Emergence and transmission of New Delhi metallo‐beta‐lactamase‐5‐producing Escherichia coli Sequence Type 361 in a Tertiary Hospital in South Korea

Abstract

Background The emergence of carbapenem‐resistant Escherichia coli (E coli) is a serious global health threat, but little is known about carbapenemase‐producing E coli in Daejeon, South Korea. The aim of this study was to investigate characteristics of thirteen carbapenem‐resistant E coli isolates in a tertiary hospital. Methods Thirteen non‐duplicate carbapenem‐resistant E coli strains were collected from October 2017 to January 2018. Antimicrobial susceptibility was determined with the E test or disk diffusion method. The carbapenem minimum inhibitory concentrations (MICs) were determined by the agar dilution method. The colistin and tigecycline MICs were determined by broth microdilution. The resistance genes, including carbapenemase genes, were evaluated by polymerase chain reaction, and DNA sequencing was performed to characterize the genes. Pulsed‐field gel electrophoresis and multilocus sequence typing (MLST) were performed to evaluate the clonal relatedness of isolates. The clinical data of patients were retrospectively reviewed. Results All the E coli isolates harbored blaNDM‐5 gene and were resistant to most of the antimicrobial agents, such as carbapenem, cephalosporins, ciprofloxacin, and chloramphenicol, excluding amikacin and colistin. Other resistant genes, such as blaTEM‐1, blaCTX‐M‐15, blaCMY‐2, aac(6')‐Ib‐cr, and qepA, were detected. The E coli isolates harboring blaNDM‐5 belonged to ST361 (n = 11), ST12 (n = 1), ST410 (n = 1), and PFGE types A (n = 11), B (n = 1), and C (n = 1). Conclusions This study reports on an outbreak of a predominant epidemic clone, the NDM‐5 producing, multidrug‐resistant E coli ST361 isolate. These findings suggest that we should pay attention to infection control measures to limit the spread of NDM‐5‐producing pathogens.

Ceftazidime-Avibactam Combination Therapy Compared to Ceftazidime-Avibactam Monotherapy for the Treatment of Severe Infections Due to Carbapenem-Resistant Pathogens: A Systematic Review and Network Meta-Analysis

“…Transmissible carbapenem-resistance in Enterobacteriaceae, among which the KPCs are the most notorious, has been reported since twenty years, but only recently it has been expressed as a public health problem with outbreaks reported worldwide [31][32][33][34]; CRE, due to the difficulty of effective treatment and the very high attributable mortality, are also known as "nightmare bacteria" [2]. Infections caused by these bacteria are associated with a mortality rate exceeding 50%.…”

Molecular epidemiology and mechanisms of tigecycline resistance in carbapenem‐resistant Klebsiella pneumoniae isolates

“…The following resistance genes were detected by PCR: (a) carbapenemase genes ( bla NDM , bla IMP , bla VIM , bla KPC , bla OXA‐48‐like , and bla GES ), (b) extended‐spectrum‐β‐lactamase (ESBL) genes ( bla CTX−M−1−like , bla CTX−M−9−like , bla TEM , and bla SHV ), (c) ampC β‐lactamase genes ( bla CIT , bla MOX , bla DHA , bla ACC , bla EBC , and bla FOX ), (d) quinolone resistance‐determinant genes ( qnrA , qnrB , qnrS , aac(6’)‐Ib‐cr , and qepA) , and (e) aminoglycoside resistance‐determinant resistance genes ( armA , rmtA , rmtB , and rmtC ) 32 . The amplicons were determined by DNA sequencing.…”

“…like , bla TEM , and bla SHV ), (c) ampC β-lactamase genes (bla CIT , bla MOX , bla DHA , bla ACC , bla EBC , and bla FOX ), (d) quinolone resistance-determinant genes (qnrA, qnrB, qnrS, aac(6')-Ib-cr, and qepA), and (e) aminoglycoside resistance-determinant resistance genes (armA, rmtA, rmtB, and rmtC). 32 The amplicons were determined by DNA sequencing. Primers used for PCR are shown in the Table S1.…”

Emergence of High Level Carbapenem and Extensively Drug Resistant Escherichia coli ST746 Producing NDM-5 in Influent of Wastewater Treatment Plant, Seoul, South Korea

“…Since the discovery of NDM in a Swedish patient who traveled to India, its variants have grown to 28 different types from diverse bacteria, mostly isolated from clinical samples. In South Korea, NDM-5 producing Enterobacteriaceae have been reported only in clinical environments (Park et al, 2016(Park et al, , 2019Kim et al, 2020), and NDM-9 producing K. variicola were found in river (Di et al, 2017). Escherichia coli strain N7 belonging to ST746 isolated from the urban influent of JN WWTP shows a variant of the NDM, NDM-5 type.…”