Epidemiological Characterization of Colistin and Carbapenem Resistant Enterobacteriaceae in a Tertiary: A Hospital from Anhui Province

Muhammad Fazal Hameed; Yanan Chen; Ying Wang; Muhammad Shafiq; Hazrat Bilal; Linqing Liu; Jinming Ma; Pengying Gu; Honghua Ge

doi:10.2147/IDR.S303739

Epidemiological Characterization of Colistin and Carbapenem Resistant Enterobacteriaceae in a Tertiary: A Hospital from Anhui Province

Infect Drug Resist. 2021 Apr 6:14:1325-1333. doi: 10.2147/IDR.S303739. eCollection 2021.

Authors

Muhammad Fazal Hameed¹, Yanan Chen¹, Ying Wang², Muhammad Shafiq³, Hazrat Bilal¹, Linqing Liu⁴, Jinming Ma¹, Pengying Gu⁴, Honghua Ge¹

Affiliations

¹ Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People's Republic of China.
² Department of Laboratory Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People's Republic of China.
³ College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, People's Republic of China.
⁴ The Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People's Republic of China.

Abstract

Purpose: Antimicrobial resistance, especially carbapenem resistance Enterobacteriaceae and plasmid mediated mobile colistin resistance, is a serious issue worldwide. This study was designed to determine the epidemiological characteristics of plasmid mediated colistin resistance and carbapenem resistant Enterobacteriaceae from tertiary A hospital located in Hefei, China.

Methods: Totally, 158 carbapenems resistant Enterobacteriaceae (CRE) were screened for antibiotic susceptibility, mcr-1, extended spectrum β-lactamases (ESBLs), metallo-β-lactamases (MBLs), and fosfomycin resistance genes using PCR and sequencing. The sequence types were identified by multilocus sequence typing (MLST). Plasmid profiles were determined by PCR based replicon typing (PBRT), and the plasmid sizes were confirmed by southern blotting.

Results: The isolates showed high MIC₅₀ and MIC₉₀ for all antimicrobials, except tigecycline, meropenem, and colistin. The main Carbapenemase genes were bla _KPC-2 (90.5%), bla _NDM-1(3.7%), bla _OXA-48(5.6%) and fosA3 (14.5%). The bla _CTXM-15 found 36.7%, mcr-1 (3.7%) recorded in six isolates. PBRT revealed bla _KPC-2 in K. pneumoniae on IncR, IncFII, and IncA/C. bla _NDM-1 in E. coli on IncFII, whereas in E. cloacae noticed on IncHI2 plasmid. mcr-1 was recorded among IncFIIK, IncFII, and IncF in E. coli, K. pneumoniae, and E. cloacae. Resistance genes (mcr-1, bla _NDM-1, bla _KPC-2) harboring plasmids are successfully trans-conjugant to EC-600. A high incidence of ST11 was observed in K. pneumoniae carbapenem resistant isolates. While in E. coli, multiple STs were identified. However, mcr-1 in ST23 was identified for the first time in Anhui Province. Among Enterobacter cloacae, ST270 detected carrying bla _NDM-1. Southern-hybridization confirmed the plasmid sizes 35-150kb.

Conclusion: This study indicates the co-carrying of mcr-1, bla _KPC-2, and bla _NDM-1 among clinical isolates, the prevalence of different Enterobacteriaceae STs is alarming, especially in E. coli. Holding such a resistance profile is a threat for humans and animals, which may be transferred between the strains through plasmid transfusion. Persistent control actions are immediately necessary to combat this hazard.

Keywords: CTXM-15; ESBL; KPC2; MBL; NDM-1; mcr-1.

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (31970103, 32071215). The funder has no role in the experimental process and paper publication.