Antibiotic Resistance Genes Among Carbapenem-resistant Enterobacterales (CRE) Isolates of Prapokklao Hospital, Chanthaburi Province, Thailand

Figures & data

Figure 1 Number of carbapenem-resistant Enterobacterales isolates during 2016–2017.

Table 1 Antimicrobial Pattern of Carbapenem-Resistant Enterobacterales Isolates

Antimicrobial Susceptibility Tests	Microorganisms								Total Number of Bacterial Isolates
	2016 (n=111)				2017 (n=171)
	E. coli	K. pneumoniae Complex	Enterobacter spp.	Total	E. coli	K. pneumoniae Complex	Enterobacter spp.	Total
	n=50 (%)	n=56 (%)	n=5 (%)	n=111 (%)	n=31 (%)	n=131 (%)	n=9 (%)	n=171 (%)	n=282 (%)
Disc diffusion
Ertapenem	50 (100)	55 (98.2)	5 (100)	110 (99)	30 (96.8)	130 (99.2)	9 (100)	169 (98.8)	279 (98.9)
Meropenem	47 (94)	53 (94.6)	5 (100)	105 (94.6)	28 (90.3)	123 (93.9)	9 (100)	160 (93.6)	265 (93.9)
Imipenem	44 (88)	44 (78.6)	3 (60)	91 (81.9)	27 (87.1)	115 (87.8)	6 (66.7)	148 (86.5)	239 (84.7)
Ampicillin	50 (100)	56 (100)	4 (80)	110 (99)	31 (100)	130 (99.2)	9 (100)	170 (99.4)	280 (99.2)
Ampicillin/Sulbactam	50 (100)	55 (98.2)	5 (100)	110 (99)	31 (100)	123 (93.9)	9 (100)	163 (95.3)	273 (96.8)
Amoxicillin/Clavulanate	50 (100)	56 (100)	5 (100)	111 (100)	31 (100)	131 (100)	9 (100)	171 (100)	282 (100)
Piperacillin/Tazobactam	48 (96)	47 (83.9)	3 (60)	98 (88.3)	30 (96.8)	116 (88.5)	9 (100)	155 (90.6)	253 (89.7)
Cefazolin	50 (100)	56 (100)	5 (100)	111 (100)	31 (100)	131 (100)	9 (100)	171 (100)	282 (100)
Cefotaxime	50 (100)	56 (100)	5 (100)	111 (100)	31 (100)	130 (99.2)	9 (100)	170 (99.4)	281 (99.6)
Ceftazidime	50 (100)	56 (100)	5 (100)	111 (100)	31 (100)	131 (100)	9 (100)	171 (100)	282 (100)
Ceftriaxone	50 (100)	56 (100)	5 (100)	111 (100)	31 (100)	130 (99.2)	9 (100)	170 (99.4)	281 (99.6)
Amikacin	35 (70)	30 (53.6)	3 (60)	68 (61.3)	24 (77.4)	91 (69.5)	1 (11.1)	116 (67.8)	184 (65.2)
Gentamicin	2 (4)	22 (39.3)	0 (0)	24 (21.6)	6 (19.4)	63 (48.1)	0 (0)	69 (40.4)	93 (32.9)
Ciprofloxacin	49 (98)	42 (75)	1 (20)	92 (82.9)	29 (93.5)	112 (85.5)	8 (88.9)	149 (87.1)	241 (85.5)
Trimethoprim/sulfamethoxazole	50 (100)	47 (83.9)	4 (80)	101 (90.9)	23 (74.2)	101 (77.1)	6 (66.7)	130 (76.1)	231 (81.9)
Fosfomycin	1 (2)	19 (33.9)	0 (0)	20 (18)	2 (6.5)	45 (34.4)	3 (33.3)	50 (29.2)	70 (24.8)
MIC test
Ertapenem	45 (90)	47 (83.9)	3 (60)	95 (85.6)	29 (93.5)	129 (98.5)	9 (100)	167 (97.7)	262 (92.9)
Meropenem	39 (78)	45 (80.4)	3 (60)	87 (78.4)	22 (70.9)	111 (84.7)	9 (100)	142 (83.1)	229 (81.2)
ESBL-positive
Ceftazidime	40 (80)	54 (96.4)	3 (60)	97 (87.4)	24 (77.4)	113 (86.3)	7 (77.8)	144 (84.2)	241 (85.5)
Cefotaxime	36 (72)	40 (71.4)	3 (60)	79 (71.2)	17 (54.8)	110 (83.9)	6 (66.7)	133 (77.8)	212 (75.2)

Abbreviations: n, number of isolates; MIC, minimum inhibitory concentration; ESBL, extended-spectrum β-lactamase.

Figure 2 Antimicrobial susceptibility test. (A) Extended-spectrum β-lactamase (ESBL) production was determined by the combination disc test. (B) Carbapenem resistance test by MIC test strips.

Abbreviations: CAZ/CLA, ceftazidime + clavulanate; CAZ, ceftazidime + cefotaxime; CTX, cefotaxime; CTX/CLA, cefotaxime + clavulanate; ETP, ertapenem; MEM, meropenem.

Table 2 Distribution of Carbapenemase-encoding Genes Among Carbapenemase-producing Carbapenem-resistant Enterobacterales Isolates by PCR

Carbapenemase Genes	Microorganisms
	E. coli  n=81 (%)	K. pneumoniae complex n=187 (%)	Enterobacter spp. n=14 (%)	Total Number of Bacterial Isolates n=282 (%)
blaKPC	0 (0)	0 (0)	0 (0)	0 (0)
blaVIM	0 (0)	0 (0)	0 (0)	0 (0)
blaIMP	3 (3.7)	6 (3.21)	0 (0)	9 (3.2)
blaNDM	11 (13.58)	9 (4.81)	2 (14.28)	22 (7.8)
blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaVIM	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaIMP	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaNDM	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaVIM, blaIMP	0 (0)	0 (0)	0 (0)	0 (0)
blaVIM, blaNDM	2 (2.46)	0 (0)	0 (0)	2 (0.7)
blaVIM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaIMP, blaNDM	19 (23.45)	88 (47.05)	4 (28.57)	111 (39.4)
blaIMP, blaOXA-48-like	0 (0)	14 (7.48)	1 (7.14)	15 (5.3)
blaNDM, blaOXA-48-like	22 (27.16)	27 (14.44)	6 (42.85)	55 (19.5)
blaKPC, blaVIM, blaIMP	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaVIM, blaNDM	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaVIM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaIMP, blaNDM	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaIMP, blaOXA-48-like	0 (0)	1 (0.53)	0 (0)	1 (0.35)
blaKPC, blaNDM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaVIM, blaIMP, blaNDM	2 (2.46)	1 (0.53)	0 (0)	3 (1.1)
blaVIM, blaIMP, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaVIM, blaNDM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaIMP, blaNDM, blaOXA-48-like	22 (27.16)	41 (21.93)	1 (7.14)	64 (22.7)
blaKPC, blaVIM, blaIMP, blaNDM	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaVIM, blaNDM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaVIM, blaIMP, blaNDM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)
blaKPC, blaVIM, blaIMP, blaNDM, blaOXA-48-like	0 (0)	0 (0)	0 (0)	0 (0)

Abbreviation: n, number of isolates.

Figure 3 Percentage of carbapenemase-encoding genes among carbapenemase-producing carbapenem-resistant Enterobacterales, based on PCR analysis.