Emerging Carriage of NDM-5 and MCR-1 in Escherichia coli From Healthy People in Multiple Regions in China: A Cross Sectional Observational Study

Zhangqi Shen; Yanyan Hu; Qiaoling Sun; Fupin Hu; Hongwei Zhou; Lingbin Shu; Tengfei Ma; Yingbo Shen; Yang Wang; Juan Li; Timothy R Walsh; Rong Zhang; Shaolin Wang

doi:10.1016/j.eclinm.2018.11.003

Emerging Carriage of NDM-5 and MCR-1 in Escherichia coli From Healthy People in Multiple Regions in China: A Cross Sectional Observational Study

EClinicalMedicine. 2018 Dec 4:6:11-20. doi: 10.1016/j.eclinm.2018.11.003. eCollection 2018 Dec.

Authors

Zhangqi Shen¹, Yanyan Hu², Qiaoling Sun², Fupin Hu³, Hongwei Zhou², Lingbin Shu², Tengfei Ma¹, Yingbo Shen¹, Yang Wang¹, Juan Li⁴, Timothy R Walsh⁵, Rong Zhang², Shaolin Wang¹

Affiliations

¹ Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China.
² Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
³ Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
⁴ State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
⁵ Department of Medical Microbiology and Infectious Disease, Institute of Infection & Immunity, UHW Main Building, Heath Park Hospital, Cardiff, UK.

Abstract

Background: Carriage of carbapenem-resistant Enterobacteriaceae (CRE) in humans may contribute to the dissemination of CRE and impact on communities and healthcare facilities. Carbapenem-resistant Escherichia coli (CREC) is one of the major type of CRE in the human gut. Here, we describe a cross-sectional study to investigate the prevalence of CREC, and in particular the mcr-1 carrying CREC, in health volunteers in China.

Methods: During September to December 2016, 3859 non-duplicated stool specimens were collected from healthy volunteers who received regular physical examinees in healthcare centers located in 19 provinces across China. Enrichment culture supplemented meropenem was used to isolate CREC. Carbapenemase producing determinants and the mcr-1 gene were determined by PCR amplification and sequencing. Isolates were further analyzed by antibiotic susceptibility test, genotyping, and whole genome analysis.

Findings: A total of 92 non-duplicated CREC were isolated from 3859 stool specimens, among which 43 CREC are carbapenemase positive. In addition, the co-existence of bla _NDM and mcr-1 was found in 14 CREC, which also showed resistance to the majority of all antimicrobial agents analyzed. The genetic background of these CREC isolates are highly diversified based on molecular typing. Furthermore, whole genome sequence indicated that NDM-5 is the predominant determinant conferring carbapenem resistance in CREC, and that NDM-5 carrying plasmids (IncX3) are very similar.

Interpretation: The incidence of CREC carriage in healthy people in China was small; however, the co-existence of CREC with mcr-1 is disconcerting. Therefore, pre-screening prior to admission and monitoring of patients on high-dependency wards is highly recommended to control and prevent the dissemination of CRE in hospitals.

Outstanding question: The high prevalence of CREC in the healthy people should not be underestimated, as it may increase the risk of infection. This knowledge could have impact on the pre-screening and monitoring of CRE before patient administration.

Keywords: CREC; Carriage; Gut; Healthy people; MCR-1; NDM.

Abstract

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