1432. Population-based Surveillance of Carbapenem-Resistant Enterobacteriaceae (CRE) in Alameda County, 2017-2020

Abstract Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE), especially those that are carbapenemase-producing (CP), are difficult to treat and result in high mortality— the Centers for Disease Control and Prevention (CDC) designates CRE an urgent level threat to public health. Alameda, a northern California county with 1.67 million residents, mandates submission of all carbapenem-resistant isolates Escherichia coli, Klebsiella spp., and Enterobacter spp. We assessed the genetic profiles of CRE isolates and compared to aggregate US data from the same time period. Methods Isolates are submitted to the Alameda County Public Health Laboratory (ACPHL), where antimicrobial resistance genetic markers are identified by whole genome sequencing (WGS) using single-end, 150-cycle reactions in a MiSeq (Illumina). Resistance genes were identified using pipelines built in Geneious and confirmed with Resfinder. All epidemiological analyses were conducted using R (Version 4.0). Results ACPHL performed WGS on 226 CRE isolates submitted between June 2017 and February 2020. A total of 34/95 (36%) Klebsiella spp., 17/60 (28%) E. coli, and 10/71 (14%) Enterobacter spp. a carbapenemase enzyme. Among all Enterobacteriaceae, 21/226 (9%) produced the New Delhi-metallo-β-lactamase (NDM) carbapenemase (Table 1). Among all CRE, 17/226 (8%) were Klebsiella pneumoniae with the multilocus sequence type (MLST) of ST-258. All six Klebsiella pneumoniae ST-35 and ST-11 isolates produced a carbapenemase (Table 2). Table 1: Carbapenemases, Extended Spectrum β-Lactamases (ESBL) and Other β-Lactamases by Organism Table 2: Organism, Multilocus Sequence Type (MLST) and Carbapenemases Present Conclusion Compared to US data, Alameda County Klebsiella spp. were nearly half as likely to produce any carbapenemase, and E. coli were three times more likely to produce an NDM carbapenemase. CP-CRE represented a wide array of MLST, with the globally distributed KPC-producing outbreak strain ST-258 being the most frequently identified. Two strains that have been associated with hypervirulent and multidrug resistant infections in Asia, K. pneumoniae ST-35 and ST-11, were also reported. Disclosures Sam Horwich-Scholefield, MPH CIC, Merck (Research Grant or Support)

Download Full-text

Draft Genome Sequence of a Multidrug-Resistant Sequence Type 231 Outbreak-Associated Clone of Klebsiella pneumoniae, KP41-2015, Producing OXA-232 Carbapenemase

Genome Announcements ◽

10.1128/genomea.00604-17 ◽

2017 ◽

Vol 5 (27) ◽

Cited By ~ 1

Author(s):

M. H. F. Abdul Momin ◽

A. Liakopoulos ◽

D. W. Wareham

Keyword(s):

Public Health ◽

Klebsiella Pneumoniae ◽

Genome Sequence ◽

Draft Genome ◽

Multidrug Resistant ◽

Sequence Type ◽

Content Type ◽

Resistance Determinants ◽

Carbapenem Resistant ◽

Public Health Threat

ABSTRACT Carbapenem-resistant Klebsiella pneumoniae infection is a rising public health threat due to limited therapeutic options. Here, we report the genome sequence of a multidrug-resistant K. pneumoniae sequence type 231 (ST231) strain associated with an outbreak of infections in an intensive care unit that carries a unique complement of resistance determinants.

Download Full-text

Temporal Trend of ST131 Clone among Urinary Escherichia coli Isolates in the Community: A Taiwan National Surveillance from 2002 to 2016

Microorganisms ◽

10.3390/microorganisms9050963 ◽

2021 ◽

Vol 9 (5) ◽

pp. 963

Author(s):

Jiun-Ling Wang ◽

Wen-Chien Ko ◽

Chih-Hsin Hung ◽

Ming-Fang Cheng ◽

Hui-Ying Wang ◽

...

Keyword(s):

