scholarly journals Plasmid-Mediated qnrB2 and Carbapenemase Gene blaKPC-2 Carried on the Same Plasmid in Carbapenem-Resistant Ciprofloxacin-Susceptible Enterobacter cloacae Isolates

2008 ◽  
Vol 52 (8) ◽  
pp. 2962-2965 ◽  
Author(s):  
Inna Chmelnitsky ◽  
Shiri Navon-Venezia ◽  
Jacob Strahilevitz ◽  
Yehuda Carmeli
Keyword(s):  
Enterobacter Cloacae ◽  
Quinolone Resistance ◽  
Clinical Implications ◽  
Resistance Determinants ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

ABSTRACT Fourteen out of 16 carbapenem-resistant quinolone-susceptible Enterobacter cloacae isolates were found to carry qnrB2 and bla KPC-2 genes encoded on the same plasmid. One isolate also carried the aac(6′)-Ib-cr gene. Coexistence of quinolone resistance determinants and bla KPC-2 on the same plasmid in quinolone-susceptible E. cloacae isolates may have important clinical implications.

The prevalence of carbapenemase genes and plasmid-mediated quinolone resistance determinants in carbapenem-resistant Enterobacteriaceae from five teaching hospitals in central China

2013 ◽  
Vol 142 (9) ◽  
pp. 1972-1977 ◽  
Author(s):  
L. HU ◽  
Q. ZHONG ◽  
Y. SHANG ◽  
H. WANG ◽  
C. NING ◽  
...  
Keyword(s):  
Klebsiella Oxytoca ◽  
Carbapenem Resistance ◽  
Quinolone Resistance ◽  
Central China ◽  
Teaching Hospitals ◽  
Resistance Determinants ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
High Prevalence ◽  
Carbapenem Resistant Enterobacteriaceae

SUMMARYWe investigated the prevalence of β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 51 carbapenem-resistant Enterobacteriaceae (CRE) from five teaching hospitals in central China. The prevalence of carbapenem resistance in Enterobacteriaceae was 1·0% (51/5012). Of 51 CRE, 31 (60·8%) isolates were positive for one tested carbapenemase gene, while 10 (19·6%) were simultaneously positive for two tested carbapenemase genes. The positive rates of blaKPC-2, blaNDM-1, blaIMP-4, blaIMP-26 and blaIMP-8 were 54·9%, 17·6%, 11·8%, 11·8% and 3·9%, respectively. Of 10 CRE with two carbapenemase genes, three, five, one and one were positive for blaKPC-2 and blaIMP-4, blaKPC-2 and blaIMP-26, blaKPC-2 and blaIMP-8, and blaKPC-2 and blaNDM-1, respectively. Eight of nine blaNDM-1-positive isolates lacked carbapenemases by the modified Hodge test, while 27/28 isolates harbouring blaKPC-2 were positive for carbapenemases determined by this test; 41·2% of the CRE-positive isolates also harboured ESBL genes in various combinations (three and two positive for blaKPC-2 also carried blaDHA-1 and blaCMY-2). The positive rates of qnrS1, qnrA1, qnrB and aac-(6/)-Ib-cr in CRE were 25·5%, 9·8%, 23·5% and 15·7%, respectively. In particular, 7/9 isolates harbouring blaNDM-1 were positive for these quinolone resistance genes, of which five carried qnrS1 and two carried qnrS1 and qnrB4. All but two of 29 Klebsiella pneumoniae isolates were grouped into 20 clonal clusters by PFGE, with the predominant cluster accounting for four blaKPC-2-positive isolates distributed in the same hospital. We conclude that there is a high prevalence of blaNDM-1 and PMQR determinants in CRE isolates in central China. Multiple resistance determinants in various combinations co-exist in these strains and we report for the first time the co-existence of blaKPC-2 and blaIMP-26 in a strain of Klebsiella oxytoca.

First description of NDM-1-, KPC-2-, VIM-2- and IMP-4-producing Klebsiella pneumoniae strains in a single Chinese teaching hospital

2014 ◽  
Vol 143 (2) ◽  
pp. 376-384 ◽  
Author(s):  
Y. LIU ◽  
L.-G. WAN ◽  
Q. DENG ◽  
X.-W. CAO ◽  
Y. YU ◽  
...  
Keyword(s):  
16S Rrna ◽  
Klebsiella Pneumoniae ◽  
Teaching Hospital ◽  
Multidrug Resistant ◽  
The Other ◽  
Quinolone Resistance ◽  
Resistance Determinants ◽  
Carbapenem Resistant ◽  
Extended Spectrum ◽  
Chinese Teaching

