Analysis of drug-resistant phenotypes and drug-resistant genes of carbapenem-resistant Enterobacteriaceae in a traditional Chinese medicine hospital_West China Medical Journal

Authors：

WANG Fang ¹ ,  WANG Qun ² , XIN Lihua ¹ , ZHANG Qiongfang ¹ , LI Rui ¹ , WU Bo ¹ , REN Ran ¹ , ZHANG Qing ¹

1. Clinical Laboratory, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P. R. China;
2. Clinical Laboratory, Dayi County People’s Hospital of Chengdu, Chengdu, Sichuan 611330, P. R. China;

Corresponding?author：

WANG Qun, Email: 1123354045@qq.com

Keywords：

Enterobacteriaceae; Carbapenemase; Drug-resistant phenotype; Drug-resistant genotype

DOI：

10.7507/1002-0179.202005354

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the drug-resistant phenotype and genotype characteristics of carbapenem-resistant Enterobacteriaceae (CRE) in a traditional Chinese medicine hospital from 2016 to 2018, to provide guidance for clinical rational drug use and effective anti-infection treatment.Methods A total of 2 901 Enterobacteriaceae bacteria strains isolated from January 2016 to December 2018 were selected, and CRE strains were screened by microdilution test and Kirby-Bauer methods. CRE strains with successful seed preservation and detailed clinical data were selected for carbapenemase phenotype confirmation test, drug-resistant gene amplification, and sequencing comparison.Results The 101 CRE strains collected between 2016 and 2018 were mainly Klebsiella pneumonia (73.27%, 74/101) and Escherichia coli (14.85%, 15/101), and the specimens were mainly from sputum (63.37%, 64/101) and catheter urine (11.88%, 12/101). The phenotypic test results of carbapenemase showed that 94 strains were positive in modified Hodge test, with a positive rate of 93.07%, 96 strains were positive in Carba NP test, with a positive rate of 95.05%, and 98 strains were positive in modified carbapenem inactivation method test, with a positive rate of 97.03%. Drug-resistant genes were detected in 92 (91.01%) of the 101 CRE strains, sequencing results showed that 66 (65.35%) carried bla_KPC-2 gene, 4 (3.96%) carried bla_KPC-19 gene, 9 (8.91%) carried bla_NDM-1 gene, and 13 (12.87%) carried bla_NDM-5 gene. No CRE strains carrying two resistance genes were detected. Among them, Klebsiella pneumoniae strains mainly carried bla_KPC-2 gene (82.43%, 61/74), and Escherichia coli strains mainly carried bla_NDM-5 gene (86.67%, 13/15), which were consistent with the main epidemic genotype in China.Conclusions In recent three years, the CRE strains in this hospital mainly included Klebsiella pneumoniae with bla_KPC-2 gene and Escherichia coli with bla_NDM-5 gene. According to the results of this test, we can reasonably select antimicrobial agents in combination with the drug sensitivity report from the microbial laboratory, so as to delay the growth of drug-resistant strains and prevent hospital transmission of multidrug-resistant bacteria.

Citation： WANG Fang, WANG Qun, XIN Lihua, ZHANG Qiongfang, LI Rui, WU Bo, REN Ran, ZHANG Qing. Analysis of drug-resistant phenotypes and drug-resistant genes of carbapenem-resistant Enterobacteriaceae in a traditional Chinese medicine hospital. West China Medical Journal, 2020, 35(8): 912-917. doi: 10.7507/1002-0179.202005354 Copy