Temporal Trend ◽

Multidrug Resistant ◽

Population Based ◽

Pulsed Field Gel Electrophoresis ◽

Sequence Type ◽

E Coli ◽

Factors Associated ◽

Resistant Group ◽

Ciprofloxacin Resistance ◽

Susceptible Group

Sequence type (ST) 131 is a multidrug-resistant pandemic lineage of E. coli responsible for extraintestinal infections. Few surveillance data of ST131 included all antimicrobial-susceptible and -resistant isolates or focused on community-acquired urinary tract infection (UTI). From a population-based surveillance pool of 2997 outpatient urine E. coli isolates, 542 were selected for detection of ST131 based on ciprofloxacin and/or cefotaxime resistance. Pulsed-field gel electrophoresis (PFGE) was performed on all ST131 isolates to further determine their relatedness. The estimated overall ST131 prevalence in this community UTI cohort increased from 11.2% (in 2002–2004), 12.2% (in 2006–2008), 13.6% (in 2010–2012), to 17.4% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-resistant group, ST131 increased from 33.3% in 2002–2004 to 72.1% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-susceptible group, ST131 was found in 24.3% overall without significant increase in its prevalence over time. PFGE showed emergence of a cluster of ciprofloxacin-resistant/cefotaxime-resistant ST131 carrying Gr. 1 CTX-M ESBL in 2014–2016, especially 2016. Multivariate analysis revealed that age (≥65 y.o) and ciprofloxacin resistance were independent factors associated with ST131. This longitudinal surveillance showed that ciprofloxacin-resistant/cefotaxime-susceptible ST131 has been circulating in the community since 2002 but ciprofloxacin-resistant/cefotaxime-resistant ST131 increased rapidly in the later years.

Download Full-text

Characterization of Carbapenem-Resistant Enterobacteriaceae Cultured From Retail Meat Products, Patients, and Porcine Excrement in China

Frontiers in Microbiology ◽

10.3389/fmicb.2021.743468 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jie Feng ◽

Qian Xiang ◽

Jiangang Ma ◽

Pei Zhang ◽

Kun Li ◽

...

Keyword(s):

Meat Products ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

E Coli ◽

Carbapenem Resistant ◽

Retail Meat ◽

Different Origins ◽

Different Sources ◽

Carbapenem Resistant Enterobacteriaceae

The emergence and dissemination of carbapenem-resistant Enterobacteriaceae (CRE) is a growing concern to animal and public health. However, little is known about the spread of CRE in food and livestock and its potential transmission to humans. To identify CRE strains from different origins and sources, 53 isolates were cultured from 760 samples including retail meat products, patients, and porcine excrement. Antimicrobial susceptibility testing was carried out, followed by phylogenetic typing, whole-genome sequencing, broth mating assays, and plasmids analyses. Forty-three Escherichia coli, nine Klebsiella pneumoniae, and one Enterobacter cloacae isolates were identified, each exhibiting multidrug-resistant phenotypes. Genetically, the main sequence types (STs) of E. coli were ST156 (n = 7), ST354 (n = 7), and ST48 (n = 7), and the dominant ST of K. pneumoniae is ST11 (n = 5). blaNDM–5 (n = 40) of E. coli and blaKPC–2 (n = 5) were the key genes that conferred carbapenem resistance phenotypes in these CRE strains. Additionally, the mcr-1 gene was identified in 17 blaNDM-producing isolates. The blaNDM–5 gene from eight strains could be transferred to the recipients via conjugation assays. Two mcr-1 genes in the E. coli isolates could be co-transferred along with the blaNDM–5 genes. IncF and IncX3 plasmids have been found to be predominantly associated with blaNDM gene in these strains. Strains isolated in our study from different sources and regions tend to be concordant and overlap. CRE strains from retail meat products are a reservoir for transition of CRE strains between animals and humans. These data also provide evidence of the dissemination of CRE strains and carbapenem-resistant genes between animal and human sources.

Download Full-text

Phylogenetically Diverse Escherichia Coli Strains From Chicken Co-Harbour Multiple Carbapenemase Encoding Genes (blaNDM-blaOXA-blaIMP)

10.20944/preprints202011.0065.v1 ◽

2020 ◽

Author(s):

Erkihun Aklilu ◽

Azian Harun ◽

Kirnpal Kaur Banga Singh ◽

Shamsaldeen Ibrahim ◽

Nor Fadhilah Kamaruzzaman

Keyword(s):

Public Health ◽

Phylogenetic Diversity ◽

Farm Animals ◽

E Coli ◽

Carbapenem Resistant ◽

Resistance Patterns ◽

Phylogenetic Grouping ◽

Encoding Genes ◽

Potential Public Health ◽

Carbapenem Resistant Enterobacteriaceae

Carbapenem resistant Enterobacteriaceae (CRE) has been public health risk in several countries and recent reports indicate the emergence of CRE in food animals. This study was conducted to investigate the occurrence, resistance patterns, and phylogenetic diversity of CRE E.coli from chicken. Routine bacteriology, PCR detection of E.coli species, multiplex PCR to detect carbapenemase encoding genes and phylogeny of CRE E. coli were conducted. The results show that 24.36 % (19/78) were identified as CRE based on the phenotypic identifications of which 17 were positive for the tested carabanemase genes. The majority, 57.99% (11/19) of the isolates harbored multiple carbapenemase genes. Four isolates harbored all blaNDM blaOXA, blaIMP, five and two different isolates harbored blaNDM and blaOXA, and blaOXA and blaIMP respectively. The Meropenem, Imipenem and Ertapenem MIC values for the isolates ranged from 2g/mL to ≥256g/mL. Phylogenetic grouping showed that the CRE E.coli isolates belonged to five different groups; groups A, B1, C, D and unknown. The detection of carbapenem resistant E.coli in this study shows that CRE is has become an emerging problem in farm animals, particularly, in poultry farms. This also implies the potential public health risks posed by CRE from chicken to the consumers.

