Molecular Characterization and Epidemiology of Carbapenem-Resistant Enterobacteriaceae Isolated from Pediatric Patients in Guangzhou, Southern China.

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Canadian Journal of Infectious Diseases & Medical Microbiology Pub Date : 2023-01-01 DOI:10.1155/2023/4762143

Fei Gao, Zhile Xiong, Bingshao Liang, Zhenting Huang, Qiulian Deng, Jielin Wang, Huamin Zhong, Yan Long, Sufei Zhu

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引用次数: 1

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are spreading worldwide, posing a serious public health concern. However, the data on CRE strains that cause infections in children in Guangzhou remain limited. Therefore, this study aimed to investigate the epidemiology of CRE, drug resistance, and resistance mechanisms in children in Guangzhou, Southern China.

Methods: In total, 54 nonrepetitive CRE strains were collected in pediatric patients at three centers in Guangzhou, Southern China, from January 2016 to August 2018. CRE isolates were used for further studies on antimicrobial susceptibility, the modified Hodge test (MHT), the modified carbapenem inactivation method (mCIM), and drug resistance genes. Multilocus sequence typing (MLST) was used to elucidate the molecular epidemiology of K. pneumoniae.

Results: The isolated CRE strains include 34 K. pneumoniae (63.0%), 10 E. coli (18.5%), 4 Enterobacter cloacae (7.4%), and 6 Proteus mirabilis (11.1%) strains. The strains were isolated mainly from the blood (31.5%, n = 17), sputum (31.5%, n = 17), and urine (16.7%, n = 9). All CRE isolates were highly resistant to the third- or fourth-generation cephalosporins, carbapenems, and β-lactam + β-lactamase inhibitors (94.4%-96.3%). In addition, the resistance rates to amikacin, ciprofloxacin, levofloxacin, tigecycline, and colistin were 5.6%, 14.8%, 16.7%, 9.3%, and 0%, respectively. Carbapenemase was detected in 35 (64.8%) of the CRE isolates. The most dominant carbapenemase gene was bla _NDM (n = 17, 48.6%), followed by bla _IMP (n = 13, 37.1%) and bla _OXA-23 (n = 4, 11.4%). Other carbapenemase genes (bla _KPC, bla _sim, bla _Aim, bla _GES, bla _Gim, bla _OXA-2 , and bla _OXA-48 ) and the mcr-1 gene were not detected. MLST analysis showed high diversity among the K. pneumoniae, and ST45 (11.7%, 4/34) was the dominant sequence type.

Conclusion: This study revealed bla _NDM was the most dominant carbapenemase gene in children in Guangzhou. Infection control measures need to be taken for the prevention and treatment of CRE infections.

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广州地区儿童耐碳青霉烯肠杆菌科的分子特征及流行病学研究

背景:碳青霉烯耐药肠杆菌科(CRE)正在世界范围内蔓延，引起了严重的公共卫生问题。然而，在广州引起儿童感染的CRE菌株的数据仍然有限。因此，本研究旨在调查广州地区儿童CRE的流行病学、耐药性及其耐药机制。方法:2016年1月至2018年8月，在中国南方广州市的三个中心共收集了54株非重复CRE菌株。利用CRE分离株进行药敏、改良霍奇试验(MHT)、改良碳青霉烯类失活法(mCIM)和耐药基因的进一步研究。采用多位点序列分型(MLST)研究肺炎克雷伯菌的分子流行病学。结果:分离到的CRE菌株包括肺炎克雷伯菌34株(63.0%)、大肠杆菌10株(18.5%)、阴沟肠杆菌4株(7.4%)、奇异变形杆菌6株(11.1%)。主要来源于血液(31.5%，n = 17)、痰液(31.5%，n = 17)和尿液(16.7%，n = 9)。所有CRE分离株均对第三代或第四代头孢菌素、碳青霉烯类和β-内酰胺+ β-内酰胺酶抑制剂高度耐药(94.4% ~ 96.3%)。此外，对阿米卡星、环丙沙星、左氧氟沙星、替加环素和粘菌素的耐药率分别为5.6%、14.8%、16.7%、9.3%和0%。35株(64.8%)CRE分离株检出碳青霉烯酶。碳青霉烯酶基因为bla NDM (n = 17, 48.6%)，其次为bla IMP (n = 13, 37.1%)和bla OXA-23 (n = 4, 11.4%)。其他碳青霉烯酶基因(bla KPC、bla sim、bla Aim、bla GES、bla Gim、bla OXA-2、bla OXA-48)和mcr-1基因未检出。MLST分析显示肺炎克雷伯菌具有较高的多样性，ST45(11.7%， 4/34)为优势序列型。结论:bla NDM是广州地区儿童碳青霉烯酶最显性基因。预防和治疗CRE感染需要采取感染控制措施。

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来源期刊

Canadian Journal of Infectious Diseases & Medical Microbiology 医学-传染病学

CiteScore

4.30

自引率

0.00%

发文量

108

审稿时长

>12 weeks

期刊介绍： Canadian Journal of Infectious Diseases and Medical Microbiology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to infectious diseases of bacterial, viral and parasitic origin. The journal welcomes articles describing research on pathogenesis, epidemiology of infection, diagnosis and treatment, antibiotics and resistance, and immunology.