1.	Webb HE, Bugarel M, Den Bakker HC, <italic>et al</italic>. Carbapenem-resistant bacteria recovered from faeces of dairy cattle in the high plains region of the USA. PLoS One, 2016, 11(1): e0147363.
2.	安軍, 蔡挺, 張順. 耐碳青霉烯類大腸埃希菌和肺炎克雷伯桿菌多重耐藥研究進展. 現代實用醫學, 2011, 23(3): 359-360.
3.	T?ngdén T, Giske CG. Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: clinical perspectives on detection, treatment and infection control. J Intern Med, 2015, 277(5): 501-512.
4.	尚紅, 王毓三, 申子瑜. 全國臨床檢驗操作規程. 4版. 北京: 人民衛生出版社, 2015: 3.
5.	Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI Supplement M100. 27th ed. Wayne, PA: Clinical and Laboratory Standards Institute, 2017.
6.	李鶯, 丁云芳, 吳水燕, 等. 多重耐藥肺炎克雷伯菌支氣管肺泡灌洗液分離株耐藥元件檢測分析. 中華臨床感染病雜志, 2014, 7(2): 150-156.
7.	Hong SS, Kim K, Huh JY, <italic>et al</italic>. Multiplex PCR for rapid detection of genes encoding class A carbapenemases. Ann Lab Med, 2012, 32(5): 359-361.
8.	Pasanen T, Koskela S, Mero S, <italic>et al</italic>. Rapid molecular characterization of <italic>Acinetobacter baumannii</italic> clones with rep-PCR and evaluation of carbapenemase genes by new multiplex PCR in Hospital District of Helsinki and Uusimaa. PLoS One, 2014, 9(1): e85854.
9.	Wei J, Zou C, Wang D, <italic>et al</italic>. Genetic diversity and <italic>in vitro</italic> activity of ceftazidime/avibactam and aztreonam/avibactam against imipenem-resistant Enterobacteriaceae isolates in Southwest China: a single-centre study. J Glob Antimicrob Resist, 2020, 22: 448-451.
10.	Zhang R, Liu L, Zhou H, <italic>et al</italic>. Nationwide surveillance of clinical carbapenem-resistant Enterobacteriaceae (CRE) strains in China. EBioMedicine, 2017, 19: 98-106.
11.	胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
12.	周仕丹, 劉春來, 楊潤時, 等. 某院耐碳青霉烯類腸桿菌科細菌耐藥基因分析. 中國感染控制雜志, 2019, 18(6): 495-504.
13.	Zhang X, Chen D, Xu G, <italic>et al</italic>. Molecular epidemiology and drug resistant mechanism in carbapenem-resistant <italic>Klebsiella pneumoniae</italic> isolated from pediatric patients in Shanghai, China. PLoS One, 2018, 13(3): e0194000.
14.	lp E, Per?in D, Colako?lu S, <italic>et al</italic>. Molecular characterization of carbapenem-resistant <italic>Klebsiella pneumoniae</italic> in a tertiary university hospital in Turkey. Hosp Infect, 2013, 84(2): 178-180.
15.	Calia C, Pazzani C, Oliva M, <italic>et al</italic>. Carbapenemases-producing <italic>Klebsiella pneumoniae</italic> in hospitals of two regions of Southern Italy. APMIS, 2017, 125(5): 491-498.
16.	Satlin MJ, Chen L, Patel G, <italic>et al</italic>. Multicenter clinical and molecular epidemiological analysis of bacteremia due to carbapenem-resistant Enterobacteriaceae (CRE) in the CRE epicenter of the United States. Antimicrob Agents Chemother, 2017, 61(4): e02349-16.
17.	王艷艷, 韓艷秋, 郭素芳, 等. 呼和浩特地區耐碳青霉烯類腸桿菌科細菌特征分析. 國際流行病學傳染病學雜志, 2019, 46(3): 195-199.
18.	韓仁如, 胡付品. 耐碳青霉烯類腸桿菌科細菌中OXA-48家族碳青霉烯酶分子流行病學研究進展. 中國感染與化療雜志, 2019, 19(6): 687-690.
19.	徐鵑鵑, 葛瑛. 碳青霉烯類耐藥腸桿菌科細菌感染治療研究進展. 中國感染與化療雜志, 2019, 19(6): 680-686.
20.	林迪, 孫長貴. 碳青霉烯類耐藥腸桿菌科細菌的研究進展. 傳染病信息, 2017, 30(5): 257-261, 271.
21.	徐英春, 肖永紅, 卓超, 等. 中國碳青酶烯類耐藥腸桿菌科細菌的流行病學和防控策略. 中國執業醫師, 2013, 10(4): 3-8.