Download Full-text

Emergence of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Sequence Type 23 Strain with a Rare blaCTX-M-24-Harboring Virulence Plasmid

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02273-18 ◽

2019 ◽

Vol 63 (3) ◽

Cited By ~ 16

Author(s):

Dingxia Shen ◽

Guannan Ma ◽

Cuidan Li ◽

Xinmiao Jia ◽

Chuan Qin ◽

...

Keyword(s):

Public Health ◽

Klebsiella Pneumoniae ◽

Genetic Basis ◽

Virulence Genes ◽

Multidrug Resistant ◽

Sequence Type ◽

Hybrid Plasmid ◽

Virulence Plasmid ◽

Drug Resistant ◽

Content Type

ABSTRACT Here, we report a multidrug-resistant hypervirulent Klebsiella pneumoniae (MDR-HvKP) strain of sequence type 23 (ST23) with a rare hybrid plasmid harboring virulence genes and blaCTX-M-24, and we analyze the genetic basis for relationship between genotypes and MDR-hypervirulence phenotypes. Further analysis indicates that the hybrid plasmid is formed by IS903D-mediated intermolecular transposition of the blaCTX-M-24 gene into the virulence plasmid. The emergence of MDR-HvKP strains, especially those carrying drug-resistant virulent plasmids, poses unprecedented threats/challenges to public health. This is a dangerous trend and should be closely monitored.

Download Full-text

A review on bacterial resistance to carbapenems: epidemiology, detection and treatment options

Future Science OA ◽

10.2144/fsoa-2019-0098 ◽

2020 ◽

Vol 6 (3) ◽

pp. FSO438 ◽

Cited By ~ 7

Author(s):

Ann A Elshamy ◽

Khaled M Aboshanab

Keyword(s):

Public Health ◽

Bacterial Resistance ◽

Antimicrobial Agents ◽

Treatment Options ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Mechanisms Of Resistance ◽

Carbapenem Resistant ◽

Public Health Threat ◽

Carbapenem Resistant Enterobacteriaceae

Carbapenems are a class of antimicrobial agents reserved for infections caused by multidrug-resistant microorganisms. The emergence of carbapenem resistance has become a serious public health threat. This type of antimicrobial resistance is spreading at an alarming rate, resulting in major outbreaks and treatment failure of community-acquired and nosocomial infections caused by the clinically relevant carbapenem-producing Enterobacteriaceae or carbapenem-resistant Enterobacteriaceae. This review is focused on carbapenem resistance, including mechanisms of resistance, history and epidemiology, phenotypic and genotypic detection in the clinically relevant bacterial pathogens and the possible treatment options available.

Download Full-text

Imipenem-Relebactam Susceptibility and Genotypic Characteristics of Carbapenem-Resistant Enterobacterales (CRE) Identified during Population-Based Surveillance

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02288-20 ◽

2021 ◽

Author(s):

Sam Horwich-Scholefield ◽

Tyler Lloyd ◽

Vici Varghese ◽

Emily Yette ◽

Sandra Huang ◽

...

Keyword(s):

Public Health ◽

Health Department ◽

Population Based ◽

Public Health Department ◽

Whole Genome ◽

Alameda County ◽

Carbapenem Resistant ◽

Genotypic Characteristics ◽

The Relationship ◽

County Public Health

Laboratories submit all carbapenem-resistant Enterobacter , Escherichia coli , and Klebsiella species to the Alameda County Public Health Department (ACPHD). ACPHD evaluated 75 isolates submitted during nine months for susceptibility to imipenem-relebactam (I-R) and identified β-lactamase genes using whole genome sequencing. Of 60 (80%) isolates susceptible to I-R, 8 (13%) had detectable carbapenemase genes, including four KPC, two NDM, and two OXA-48-like; we described the relationship between the presence of β-lactamase resistance genes and susceptibility to I-R.

