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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2018

Open Access 01-12-2018 | Research article

Molecular characterization and epidemiology of carbapenem non-susceptible Enterobacteriaceae isolated from the Eastern region of Heilongjiang Province, China

Authors: Xue Gong, Jisheng Zhang, Shanshan Su, Yanjun Fu, Mingjia Bao, Yong Wang, Xiaoli Zhang

Published in: BMC Infectious Diseases | Issue 1/2018

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Abstract

Background

The aim of this study was to elucidate the molecular epidemiology of carbapenem non-susceptible Enterobacteriaceae(CNSE) isolated in the Eastern region of Heilongjiang Province, China, and the mechanism of carbapenem resistance.

Methods

A total of 53 CNSE isolates were collected in a grade-3 hospital in Heilongjiang province. Sensitivity to antibiotics was determined using the VITEK-2 Compact automatic system. The modified Hodge test (MHT) and modified carbapenem inactivation test (mCIM) were performed for phenotypic identification. Beta-lactamases gene were detected by Polymerase chain reaction(PCR) and DNA sequencing. The transfer of blaNDM and blaKPC was investigated through conjugation experiment. The clinical data of patients were retrospectively reviewed. Homology of Carbapenem-resistant Klebsiella pneumoniae(CRKP) was conducted by multilocus sequence typing (MLST).

Results

CNSE were highly resistant to the majority of antimicrobial agents. The resistance rate was 100% for first, third, fourth generation cephalosporins and enzyme inhibitor compounds. Gentamicin and tobramycin recorded a resistance rate higher than 80%. Less than 30% resistance was detected for amikacin and levofloxacin. Among CNSE 52(98.1%) and 48(90.6%) of CNSE were positive for mCIM and MHT respectively. There were 42 positive blaKPC genes, three blaNDM-1 genes, three blaNDM-5 genes, one blaNDM-7 gene, and six blaIMP-4 genes. Most isolates harbored multiple drug resistance gene, especially as related to extended-spectrum-β-lactamases, blaSHV, blaTEM and blaCTX-M-15 genes.The resistant gene was transferred into recipient Escherichia coli J53 through conjugation in 21.3% (10/47) of the strains. MLST revealed that ST76 (n = 36) was the most predominant clone, followed by ST896, ST323 and ST11. A new one ST 2946 was identity by this study.

