Outbreak of Carbapenem-Resistant Enterobacteriaceae Containing blaNDM-1, Ontario, Canada

Borgia, Sergio; Lastovetska, Olga; Richardson, David J.; Eshaghi, Alireza; Xiong, Jianhui; Chung, Catherine; Baqi, Mahin; McGeer, Allison; Ricci, Gloria; Sawicki, Rachael; Pantelidis, Rajni; Low, Donald E.; Patel, Samir N.; Melano, Roberto G.

doi:10.1093/cid/cis737

Cited by 94 publications

(58 citation statements)

References 35 publications

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“…Additional studies are ongoing to characterize this plasmid. In vivo interspecies dissemination of IncA/C plasmids carrying bla NDM-1 was described in previous studies (23,36). However, all of the NDM-1 plasmids identified in the 16 bla NDM-1 -positive CRE isolates were different either in size or replicon type, suggesting that insertion elements or transposons may play important roles in the mobilization of bla NDM-1 .…”

Section: Resultsmentioning

confidence: 63%

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High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

Qin

Zhang

et al. 2014

Antimicrob Agents Chemother

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The emergence and spread of New Delhi metallo-␤-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla NDM-1 , and the gene was found to be carried on plasmids of various sizes (ϳ55 to ϳ360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla NDM-1 -positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla NDM-1 -positive CRE isolate, the bla NDM-1 gene was downstream of an intact ISAba125 element and upstream of the ble MBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla NDM-1 -containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.

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Section: Resultsmentioning

confidence: 63%

“…Conjugative assays were performed according to the method described previously (23). The bla NDM-1 -positive CRE served as the donors, while E. coli J53 (sodium azide resistant) was used as the recipient strain.…”

Section: Methodsmentioning

confidence: 99%

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

Qin

Zhang

et al. 2014

Antimicrob Agents Chemother

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“…Southern blot analysis was performed to locate the bla NDM genes by using specific bla NDM digoxigenin-labeled probes (Roche) (8). K. pneumoniae ATCC BAA-2146 was used as a positive control, and E. coli J53 was used as a negative control.…”

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confidence: 99%

A Novel New Delhi Metallo-β-Lactamase Variant, NDM-14, Isolated in a Chinese Hospital Possesses Increased Enzymatic Activity against Carbapenems

Zou

Huang

Zhao

et al. 2015

Antimicrob Agents Chemother

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A novel New Delhi metallo-␤-lactamase (NDM) variant, NDM-14, was identified in clinical isolate Acinetobacter lwoffii JN49-1, which was recovered from an intensive care unit patient at a local hospital in China. NDM-14, which differs from other existing enzymes by an amino acid substitution at position 130 (Asp130Gly), possesses enzymatic activity toward carbapenems that is greater than that of NDM-1. Kinetic data indicate that NDM-14 has a higher affinity for imipenem and meropenem.

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“…arbapenemase-producing organism (CPO) infections are now globally epidemic, causing rising concern as they demonstrate easy transmissibility between patients and the environment, with increasing numbers of reported outbreaks (1)(2)(3)(4). The morbidity and mortality associated with CPO infections are high, and effective therapeutic options are limited.…”

mentioning

confidence: 99%

Clinical Performance of Check-Direct CPE, a Multiplex PCR for Direct Detection of bla _KPC , bla _NDM and/or bla _VIM , and bla _OXA-48 from Perirectal Swabs

et al. 2015

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We evaluated the clinical performance of Check-Direct CPE for carbapenemase detection directly from 301 perirectal swabs (258 patients) in a nonoutbreak setting. Culture of a PCR-confirmed, carbapenemase-containing organism, or history of colonization with such organism within the previous 2 weeks, was used as the reference standard. Check-Direct CPE demonstrated a sensitivity value, specificity value, positive predictive value (PPV), and negative predictive value (NPV) of 100% (all bla KPC ), 88%, 21%, and 100%, respectively. False positives accounted for 79% (n ‫؍‬ 34) of samples for which a cycle threshold (C T ) value was reached. Simulated studies to evaluate specimen pooling as an approach to minimize costs showed no difference in C T values for pooled groups of three or five that each contained a single specimen spiked with ϳ1,500 CFU bla KPC Klebsiella pneumoniae; however, the detection rate dropped to 60% at a seeded concentration of ϳ150 CFU. When data were pooled, C T values for bla KPC were higher for heavy-feces-containing than for light-feces-containing liquid-suspended specimens. Furthermore, C T values for liquid-suspended specimens were 4 to 5 C T values lower (i.e., represented greater sensitivity) than those seen in direct swab analysis. Culture was equivalent to or better than Check-Direct CPE for 13/15 (87%) isolates tested in a limit-of-detection analysis. Detection of a carbapenemase gene at a C T cutoff value of <35 was culture confirmed in 23/24 (96%) of cases; however, C T values of >35 overlapped broadly between culture-positive (n ‫؍‬ 21) and culture-negative (n ‫؍‬ 36) specimens. Check-Direct CPE will likely prove most useful in high-prevalence areas or in outbreak settings where rapid carbapenemase detection is critical for infection control management. C arbapenemase-producing organism (CPO) infections are now globally epidemic, causing rising concern as they demonstrate easy transmissibility between patients and the environment, with increasing numbers of reported outbreaks (1-4). The morbidity and mortality associated with CPO infections are high, and effective therapeutic options are limited. Recent data show that bla KPC , bla NDM , and bla OXA-48 are the most common carbapenemases worldwide (5). Carbapenemase detection, however, can be complicated, and detection methods are not standardized among laboratories. Because gastrointestinal colonization with a CPO is a reservoir for transmission (6), routine CPO surveillance via collection of rectal/perirectal swabs or stool samples is increasingly being utilized in many infection control programs (7) and is recommended by public health agencies such as the Centers for Disease Control and Prevention (CDC) (8).Current methods for CPO surveillance generally rely on culture using selective media. The Clinical and Laboratory Standards Institute (CLSI) recommends performing carbapenemase testing on Enterobacteriaceae isolates (i) with imipenem or meropenem MICs of 2 to 4 g/ml or an ertapenem MIC of 2 g/ml (if using the 2010 M100-S20 brea...

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Outbreak of Carbapenem-Resistant Enterobacteriaceae Containing blaNDM-1, Ontario, Canada

Cited by 94 publications

References 35 publications

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

A Novel New Delhi Metallo-β-Lactamase Variant, NDM-14, Isolated in a Chinese Hospital Possesses Increased Enzymatic Activity against Carbapenems

Clinical Performance of Check-Direct CPE, a Multiplex PCR for Direct Detection of bla _KPC , bla _NDM and/or bla _VIM , and bla _OXA-48 from Perirectal Swabs

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Outbreak of Carbapenem-Resistant Enterobacteriaceae Containing blaNDM-1, Ontario, Canada

Cited by 94 publications

References 35 publications

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

A Novel New Delhi Metallo-β-Lactamase Variant, NDM-14, Isolated in a Chinese Hospital Possesses Increased Enzymatic Activity against Carbapenems

Clinical Performance of Check-Direct CPE, a Multiplex PCR for Direct Detection of bla KPC , bla NDM and/or bla VIM , and bla OXA-48 from Perirectal Swabs

Contact Info

Product

Resources

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Clinical Performance of Check-Direct CPE, a Multiplex PCR for Direct Detection of bla _KPC , bla _NDM and/or bla _VIM , and bla _OXA-48 from Perirectal Swabs