AUTHOR=Han Renru , Shi Qingyu , Wu Shi , Yin Dandan , Peng Mingjia , Dong Dong , Zheng Yonggui , Guo Yan , Zhang Rong , Hu Fupin ,  China Antimicrobial Surveillance Network (CHINET) Study Group 

TITLE=Dissemination of Carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) Among Carbapenem-Resistant Enterobacteriaceae Isolated From Adult and Children Patients in China

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2020.00314

DOI=10.3389/fcimb.2020.00314

ISSN=2235-2988

ABSTRACT=<p>This study aimed to investigate the dissemination and characteristics of <italic>bla</italic><sub>KPC</sub>, <italic>bla</italic><sub>NDM</sub>, <italic>bla</italic><sub>OXA-48-<italic>like</italic></sub>, <italic>bla</italic><sub>IMP</sub>, and <italic>bla</italic><sub>VIM</sub> among the carbapenem-resistant <italic>Enterobacteriaceae</italic> (CRE) strains isolated from adult and children patients. A total of 935 non-duplicate CRE strains were collected from 36 hospitals in 24 provinces or cities across China from 2016 to 2018. Antimicrobial susceptibility testing was performed by broth microdilution method and carbapenemase genes <italic>bla</italic><sub>KPC</sub>, <italic>bla</italic><sub>NDM</sub>, <italic>bla</italic><sub>OXA-48-<italic>like</italic></sub>, <italic>bla</italic><sub>IMP</sub>, and <italic>bla</italic><sub>VIM</sub> were screened by PCR and confirmed by DNA sequencing. Overall, carbapenemases were produced in 97.4% (911/935) of CRE strains, including KPC-2 (51.6%, 482/935), NDM (35.7%, 334/935), and OXA-48-like carbapenemases (7.3%, 68/935). Overall, the most prevalent carbapenemase gene was <italic>bla</italic><sub>KPC-2</sub> among <italic>Klebsiella pneumoniae</italic> (64.6%, 457/709) and the CRE strains isolated from adult patients (70.3%, 307/437), and <italic>bla</italic><sub>NDM</sub> among <italic>Escherichia coli</italic> (96.0%, 143/149) and the CRE strains from children (49.0%, 247/498). The <italic>bla</italic><sub>OXA-232</sub>-positive carbapenem-resistant <italic>K. pneumoniae</italic> (9.3%, 66/709) were all isolated from children. Sixteen strains were positive for <italic>bla</italic><sub>IMP</sub> and 9 strains produced multiple carbapenemases. No strain was positive for <italic>bla</italic><sub>VIM</sub>. Most of the CRE strains (&gt;90%) were resistant to cephalosporins and carbapenems, more than half (&gt;50%) were resistant to aminoglycosides and fluoroquinolones, but the majority (95.8 and 98.4%) were susceptible to polymyxin B and tigecycline. Ceftazidime-avibactam showed excellent <italic>in vitro</italic> activity against <italic>bla</italic><sub>KPC-2</sub> and <italic>bla</italic><sub>OXA-48-<italic>like</italic></sub> positive strains (100% susceptible). In China, KPC-2, NDM, and OXA-48-like carbapenemases were predominant among CRE clinical isolates. The most prevalent carbapenemase gene was <italic>bla</italic><sub>KPC-2</sub> among <italic>K. pneumoniae</italic> isolates from adult patients, and <italic>bla</italic><sub>NDM</sub> among <italic>E. coli</italic> isolates from children.</p>