Conclusion

The carbapenem resistance phenomenon is alarming and blaKPC-2 is the main resistant gene of CNSE in our hospital. This is the first report of an outbreak caused by blaKPC-2 positive K. pneumoniae ST76 in the Eastern region of Heilongjiang Province, China. Relevant departments should implement infection control and prevention measures to avoid further dissemination of the multi drug-resistant bacteria (MDR).
Literature
1.
Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis. 2014;20(7):1170–5.CrossRefPubMedPubMedCentral
2.
Papadimitriou-Olivgeris M, Marangos M, Fligou F, Christofidou M, Bartzavali C, Anastassiou ED, Filos KS. Risk factors for KPC-producing Klebsiella pneumoniae enteric colonization upon ICU admission. J Antimicrob Chemother. 2012;67(12):2976–81.CrossRefPubMed
3.
Xu Y, Gu B, Huang M, Liu H, Xu T, Xia W, Wang T. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000-2012 in Asia. Thoracic disease. 2015;7(3):376–85.
4.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 27th ed CLSI supplement M100. Clinical and laboratory standards institute. Wayne: Clinical and Laboratory Standards Institute; 2017.
5.
Zhang JX. Study on bacterial resistance and transmission mechanism of carbapenem non-susceptible Enterobacteriaceae[D]. Beijing: Peking Union Medical College Hospital; 2012.
6.
Yang QW. Epidemiology and drug resistance mechanism of carbapenem resistant Enterobacteriaceae in China [D]. Beijing: Peking Union Medical College Hospital; 2015.
7.
Pu SL. Resistance Mechanism and Molecular Epidemiology of Carbapenem - resistant Klebsiell pneumoniae.[D]. Chongqing: Chongqing Medical University; 2015.
8.
Wang X, Chen G, Wu X, et al. Increased prevalence of carbapenem resistant Enterobacteriaceae in hospital setting due to cross-species transmission of the blaNDM-1 element and clonal spread of progenitor resistant strains. Front Microbiol. 2015;6:595.
9.
Torres-Gonzalez P, Cervera-Hernandez M, Niembro-Ortega M, Leal-Vega F, Cruz-Hervert L, García-García L, Galindo-Fraga A, Martinez-Gamboa A, Bobadilla-Del Valle M, Sifuentes-Osornio J, Ponce-de-Leon A. Factors associated to prevalence and incidence of Carbapenem-resistant Enterobacteriaceae fecal carriage: a cohort study in a Mexican tertiary care hospital. PLoS One. 2015;10(10):e0139883.CrossRefPubMedPubMedCentral
10.
11.
Kazmierczak KM, Biedenbach DJ, Hackel M, Rabine S, de Jonge BL, Bouchillon SK, Sahm DF, Bradford PA. Global dissemination of blaKPC into bacterial species beyond Klebsiella pneumoniae and in vitro susceptibility to ceftazidime-avibactam and Aztreonam-avibactam. Antimicrob Agents Chemother. 2016;60(8):4490–500.CrossRefPubMedPubMedCentral
12.
Wei ZQ, Du XX, Yu YS, Shen P, Chen YG, Li LJ. Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China. Antimicrob Agents Chemother. 2006;51(2):763–5.CrossRefPubMedPubMedCentral
13.
Feng J, Yin Z, Zhao Q, Zhao Y, Zhang D, Jiang X, Wu W, Chen W, Wang H, Song Y, Tong Y, Wang J, Li Y, Zhou D. Genomic characterization of novel IncFII-type multidrug resistant plasmids p0716-KPC and p12181-KPC from Klebsiella pneumoniae. Sci Rep. 2017;7(1):5830.CrossRefPubMedPubMedCentral
14.
Cai JC, Zhang R, Hu YY, Zhou HW, Chen GX. Emergence of Escherichia coli sequence type 131 isolates producing KPC-2 carbapenemase in China. Antimicrob Agents Chemother. 2014;58(2):1146–52.CrossRefPubMedPubMedCentral
15.
Tseng IL, Liu YM, Wang SJ, Yeh HY, Hsieh CL, Lu HL, Tseng YC, Mu JJ. Emergence of Carbapenemase producing Klebsiella pneumonia and spread of KPC-2 and KPC-17 in Taiwan: a Nationwide study from 2011 to 2013. PLoS One. 2015;10(9):e0138471.CrossRefPubMedPubMedCentral
16.
Wu W, Feng Y, Carattoli A, Zong Z. Characterization of an Enterobacter cloacae strain producing both KPC and NDM Carbapenemases by whole-genome sequencing. Antimicrob Agents Chemother. 2015;59(10):6625–8.CrossRefPubMedPubMedCentral
17.
Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Ann Clin Microbiol Antimicrob. 2016;15:20.CrossRefPubMedPubMedCentral
18.
Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, Walsh TR. Characterization of a new metallo-beta-lactamase gene, Bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009;53(12):5046–54.CrossRefPubMedPubMedCentral
19.
Poirel L, Yilmaz M, Istanbullu A, Arslan F, Mert A, Bernabeu S, Nordmann P. Spread of NDM-1-producing Enterobacteriaceae in a neonatal intensive care unit in Istanbul, Turkey. Antimicrob Agents Chemother. 2014;58(5):2929–33.CrossRefPubMedPubMedCentral
20.
Yousfi M, Mairi A, Bakour S, Touati A, Hassissen L, Hadjadj L, Rolain J. First report of NDM-5-producing Escherichia coli ST1284 isolated from dog in Bejaia, Algeria. New Microbes New Infect. 2015;8:17–8.CrossRefPubMedPubMedCentral
21.
Van der Mee-Marquet N, Diene SM, Chopin F, Goudeau A, Francois P. Enigmatic occurrence of NDM-7 enzyme in the community. Int J Antimicrob Agents. 2016;47(6):505–7.CrossRefPubMed
22.
Bitar I, Piazza A, Gaiarsa S, Villa L, Pedroni P, Oliva E, Nucleo E, Pagani L, Carattoli A, Migliavacca R. ST405 NDM-5 producing Escherichia coli in northern Italy: the first two clinical cases. Clin Microbiol Infect. 2017;23(7):489–90.CrossRefPubMed
23.
Spyropoulou A, Bartzavali C, Vamvakopoulou S, Marangos M, Anastassiou E, Spiliopoulou I, Christofidou M. The first NDM metallo-β-lactamase producing Klebsiella pneumoniae isolate in a University Hospital of Southwestern Greece. J Chemother. 2016;28(4):350–1.CrossRefPubMed
24.
Howard JC, Creighton J, Heffernan H, Werno A. Evidence of transmission of an NDM-5-producing Klebsiella pneumoniae in a healthcare facility in New Zealand. Antimicrob Chemother. 2017;72(3):949–51.
25.
Torres-Gonzalez P, Bobadilla-Del Valle M, Tovar-Calderon E, Leal-Vega F, Hernandez-Cruz A, Martinez-Gamboa A, Niembro-Ortega MD, Sifuentes-Osornio J, Ponce-de-Leon A. Outbreak caused by Enterobacteriaceae harboring NDM-1 metallo-beta-lactamase carried in an IncFII plasmid in a tertiary care hospital in Mexico City. Antimicrob Agents Chemother. 2015;59(11):7080–3.CrossRefPubMedPubMedCentral
26.
Ho PL, Li Z, Lo WU, Cheung YY, Lin CH, Sham PC, Cheng VC, Ng TK, Que TL, Chow KH. Identification and characterization of a novel incompatibility group X3 plasmid carrying Bla NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China. Emerg Microbes Infect. 2012;1(11):e39.CrossRefPubMedPubMedCentral
27.
Chen Y, Zhou Z, Jiang Y, Yu Y. Emergence of NDM-1-producing Acinetobacter baumannii in China. J Antimicrob Chemother. 2011;66(6):1255–9.CrossRefPubMed
28.
Liu C, Qin S, Xu H, Xu L, Zhao D, Liu X, Lang S, Feng X, Liu HM. New Delhi Metallo-beta-Lactamase 1(NDM-1), the Dominant Carbapenemase Detected in Carbapenem-Resistant Enterobacter cloacae from Henan Province, China. PloS one. 2015;10(8):e0135044.CrossRefPubMedPubMedCentral
29.
Yang Q, Fang L, Fu Y, Du X, Shen Y, Yu Y. Dissemination of NDM-1-producing Enterobacteriaceae mediated by the IncX3-type plasmid. PLoS One. 2015;10(6):e0129454.CrossRefPubMedPubMedCentral
30.
Zheng R, Zhang Q, Guo Y, Feng Y, Liu L, Zhang A, Zhao Y, Yang X, Xia X. Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan. China Ann Clin Microbiol Antimicrob. 2016;15:10.CrossRefPubMed
31.
Zhang X, Li X, Wang M, Yue H, Li P, Liu Y, Cao W, Yao D, Liu L, Zhou X, et al. Outbreak of NDM-1-producing Klebsiella pneumoniae causing neonatal infection in a teaching hospital in mainland China. Antimicrob Agents Chemother. 2015;59(7):4349–51.CrossRefPubMedPubMedCentral
32.
Netikul T, Kiratisin P. Genetic characterization of Carbapenem-resistant Enterobacteriaceae and the spread of Carbapenem-resistant Klebsiella pneumonia ST340 at a University Hospital in Thailand. PLoS One. 2015;10(9):e0139116.CrossRefPubMedPubMedCentral
33.
Shen P, Wei Z, Jiang Y, Du X, Ji S, Yu Y, Li L. Novel genetic environment of the carbapenem-hydrolyzing beta-lactamase KPC-2 among Enterobacteriaceae in China. Antimicrob Agents Chemother. 2009;53(10):4333–8.CrossRefPubMedPubMedCentral
34.
Rossolini GM, D'Andrea MM, Mugnaioli C. The spread of CTX-M-type extended-spectrum beta-lactamases. Clin Microbiol Infect. 2008;14(Suppl 1):33–41.CrossRefPubMed
35.
