by broth microdilution method or epsilometer test. Resistant β-lactamase genes were identified by polymerase chain reaction and sequencing. Genotypes were investigated by phylogenetic analysis. Klebsiella pneumoniae and Escherichia coli were the most prevalent types of species, with occurrence in 71.9% and 21.9% of the strains, respectively. All strains exhibited high resistance (>70%) against β-lactam antibiotics, ciprofloxacin, trimethoprim–sulfamethoxazole, and nitrofurantoin but exhibited low resistance against tigecycline (0.8%) and minocycline (8.3%). A total of 123 strains harbored more than two kinds of β-lactamase genes. bla_KPC-2, bla_SHV-11, bla_TEM-1, and bla_CTX-M-14 were the predominant genotypes, with detection rates of 60.3%, 61.6%, 43.4%, and 16.5%, respectively, and were highly identical with reference sequences in different countries, indicating potential horizontal dissemination. IMP-4 was the most frequent class B metallo-lactamases in this study. In conclusion, continuous surveillance and effective prevention should be emphasized to reduce spread of CRE.

Keywords

Enterobacteriaceae / carbapenem / β-lactamase genes / phylogenetic analysis

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Acknowledgements

This work was supported by a grant from the Medical Science Foundation of Nanjing Military Command (No. 10Z037). The authors are grateful to Prof. A.A. Medeiros (The Miriam Hospital, Providence, RI, USA) for the Enterobacter cloacae IMI-1 strain, Prof. G. A. Jacoby (Massachusetts General Hospital, Boston, MA, USA) for the Klebsiella pneumoniae IMP-4 strain, and Prof. Rong Zhang (Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China) for the Klebsiella pneumoniae KPC-2 strain.

Compliance with ethics guidelines

Yan Yang, Jian Chen, Di Lin, Xujian Xu, Jun Cheng, and Changgui Sun declare that they have no conflict of interest. All procedures followed were in accordance with ethical standards of the Institutional Review Board of the 117th Hospital of PLA and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients included in the study.

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