SUMMARYA total of 180 non-duplicate carbapenem-resistant Klebsiella pneumoniae isolates were recovered from patients hospitalized between December 2010 and January 2012 at a Chinese hospital. Eight KPC-2, four NDM-1, one VIM-2, and five KPC-2 plus IMP-4 producers were identified and all were multidrug resistant due to the presence of other resistance determinants, including extended-spectrum β-lactamases (CTX-M-15, SHV-12), 16S rRNA methylases (armA, rmtB) and plasmid-mediated quinolone-resistance determinants (qnrA, B, S, aac(6′)-Ib-cr). Nine K. pneumoniae clones (Kpn-A1/ST395, Kpn-A3/ST11, Kpn-A2/ST134, Kpn-B/ST263, Kpn-C/ST37, Kpn-D/ST39, Kpn-E/ST1151, Kpn-F/ST890, Kpn-G/ST1153) were identified. blaKPC-2 was located on transferable ~65 kb IncL/M (ST395, ST11, ST134, ST39) and ~100 kb IncA/C (ST37, ST1153, ST890) plasmids, respectively. On the other hand, blaNDM-1 was associated with a ~70 kb IncA/C plasmid (ST263). However, non-typable plasmids of ~40 kb containing blaVIM-2 were detected in the ST1151 clone. This work reports the first co-occurrence of four diverse types of carbapenemase of K. pneumoniae clones from a single hospital in China. IncA/C, IncL/M, and other successful plasmids may be important for the dissemination of carbapenemases, producing a complex epidemiological picture.

scholarly journals Distinctive features of ertapenem mono-resistant carbapenem-resistant Enterobacterales in the United States: A cohort study

2021 ◽  
Author(s):  
Max W Adelman ◽  
Chris W Bower ◽  
Julian E Grass ◽  
Uzma A Ansari ◽  
Elizabeth A Soda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enterobacter Cloacae ◽  
The United States ◽  
Resistant Bacteria ◽  
Emerging Infections ◽  
Logistic Regression Models ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Sterile Site ◽  
Enterobacter Cloacae Complex

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are highly antibiotic-resistant bacteria. Whether CRE resistant only to ertapenem among carbapenems (ertapenem “mono-resistant”) represent a unique CRE subset with regards to risk factors, carbapenemase genes, and outcomes is unknown. Methods We analyzed surveillance data from nine CDC Emerging Infections Program (EIP) sites. A case was the first isolation of a carbapenem-resistant Enterobacter cloacae complex, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, or K. variicola from a normally sterile site or urine in an EIP catchment area resident in 2016-2017. We compared risk factors, carbapenemase genes, antibiotic susceptibility, and mortality of ertapenem “mono-resistant” cases to “other” CRE cases (resistant to ≥1 carbapenem other than ertapenem), and analyzed risk factors for mortality. Results Of 2009 cases, 1249 (62.2%) were ertapenem mono-resistant and 760 (37.8%) were other CRE. Ertapenem mono-resistant CRE cases were more frequently ≥80 years old (29.1% vs. 19.5%, p<0.0001) and female (67.9% vs 59.0%, p<0.0001). Ertapenem mono-resistant isolates were more likely to be Enterobacter cloacae complex (48.4% vs. 15.4%, p<0.0001) but less likely to be isolated from a normally sterile site (7.1% vs. 11.7%, p<0.01) or have a carbapenemase gene (2.4% vs. 47.4%, p<0.0001). Ertapenem mono-resistance was not associated with 90-day mortality in logistic regression models. Carbapenemase-positive isolates were associated with mortality (odds ratio 1.93, 95% confidence interval 1.30-2.86). Conclusions Ertapenem mono-resistant CRE rarely have carbapenemase genes and have distinct clinical and microbiologic characteristics from other CRE. These findings may inform antibiotic choice and infection prevention practices, particularly when carbapenemase testing is not available.

scholarly journals Enterobacter cloacae Complex Isolates Harboring blaNMC-A or blaIMI-Type Class A Carbapenemase Genes on Novel Chromosomal Integrative Elements and Plasmids

2017 ◽  
Vol 61 (5) ◽  
Author(s):  
David A. Boyd ◽  
Laura F. Mataseje ◽  
Ross Davidson ◽  
Johannes A. Delport ◽  
Jeff Fuller ◽  
...  
Keyword(s):  
Enterobacter Cloacae ◽  
Reference Laboratory ◽  
Chromosomal Locus ◽  
Complex Species ◽  
Content Type ◽  
Class A ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Enterobacter Ludwigii ◽  
Enterobacter Cloacae Complex

ABSTRACT Carbapenem-resistant Enterobacter cloacae complex isolates submitted to a reference laboratory from 2010 to 2015 were screened by PCR for seven common carbapenemase gene groups, namely, KPC, NDM, OXA-48, VIM, IMP, GES, and NMC-A/IMI. Nineteen of the submitted isolates (1.7%) were found to harbor Ambler class A bla NMC-A or bla IMI-type carbapenemases. All 19 isolates were resistant to at least one carbapenem but susceptible to aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, and ciprofloxacin. Most isolates (17/19) gave positive results with the Carba-NP test for phenotypic carbapenemase detection. Isolates were genetically diverse by pulsed-field gel electrophoresis macrorestriction analysis, multilocus sequence typing, and hsp60 gene analysis. The genes were found in various Enterobacter cloacae complex species; however, bla NMC-A was highly associated with Enterobacter ludwigii. Whole-genome sequencing and bioinformatics analysis revealed that all NMC-A (n = 10), IMI-1 (n = 5), and IMI-9 (n = 2) producers harbored the carbapenemase gene on EludIMEX-1-like integrative mobile elements (EcloIMEXs) located in the identical chromosomal locus. Two novel genes, bla IMI-5 and bla IMI-6, were harbored on different IncFII-type plasmids. Enterobacter cloacae complex isolates harboring bla NMC-A/IMI-type carbapenemases are relatively rare in Canada. Though mostly found integrated into the chromosome, some variants are located on plasmids that may enhance their mobility potential.

