Phenotypic and Genotypic Characterization of Carbapenem-Resistant Enterobacteriaceae Recovered from a Single Hospital in China, 2013 to 2017

Yan Zhang; Wenjie Li; Xiaomin Tian; Ruanyang Sun; Shidan Zhou; Ling Jia; Jian Sun; Xiao-Ping Liao; Ya-Hong Liu; Yang Yu

doi:10.2147/IDR.S393155

Phenotypic and Genotypic Characterization of Carbapenem-Resistant Enterobacteriaceae Recovered from a Single Hospital in China, 2013 to 2017

Infect Drug Resist. 2022 Dec 23:15:7679-7690. doi: 10.2147/IDR.S393155. eCollection 2022.

Authors

Yan Zhang¹, Wenjie Li¹, Xiaomin Tian¹, Ruanyang Sun¹, Shidan Zhou², Ling Jia¹, Jian Sun^{1

3

4}, Xiao-Ping Liao^{1

3

4}, Ya-Hong Liu^{1

3

4}, Yang Yu^{1

3

4}

Affiliations

¹ Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, People's Republic of China.
² Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou, People's Republic of China.
³ Guangdong Provincial Key Laboratory of Microbial Safety and Health, Guangdong Institute of Microbiology, Guangdong Academy of Science, Guangzhou, People's Republic of China.
⁴ Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, People's Republic of China.

Abstract

Objective: Carbapenem-resistant Enterobacteriaceae (CRE) have become an increasingly common cause of healthcare-related infections and present a serious challenge to clinical treatment. This study examined the phenotypic, genotypic characterization, clinical, and microbiological data of CRE in the Huizhou Municipal Central Hospital.

Methods: We conducted a phenotypic susceptibility evaluation and whole genome sequence analysis for 52 CRE strains isolated from 37 patients and 2 medical device-related samples during 2013-2017 to characterize risk factors, antimicrobial resistance profiles, dominant clones and hospital transmission.

Results: Long-term hospitalization, treatment time with antibiotics and use of invasive devices were linked to the risk of CRE infection. The carbapenem resistance genes (CRGs) we found included bla_NDM (82.7%), bla_IMP (19.2%) and bla_KPC (3.8%), Escherichia coli (44.2%) and Klebsiella pneumoniae (44.2%) were the dominant species we identified, and the type of CRG carried by isolates was highly correlated with species. The coexistence of CRGs with a variety of other antibiotic resistance genes leads to an increased prevalence of high resistance levels for CRE to β-lactams and other antibiotic classes such as aminoglycosides and fluoroquinolones. These isolates were sensitive only to colistin and tigecycline. In addition to this, we observed significantly genomic diversity of CRE isolates in this hospital. Importantly, we found that long-term transmission of multiple CRE clones had occurred at this hospital between various wards.

Conclusion: Evaluating and improving the current infection control strategies may be necessary, and reducing nosocomial transmission remains the primary control element for CRE infections in China.

Keywords: bacteremia; carbapenem resistance genes; carbapenem-resistant Enterobacteriaceae; nosocomial transmission.

Grants and funding

National Key Research & Development Program of China, 2022YFE0103200; The National Natural Science Foundation of China (31730097). Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program (2019BT02N054) Program for Changjiang Scholars and Innovative Research Team in University of Ministry of Education of China (IRT_17R39) Innovation Team Project of Guangdong University (2019KCXTD001) 6. the 111 Project (D20008).