With the abuse of antimicrobial agents in developing countries, increasing number of carbapenem-resistant Enterobacteriaceae (CRE) attracted considerable public concern. A retrospective study was conducted based on 242 CRE strains from a tertiary hospital in Hangzhou, China to investigate prevalence and drug resistance characteristics of CRE in southeast China. Bacterial species were identified. Antimicrobial susceptibility was examined by broth microdilution method or epsilometer test. Resistant β-lactamase genes were identified by polymerase chain reaction and sequencing. Genotypes were investigated by phylogenetic analysis. Klebsiella pneumoniae and Escherichia coli were the most prevalent types of species, with occurrence in 71.9% and 21.9% of the strains, respectively. All strains exhibited high resistance (> 70%) against β-lactam antibiotics, ciprofloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin but exhibited low resistance against tigecycline (0.8%) and minocycline (8.3%). A total of 123 strains harbored more than two kinds of β-lactamase genes. bla, bla, bla, and bla were the predominant genotypes, with detection rates of 60.3%, 61.6%, 43.4%, and 16.5%, respectively, and were highly identical with reference sequences in different countries, indicating potential horizontal dissemination. IMP-4 was the most frequent class B metallo-lactamases in this study. In conclusion, continuous surveillance and effective prevention should be emphasized to reduce spread of CRE.
AbstractBackgroundThis research is aimed to study the resistance and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP).Methodology38 isolated CRKP strains were collected from clinical specimens.ResultsThe resistance rates were more than 70.0%. Ampicillin had the highest rates among them (100.0%). 34 strains (89.5%) among the 38 CRKP strains carried blaKPC-2 gene, and 3 strains (7.9%) carried blaIMP-4 gene. 36 strains (94.7%) among the 38 CRKP strains carried blaSHV gene, 29 strains (76.3%) carried blaTEM gene, and 26 strains (68.4%) carried blaCT-M gene. 7 strains (18.4%) among the 38 CRKP strains carried blaDHA-1 gene. 15 strains (39.5%) in 38 CRKP strains lost two fenestra proteins, ompK35 and ompK36, and the rest 23 strains carried ompK36 genes. 38 CRKP strains were divided into five kinds of ST types, with ST11 type as the most (86.8%, 33/38). The rest of the ST types included 2 strains of ST23 (5.3%, 2/38), one strain of ST15, ST1373 and ST1415 (2.6%, 1/38).ConclusionsCRKP resistance is severe, and the mechanism of drug resistance has become increasingly complex. Various ST types and resistance genes are related to CRKP. The clinical prevention and control work is imminent.
Apart from the well-recognized risk factor previous antibiotic treatment, the risk factors age and presence of a CVC might suggest that bacterial overgrowth of the gut either due to an increased susceptibility in younger age or as a consequence of parenteral nutrition is a relevant mechanism for acquiring carriage of CRE in a non-outbreak situation.
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