scholarly journals Distribution of fluoroquinolone resistance determinants in Carbapenem-resistant Klebsiella pneumoniae clinical isolates associated with bloodstream infections in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qing Zhan ◽  
Yanlei Xu ◽  
Bingjie Wang ◽  
Jingyi Yu ◽  
Xiaofei Shen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bloodstream Infections ◽  
Quinolone Resistance ◽  
Fluoroquinolone Resistance ◽  
Teaching Hospitals ◽  
Resistance Level ◽  
Extended Spectrum Beta Lactamase ◽  
Resistance Determinants ◽  
Carbapenem Resistant ◽  
High Prevalence

Abstract Background The rate of fluoroquinolone (FQ) resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) is high. The present study aimed to investigate the distribution of fluoroquinolone resistance determinants in clinical CRKP isolates associated with bloodstream infections (BSIs). Results A total of 149 BSI-associated clinical CRKP isolates collected from 11 Chinese teaching hospitals from 2015 to 2018 were investigated for the prevalence of fluoroquinolone resistance determinants, including plasmid-mediated quinolone resistance (PMQR) genes and spontaneous mutations in the quinolone resistance-determining regions (QRDRs) of the gyrA and parC genes. Among these 149 clinical CRKP isolates, 117 (78.5%) exhibited resistance to ciprofloxacin. The GyrA substitutions (Ser83 → IIe/Phe) and (Asp87 → Gly/Ala) were found among 112 (75.2%) of 149 isolates, while the substitution (Ser80 → IIe) of ParC was found in 111 (74.5%) of the 149 isolates. In total, 70.5% (105/149) of the CRKP isolates had at least two mutations within gyrA as well as a third mutation in parC. No mutations in the QRDRs were found in 31 ciprofloxacin susceptible CRKP isolates. Eighty-nine (56.9%) of 149 were found to carry PMQR genes including qnrS1 (43.0%), aac(6′)-Ib-cr (16.1%), qnrB4 (6.0%), qnrB2 (2.7%), and qnrB1 (1.3%). Nine isolates contained two or more PMQR genes, with one carrying four [aac(6′)-Ib-cr, qnr-S1, qnrB2, and qnrB4]. The co-existence rate of PMQR determinants and mutations in the QRDRs of gyrA and parC reached 68.5% (61/89). Seventy-four (83.1%, 74/89) PMQR-positive isolates harbored extended-spectrum beta-lactamase (ESBL)-encoding genes. Multilocus sequence typing (MLST) analysis demonstrated that the ST11 was the most prevalent STs in our study. Conclusions Mutations in the QRDRs of gyrA and parC were the key factors leading to the high prevalence of fluoroquinolone resistance among BSI-associated CRKP. The co-existence of PMQR genes and mutations in the QRDRs can increase the resistance level of CRKP to fluoroquinolones in clinical settings. ST11 CRKP isolates with identical QRDR substitution patterns were found throughout hospitals in China.

scholarly journals Resistome Analysis of Enterobacter cloacae CY01, an Extensively Drug-Resistant Strain Producing VIM-1 Metallo-β-Lactamase from China

2014 ◽  
Vol 58 (10) ◽  
pp. 6328-6330 ◽  
Author(s):  
Ling Yang ◽  
Ai-Wu Wu ◽  
Dan-Hong Su ◽  
Yong-Ping Lin ◽  
Ding-Qiang Chen ◽  
...  
Keyword(s):  
Enterobacter Cloacae ◽  
Multiple Resistance ◽  
Replicase Gene ◽  
Drug Resistant ◽  
Content Type ◽  
Resistance Determinants ◽  
Extensively Drug Resistant ◽  
Carbapenemase Gene ◽  
Resistance Plasmids ◽  
Cole1 Plasmid

ABSTRACTResistome analysis of clinical VIM-1-producingEnterobacter cloacaestrain CY01 from China revealed the presence of multiple resistance determinants. Two resistance plasmids were identified in CY01. The pCY-VIM plasmid was 14 kb in size and possessed a replicase gene (repA), a gene cluster encoding the partitioning function (parABC), and a carbapenemase gene (blaVIM-1). Another 5.9-kb plasmid, pCY-MdT, with anaac(6′)-Ibgene, was very closely related (13 nucleotide differences) to pMdT1, a ColE1 plasmid carryingaac(6′)-Ib-cr4.

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