Phenotypic and Genotypic Characterization of Carbapenem-Resistant Enterobacteriaceae Recovered from a Single Hospital in China, 2013 to 2017

Abstract

Objective

Carbapenem-resistant Enterobacteriaceae (CRE) have become an increasingly common cause of healthcare-related infections and present a serious challenge to clinical treatment. This study examined the phenotypic, genotypic characterization, clinical, and microbiological data of CRE in the Huizhou Municipal Central Hospital.

Methods

We conducted a phenotypic susceptibility evaluation and whole genome sequence analysis for 52 CRE strains isolated from 37 patients and 2 medical device-related samples during 2013–2017 to characterize risk factors, antimicrobial resistance profiles, dominant clones and hospital transmission.

Results

Long-term hospitalization, treatment time with antibiotics and use of invasive devices were linked to the risk of CRE infection. The carbapenem resistance genes (CRGs) we found included bla_NDM (82.7%), bla_IMP (19.2%) and bla_KPC (3.8%), Escherichia coli (44.2%) and Klebsiella pneumoniae (44.2%) were the dominant species we identified, and the type of CRG carried by isolates was highly correlated with species. The coexistence of CRGs with a variety of other antibiotic resistance genes leads to an increased prevalence of high resistance levels for CRE to β-lactams and other antibiotic classes such as aminoglycosides and fluoroquinolones. These isolates were sensitive only to colistin and tigecycline. In addition to this, we observed significantly genomic diversity of CRE isolates in this hospital. Importantly, we found that long-term transmission of multiple CRE clones had occurred at this hospital between various wards.

Conclusion

Evaluating and improving the current infection control strategies may be necessary, and reducing nosocomial transmission remains the primary control element for CRE infections in China.

Keywords:

• carbapenem-resistant Enterobacteriaceae
• bacteremia
• carbapenem resistance genes
• nosocomial transmission

Sequence Information

All genome assemblies of 52 isolates were deposited in GenBank and are registered with BioProject: PRJNA832055.

Ethical Approval

The ethical protocol was approved by the Ethics Committee of Huizhou Municipal Central Hospital. Informed written consent was obtained from the parents or legal guardian of the patient before inclusion in the study.

Disclosure

The authors have any conflict of interest.

Additional information

Funding

National Key Research & Development Program of China, 2022YFE0103200; The National Natural Science Foundation of China (31730097). Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program (2019BT02N054) Program for Changjiang Scholars and Innovative Research Team in University of Ministry of Education of China (IRT_17R39) Innovation Team Project of Guangdong University (2019KCXTD001) 6. the 111 Project (D20008).