Zhao XJ, Deng LH, Shi DS, Kang HQ, Jiang F, Ma P. Mechanism of drug resistance of Klebsiella pneumoniae resistant carbapenem pneumonia. Chin J Infect Sci. 2015;25(17):3851–3.
36.
Datta S, Roy S, Chatterjee S, Saha A, Sen B, Pal T, Som T, Basu S. A five-year experience of carbapenem resistance in Enterobacteriaceae causing neonatal septicaemia: predominance of NDM-1. PLoS One. 2014;9(11):e112101.CrossRefPubMedPubMedCentral
37.
Del Franco M, Paone L, Novati R, Giacomazzi CG, Bagattini M, Galotto C, Montanera PG, Triassi M, Zarrilli R. Molecular epidemiology of carbapenem resistant Enterobacteriaceae in Valle d'Aosta region, Italy, shows the emergence of KPC-2 producing Klebsiella pneumoniae clonal complex 101 (ST101 and ST1789). BMC Microbiol. 2015;15(1):260.CrossRefPubMedPubMedCentral
38.
Mathers AJ, Peirano G, Pitout JD. The role of epidemic resistance plasmids and international high-risk clones in the spread of multidrug-resistant Enterobacteriaceae. Clin Microbiol Rev. 2015;28(3):565–91.CrossRefPubMedPubMedCentral
39.
Daikos GL, Petrikkos P, Psichogiou M, Kosmidis C, Vryonis E, Skoutelis A, Georgousi K, Tzouvelekis LS, Tassios PT, Bamia C, et al. Prospective observational study of the impact of VIM-1 metallo-beta-lactamase on the outcome of patients with Klebsiella pneumoniae bloodstream infections. Antimicrob Agents Chemother. 2009;53(5):1868–73.CrossRefPubMedPubMedCentral
40.
41.
Girlich D, Poirel L, Nordmann P. Value of the modified Hodge test for detection of emerging carbapenemases in Enterobacteriaceae. J Clin Microbiol. 2012;50(2):477–9.CrossRefPubMedPubMedCentral
42.
Bengoechea JA, Bowers JR, Kitchel B, Driebe EM, MacCannell DR, Roe C, Lemmer D, de Man T, Rasheed JK, Engelthaler DM, et al. Genomic analysis of the emergence and rapid global dissemination of the clonal group 258 Klebsiella pneumoniae pandemic. PLoS One. 2015;10(7):e0133727.CrossRef
43.
Pasteran FG, Otaegui L, Guerriero L, Radice G, Maggiora R, Rapoport M, Faccone D, Di Martino A, Galas M. Klebsiella pneumoniae Carbapenemase–2, Buenos Aires. Argentina Emerg Infect Dis. 2008;14(7):1178–18.CrossRefPubMed
44.
Li J, Zou MX, Wang HC, Dou QY, Hu YM, Yan Q, Liu WE. An outbreak of infections caused by a Klebsiella pneumoniae ST11 clone coproducing Klebsiella pneumoniae Carbapenemase-2 and RmtB in a Chinese teaching hospital. Chin Med J. 2016;129(17):2033–9.CrossRefPubMedPubMedCentral
45.
Yan JJ, Zheng PX, Wang MC, Tsai SH, Wang LR, Wu JJ. Allocation of Klebsiella pneumoniae bloodstream isolates into four distinct groups by ompK36 typing in a Taiwanese University hospital. J Clin Microbiol. 2015;53(10):3256–63.CrossRefPubMedPubMedCentral
46.
Davis GS, Waits K, Nordstrom L, Weaver B, Aziz M, Gauld L, Grande H, Bigler R, Horwinski J, Porter S, et al. Intermingled Klebsiella pneumoniae populations between retail meats and human urinary tract infections. Clin Infect Dis. 2015;61(6):892–9.CrossRefPubMedPubMedCentral
47.
Nakano R, Nakano A, Hikosaka K, Kawakami S, Matsunaga N, Asahara M, Ishigaki S, Furukawa T, Suzuki M, Shibayama K, et al. First report of metallo-beta-lactamase NDM-5-producing Escherichia coli in Japan. Antimicrob Agents Chemother. 2014;58(12):7611–2.CrossRefPubMedPubMedCentral
48.
Zhu J, Sun L, Ding B, Yang Y, Xu X, Liu W, Zhu D, Yang F, Zhang H, Hu F. Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates. Eur J Clin Microbiol Infect Dis. 2016;35(4):611–8.CrossRefPubMed
49.
Sahin K, Tekin A, Ozdas S, Akin D, Yapislar H, Dilek AR, Sonmez E. Evaluation of carbapenem resistance using phenotypic and genotypic techniques in Enterobacteriaceae isolates. Ann Clin Microbiol Antimicrob. 2015;14:44.CrossRefPubMedPubMedCentral
50.
Metadata
Title
Molecular characterization and epidemiology of carbapenem non-susceptible Enterobacteriaceae isolated from the Eastern region of Heilongjiang Province, China
Authors
Xue Gong
Jisheng Zhang
Shanshan Su
Yanjun Fu
Mingjia Bao
Yong Wang
Xiaoli Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2018
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-018-3294-3

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