Download Full-text

Molecular Epidemiology, Sequence Types, and Plasmid Analyses of KPC-Producing Klebsiella pneumoniae Strains in Israel

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01818-09 ◽

2010 ◽

Vol 54 (7) ◽

pp. 3002-3006 ◽

Cited By ~ 62

Author(s):

Azita Leavitt ◽

Yehuda Carmeli ◽

Inna Chmelnitsky ◽

Moran G. Goren ◽

Itzhak Ofek ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Molecular Epidemiology ◽

Medical Center ◽

Sequence Type ◽

Beta Lactamase ◽

Drug Resistant ◽

E Coli ◽

Carbapenem Resistant ◽

Clonal Spread ◽

Sequence Types

ABSTRACT Sporadic isolates of carbapenem-resistant KPC-2-producing Klebsiella pneumoniae were isolated in Tel Aviv Medical Center during 2005 and 2006, parallel to the emergence of the KPC-3-producing K. pneumoniae sequence type 258 (ST 258). We aimed to study the molecular epidemiology of these isolates and to characterize their bla KPC-carrying plasmids and their origin. Ten isolates (8 KPC-2 and 2 KPC-3 producing) were studied. All isolates were extremely drug resistant. They possessed the bla KPC gene and varied in their additional beta-lactamase contents. The KPC-2-producing strains belonged to three different sequence types: ST 340 (n = 2), ST 277 (n = 2), and a novel sequence type, ST 376 (n = 4). Among KPC-3-producing strains, a single isolate (ST 327) different from ST 258 was identified, but both strains carried the same plasmid (pKpQIL). The KPC-2-encoding plasmids varied in size (45 to 95 kb) and differed among each of the STs. Two of the Klebsiella bla KPC-2-carrying plasmids were identical to plasmids from Escherichia coli, suggesting a common origin of these plasmids. These data indicate that KPC evolution in K. pneumoniae is related to rare events of interspecies spread of bla KPC-2-carrying plasmids from E. coli followed by limited clonal spread, whereas KPC-3 carriage in this species is related almost strictly to clonal expansion of ST 258 carrying pKpQIL.

Download Full-text

IS26 mediate the acquisition of tigecycline resistance gene cluster tmexCD1-toprJ1 by IncHI1B-FIB plasmids in Klebsiella pneumoniae and Klebsiella quasipneumoniae from food market sewage

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02178-20 ◽

2020 ◽

Author(s):

Miao Wan ◽

Xun Gao ◽

Luchao Lv ◽

Zhongpeng Cai ◽

Jian-Hua Liu

Keyword(s):

Klebsiella Pneumoniae ◽

Gene Cluster ◽

Resistance Gene ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Resistance Gene Cluster ◽

Carbapenem Resistant ◽

Food Market ◽

Carbapenem Resistant Enterobacteriaceae

Tigecycline and colistin are considered 20 as the final options for the treatment of infections caused by multidrug-resistant (MDR) gram-negative bacteria, especially carbapenem-resistant Enterobacteriaceae (1).…

Download Full-text

Successful Treatment of Klebsiella pneumoniae NDM Sepsis and Intestinal Decolonization with Ceftazidime/Avibactam Plus Aztreonam Combination in a Patient with TTP Complicated by SARSCoV-2 Nosocomial Infection

Medicina ◽

10.3390/medicina57050424 ◽

2021 ◽

Vol 57 (5) ◽

pp. 424

Author(s):

Francesco Perrotta ◽

Marco Paolo Perrini

Keyword(s):

Klebsiella Pneumoniae ◽

Therapeutic Option ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Carbapenem Resistant ◽

Global Concern ◽

Rectal Colonization ◽

Hospital Acquired ◽

Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) are a serious public health threat. Infections due to these organisms are associated with significant morbidity and mortality. Among them, metallo-β-lactamases (MBLs)-producing Klebsiella pneumoniae are of global concern today. The ceftazidime/avibactam combination and the ceftazidime/avibactam + aztreonam combination currently represent the most promising antibiotic strategies to stave off these kinds of infections. We describe the case of a patient affected by thrombotic thrombocytopenic purpura (TTP) admitted in our ICU after developing a hospital-acquired SarsCoV2 interstitial pneumonia during his stay in the hematology department. His medical conditions during his ICU stay were further complicated by a K. Pneumoniae NDM sepsis. To our knowledge, the patient had no risk factors for multidrug-resistant bacteria exposure or contamination during his stay in the hematology department. During his stay in the ICU, we treated the sepsis with a combination therapy of ceftazidime/avibactam + aztreonam. The therapy solved his septic state, allowing for a progressive improvement in his general condition. Moreover, we noticed that the negativization of the hemocultures was also associated to a decontamination of his known rectal colonization. The ceftazidime/avibactam + aztreonam treatment could not only be a valid therapeutic option for these kinds of infections, but it could also be considered as a useful tool in selected patients’ intestinal decolonizations.

Download Full-text