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：

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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.	安军, 蔡挺, 张顺. 耐碳青霉烯类大肠埃希菌和肺炎克雷伯杆菌多重耐药研究进展. 现代实用医学, 2011, 23(3): 359-360.
3.	Tängdén 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.	尚红, 王毓三, 申子瑜. 全国临床检验操作规程. 4版. 北京: 人民卫生出版社, 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.	李莺, 丁云芳, 吴水燕, 等. 多重耐药肺炎克雷伯菌支气管肺泡灌洗液分离株耐药元件检测分析. 中华临床感染病杂志, 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中国细菌耐药性监测. 中国感染与化疗杂志, 2018, 18(3): 241-251.
12.	周仕丹, 刘春来, 杨润时, 等. 某院耐碳青霉烯类肠杆菌科细菌耐药基因分析. 中国感染控制杂志, 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, Perçin D, Colakoğlu 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.	王艳艳, 韩艳秋, 郭素芳, 等. 呼和浩特地区耐碳青霉烯类肠杆菌科细菌特征分析. 国际流行病学传染病学杂志, 2019, 46(3): 195-199.
18.	韩仁如, 胡付品. 耐碳青霉烯类肠杆菌科细菌中OXA-48家族碳青霉烯酶分子流行病学研究进展. 中国感染与化疗杂志, 2019, 19(6): 687-690.
19.	徐鹃鹃, 葛瑛. 碳青霉烯类耐药肠杆菌科细菌感染治疗研究进展. 中国感染与化疗杂志, 2019, 19(6): 680-686.
20.	林迪, 孙长贵. 碳青霉烯类耐药肠杆菌科细菌的研究进展. 传染病信息, 2017, 30(5): 257-261, 271.
21.	徐英春, 肖永红, 卓超, 等. 中国碳青酶烯类耐药肠杆菌科细菌的流行病学和防控策略. 中国执业医师, 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. 安军, 蔡挺, 张顺. 耐碳青霉烯类大肠埃希菌和肺炎克雷伯杆菌多重耐药研究进展. 现代实用医学, 2011, 23(3): 359-360.
3. Tängdén 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. 尚红, 王毓三, 申子瑜. 全国临床检验操作规程. 4版. 北京: 人民卫生出版社, 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. 李莺, 丁云芳, 吴水燕, 等. 多重耐药肺炎克雷伯菌支气管肺泡灌洗液分离株耐药元件检测分析. 中华临床感染病杂志, 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中国细菌耐药性监测. 中国感染与化疗杂志, 2018, 18(3): 241-251.
12. 周仕丹, 刘春来, 杨润时, 等. 某院耐碳青霉烯类肠杆菌科细菌耐药基因分析. 中国感染控制杂志, 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, Perçin D, Colakoğlu 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. 王艳艳, 韩艳秋, 郭素芳, 等. 呼和浩特地区耐碳青霉烯类肠杆菌科细菌特征分析. 国际流行病学传染病学杂志, 2019, 46(3): 195-199.
18. 韩仁如, 胡付品. 耐碳青霉烯类肠杆菌科细菌中OXA-48家族碳青霉烯酶分子流行病学研究进展. 中国感染与化疗杂志, 2019, 19(6): 687-690.
19. 徐鹃鹃, 葛瑛. 碳青霉烯类耐药肠杆菌科细菌感染治疗研究进展. 中国感染与化疗杂志, 2019, 19(6): 680-686.
20. 林迪, 孙长贵. 碳青霉烯类耐药肠杆菌科细菌的研究进展. 传染病信息, 2017, 30(5): 257-261, 271.
21. 徐英春, 肖永红, 卓超, 等. 中国碳青酶烯类耐药肠杆菌科细菌的流行病学和防控策略. 中国执业医师, 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

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