Association of Carbapenemase-Producing Enterobacterales Detected in Stream and Clinical Samples

Gyung-Hye Sung; Si Hyun Kim; Eun Hee Park; Suk Nam Hwang; Jea-Dong Kim; Gyu Ri Kim; Eun-Young Kim; Joseph Jeong; Sunjoo Kim; Jeong Hwan Shin

doi:10.3389/fmicb.2022.923979

Association of Carbapenemase-Producing Enterobacterales Detected in Stream and Clinical Samples

Front Microbiol. 2022 Jun 9:13:923979. doi: 10.3389/fmicb.2022.923979. eCollection 2022.

Authors

Gyung-Hye Sung¹, Si Hyun Kim², Eun Hee Park¹, Suk Nam Hwang³, Jea-Dong Kim⁴, Gyu Ri Kim⁵, Eun-Young Kim⁵, Joseph Jeong⁶, Sunjoo Kim⁷, Jeong Hwan Shin⁵

Affiliations

¹ Busan Institute of Health and Environment, Busan, South Korea.
² Department of Clinical Laboratory Science, Semyung University, Jecheon, South Korea.
³ Ulsan Health and Environment Research Institute, Ulsan, South Korea.
⁴ Gyeongsangnam-do Provincial Government Health and Environment Institute, Jinju, South Korea.
⁵ Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea.
⁶ Department of Laboratory Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea.
⁷ Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Jinju, South Korea.

Abstract

Background: The spread of carbapenem-resistant Enterobacterales (CRE) strains has caused treatment failure and is a worldwide threat to public health. However, there are limited reports on the prevalence of carbapenemase-producing Enterobacterales (CPE) in aquatic environments and its association with clinical isolates. This study aimed to investigate the prevalence of CPE in a stream environment and its genetic relationship with clinical isolates in Korea.

Methods: A total of 4,582 water samples were collected from 94 streams. Multiplex PCR and sequencing were used to detect and identify six carbapenemase genes. Multi-locus sequence typing (MLST) was performed to investigate the genetic relatedness between the environmental strains and clinical isolates.

Results: A total of 133 CRE strains were isolated from the streams. Klebsiella pneumoniae was the most common CRE (45.9%), followed by Enterobacter cloacae complex (29.3%), Escherichia coli (13.5%), Raoultella ornithinolytica (5.3%), and Citrobacter freundii (2.3%). Ninety (67.7%) isolates carried carbapenemase genes. K. pneumoniae carbapenemase-2 (36.7%) and New Delhi metallo-β-lactamase-5 (32.2%) were the common carbapenemases detected. Sequence type (ST)307 and ST11 K. pneumoniae strains harboring the bla _KPC-2 gene were the most prevalent in stream and patient samples.

Conclusion: CPE was highly prevalent in streams and closely related to the isolates obtained from patients. Therefore, continuous monitoring of stream environments is required to control the spread of carbapenem resistance.

Keywords: antimicrobial resistance; carbapenem; carbapenemase-producing Enterobacterales; multi-locus sequence typing; stream.