1. Webb HE, Bugarel M, Den Bakker HC, <italic>et al</italic>. Carbapenem-resistant bacteria recovered from faeces of dairy cattle in the high plains region of the USA. PLoS One, 2016, 11(1): e0147363.
2. 安軍, 蔡挺, 張順. 耐碳青霉烯類大腸埃希菌和肺炎克雷伯桿菌多重耐藥研究進展. 現代實用醫學, 2011, 23(3): 359-360.
3. T?ngdén T, Giske CG. Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: clinical perspectives on detection, treatment and infection control. J Intern Med, 2015, 277(5): 501-512.
4. 尚紅, 王毓三, 申子瑜. 全國臨床檢驗操作規程. 4版. 北京: 人民衛生出版社, 2015: 3.
5. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI Supplement M100. 27th ed. Wayne, PA: Clinical and Laboratory Standards Institute, 2017.
6. 李鶯, 丁云芳, 吳水燕, 等. 多重耐藥肺炎克雷伯菌支氣管肺泡灌洗液分離株耐藥元件檢測分析. 中華臨床感染病雜志, 2014, 7(2): 150-156.
7. Hong SS, Kim K, Huh JY, <italic>et al</italic>. Multiplex PCR for rapid detection of genes encoding class A carbapenemases. Ann Lab Med, 2012, 32(5): 359-361.
8. Pasanen T, Koskela S, Mero S, <italic>et al</italic>. Rapid molecular characterization of <italic>Acinetobacter baumannii</italic> clones with rep-PCR and evaluation of carbapenemase genes by new multiplex PCR in Hospital District of Helsinki and Uusimaa. PLoS One, 2014, 9(1): e85854.
9. Wei J, Zou C, Wang D, <italic>et al</italic>. Genetic diversity and <italic>in vitro</italic> activity of ceftazidime/avibactam and aztreonam/avibactam against imipenem-resistant Enterobacteriaceae isolates in Southwest China: a single-centre study. J Glob Antimicrob Resist, 2020, 22: 448-451.
10. Zhang R, Liu L, Zhou H, <italic>et al</italic>. Nationwide surveillance of clinical carbapenem-resistant Enterobacteriaceae (CRE) strains in China. EBioMedicine, 2017, 19: 98-106.
11. 胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
12. 周仕丹, 劉春來, 楊潤時, 等. 某院耐碳青霉烯類腸桿菌科細菌耐藥基因分析. 中國感染控制雜志, 2019, 18(6): 495-504.
13. Zhang X, Chen D, Xu G, <italic>et al</italic>. Molecular epidemiology and drug resistant mechanism in carbapenem-resistant <italic>Klebsiella pneumoniae</italic> isolated from pediatric patients in Shanghai, China. PLoS One, 2018, 13(3): e0194000.
14. lp E, Per?in D, Colako?lu S, <italic>et al</italic>. Molecular characterization of carbapenem-resistant <italic>Klebsiella pneumoniae</italic> in a tertiary university hospital in Turkey. Hosp Infect, 2013, 84(2): 178-180.
15. Calia C, Pazzani C, Oliva M, <italic>et al</italic>. Carbapenemases-producing <italic>Klebsiella pneumoniae</italic> in hospitals of two regions of Southern Italy. APMIS, 2017, 125(5): 491-498.
16. Satlin MJ, Chen L, Patel G, <italic>et al</italic>. Multicenter clinical and molecular epidemiological analysis of bacteremia due to carbapenem-resistant Enterobacteriaceae (CRE) in the CRE epicenter of the United States. Antimicrob Agents Chemother, 2017, 61(4): e02349-16.
17. 王艷艷, 韓艷秋, 郭素芳, 等. 呼和浩特地區耐碳青霉烯類腸桿菌科細菌特征分析. 國際流行病學傳染病學雜志, 2019, 46(3): 195-199.
18. 韓仁如, 胡付品. 耐碳青霉烯類腸桿菌科細菌中OXA-48家族碳青霉烯酶分子流行病學研究進展. 中國感染與化療雜志, 2019, 19(6): 687-690.
19. 徐鵑鵑, 葛瑛. 碳青霉烯類耐藥腸桿菌科細菌感染治療研究進展. 中國感染與化療雜志, 2019, 19(6): 680-686.
20. 林迪, 孫長貴. 碳青霉烯類耐藥腸桿菌科細菌的研究進展. 傳染病信息, 2017, 30(5): 257-261, 271.
21. 徐英春, 肖永紅, 卓超, 等. 中國碳青酶烯類耐藥腸桿菌科細菌的流行病學和防控策略. 中國執業醫師, 2013, 10(4): 3-8.

West China Medical Journal

Analysis of drug-resistant phenotypes and drug-resistant genes of carbapenem-resistant Enterobacteriaceae in a traditional Chinese medicine hospital

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content