Clinical and Microbiological Characteristics of Community-Onset Carbapenem-Resistant Enterobacteriaceae Isolates

Hangbin Hu; Jinchao Mao; Yiyi Chen; Jie Wang; Piaopiao Zhang; Yan Jiang; Qing Yang; Yunsong Yu; Tingting Qu

doi:10.2147/IDR.S260804

Clinical and Microbiological Characteristics of Community-Onset Carbapenem-Resistant Enterobacteriaceae Isolates

Infect Drug Resist. 2020 Sep 11:13:3131-3143. doi: 10.2147/IDR.S260804. eCollection 2020.

Authors

Hangbin Hu^#¹, Jinchao Mao^#^{1

2}, Yiyi Chen^{3

4}, Jie Wang⁵, Piaopiao Zhang¹, Yan Jiang^{3

4}, Qing Yang¹, Yunsong Yu^{3

4}, Tingting Qu¹

Affiliations

¹ State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
² Infectious Disease Department, The First People's Hospital of Wenling, Wenling, Zhejiang Province, People's Republic of China.
³ Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
⁴ Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
⁵ Respiratory Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.

^# Contributed equally.

Abstract

Objective: The aim of this study was to investigate the clinical and microbiological features of community-onset CRE (CO-CRE) obtained from outpatients at a tertiary hospital in China.

Patients and methods: We isolated 64 CRE strains from outpatients and divided them into three groups: 36 hospital-acquired CRE (HA-CRE), 28 CO-CRE including 15 community-acquired CRE (CA-CRE) and 13 healthcare-associated CRE (HCA-CRE). Clinical information was collected. The antibiotic susceptibilities of the 28 CO-CRE strains were tested. Whole-genome sequencing (WGS) was conducted, and then drug resistance gene analysis was performed. CgMLST and SNP comparisons were used to analyze the genomic relationship with E. coli and K. pneumoniae strains, respectively.

Results: In this study, the 28 CO-CRE isolates included K. pneumoniae (53.6%), E. coli (28.6%), E. cloacae (7.1%), C. freundii (7.1%) and E. asburiae (3.6%). The CO-CRE isolates were mainly isolated from urine samples (75%). The ceftazidime/avibactam resistance rate of community-onset E. coli was significantly higher than that of community-onset K. pneumoniae, while the aztreonam, ciprofloxacin, levofloxacin, and chloramphenicol resistance rates were significantly lower (P<0.05). Thirteen of the 15 K. pneumoniae strains belonged to ST11 containing bla_KPC-2. Correspondingly, 8 E. coli strains belonged to 7 STs, and they all were NDM producers. K. pneumoniae belonged to two major clusters, while E. coli was sporadic. The number of SNPs separating ST11 K. pneumoniae isolates ranged from 7 to 2154.

Conclusion: Community-onset CRE is not rare, and the dissemination of E. coli was sporadic while K. pneumoniae was clonal spread with similar STs as HA-CRE. Active surveillance of CRE in the community setting is in demand.

Keywords: E. coli; K. pneumoniae; MLST; cgMLST; community-acquired CRE; healthcare-associated CRE.

Grants and funding

This work was supported by research grants from the National Natural Science Foundation of China (No. NSFC81871689) and Zhejiang Province Medical and Health Science and Technology Project(2018KY382).