Epidemiological Characterization of Colistin and Carbapenem Resistant Enterobacteriaceae in a Tertiary: A Hospital from Anhui Province

Abstract

Purpose

Antimicrobial resistance, especially carbapenem resistance Enterobacteriaceae and plasmid mediated mobile colistin resistance, is a serious issue worldwide. This study was designed to determine the epidemiological characteristics of plasmid mediated colistin resistance and carbapenem resistant Enterobacteriaceae from tertiary A hospital located in Hefei, China.

Methods

Totally, 158 carbapenems resistant Enterobacteriaceae (CRE) were screened for antibiotic susceptibility, mcr-1, extended spectrum β-lactamases (ESBLs), metallo-β-lactamases (MBLs), and fosfomycin resistance genes using PCR and sequencing. The sequence types were identified by multilocus sequence typing (MLST). Plasmid profiles were determined by PCR based replicon typing (PBRT), and the plasmid sizes were confirmed by southern blotting.

Results

The isolates showed high MIC₅₀ and MIC₉₀ for all antimicrobials, except tigecycline, meropenem, and colistin. The main Carbapenemase genes were bla_KPC-2 (90.5%), bla_NDM-1(3.7%), bla_OXA-48(5.6%) and fosA3 (14.5%). The bla_CTXM-15 found 36.7%, mcr-1 (3.7%) recorded in six isolates. PBRT revealed bla_KPC-2 in K. pneumoniae on IncR, IncFII, and IncA/C. bla_NDM-1 in E. coli on IncFII, whereas in E. cloacae noticed on IncHI2 plasmid. mcr-1 was recorded among IncFIIK, IncFII, and IncF in E. coli, K. pneumoniae, and E. cloacae. Resistance genes (mcr-1, bla_NDM-1, bla_KPC-2) harboring plasmids are successfully trans-conjugant to EC-600. A high incidence of ST11 was observed in K. pneumoniae carbapenem resistant isolates. While in E. coli, multiple STs were identified. However, mcr-1 in ST23 was identified for the first time in Anhui Province. Among Enterobacter cloacae, ST270 detected carrying bla_NDM-1. Southern-hybridization confirmed the plasmid sizes 35–150kb.

Conclusion

This study indicates the co-carrying of mcr-1, bla_KPC-2, and bla_NDM-1 among clinical isolates, the prevalence of different Enterobacteriaceae STs is alarming, especially in E. coli. Holding such a resistance profile is a threat for humans and animals, which may be transferred between the strains through plasmid transfusion. Persistent control actions are immediately necessary to combat this hazard.

Keywords:

• ESBL
• MBL
• KPC2
• mcr-1
• NDM-1
• CTXM-15

Acknowledgment

The authors are grateful to the Institute of Life Sciences of Anhui University for publishing this work.

Abbreviations

MLST, Multilocus sequence typing; PFGE, Pulse field gel electrophoresis; PBRT, PCR based replicon typing; MCR, mobilized colistin resistance gene.

Statement of Ethics

This study has been approved (approval number 2020KY-191) by the ethical committee of the First Affiliated Hospital of the university of science and technology of China (USTC).

Disclosure

Dr Muhammad Shafiq is now affiliated with Cell Biology and Genetics Department, Shantou University Medical College, Shantou 515041, China. The authors declare that they have no conflicts of interest for this work.