Prevalence of Intestinal Colonization and Nosocomial Infection with Carbapenem-resistant in Children: a Retrospective Study

Overview

Journal Front Public Health

Specialty Public Health

Date 2023 Dec 11

PMID 38074706

Authors

Fen Pan

Pengcheng Chen

Yuxin Duan

Fangyuan Yu

Wenhao Weng

Hong Zhang

Affiliations

Soon will be listed here.

Abstract

Objective: We investigated the epidemiological surveillance of the intestinal colonization and nosocomial infection of carbapenem-resistant (CRE) isolates from inpatients, which can provide the basis for developing effective prevention.

Methods: A total of 96 CRE strains were collected from 1,487 fecal samples of hospitalized children between January 2016 and June 2017, which were defined as the "CRE colonization" group. In total, 70 CRE clinical isolates were also randomly selected for the comparison analysis and defined as the "CRE infection" group. The antimicrobial susceptibility of all strains was determined by the microdilution broth method. Polymerase chain reaction (PCR) was used to analyze carbapenemase genes, plasmid typing, and integrons. Multilocus sequence typing was further used to determine clonal relatedness.

Results: In the "CRE colonization" group, was mostly detected with a rate of 42.7% (41/96), followed by (34.4%, 33/96) and (15.6%, 15/96). The ST11 KPC-2 producer, ST8 NDM-5 producer, and ST45 NDM-1 producer were commonly present in carbapenem-resistant (CRKPN), carbapenem-resistant (CRECO), and carbapenem-resistant (CRECL) isolates, respectively. In the "CRE infection" group, 70% (49/70) of strains were , with 21.4% (15/70) and 5.7% (4/70). The ST15 OXA-232 producer and ST48 NDM-5 producer were frequently observed in CRKPN isolates, while the majority of NDM-1-producing CRECL isolates were assigned as ST45. Phylogenetic analysis showed that partial CRE isolates from intestinal colonization and nosocomial infection were closely related, especially for ST11 KPC-2-producing CRKPN and ST45 NDM-1-producing CRECL. Furthermore, plasmid typing demonstrated that IncF and IncFIB were the most prevalent plasmids in KPC-2 producers, while IncX3/IncX2 and ColE were widely spread in NDM producer and OXA-232 producer, respectively. Then, class 1 integron intergrase was positive in 74.0% (71/96) of the "CRE colonization" group and 52.9% (37/70) of the "CRE infection" group.

Conclusion: This study revealed that CRE strains from intestinal colonization and nosocomial infection showed a partial correlation in the prevalence of CRE, especially for ST11 KPC-2-producing CRKPN and ST45 NDM-1-producing CRECL. Therefore, before admission, long-term active screening of rectal colonization of CRE isolates should be emphasized.

Citing Articles

The pivotal role of IncFIB(Mar) plasmid in the emergence and spread of hypervirulent carbapenem-resistant .

Sun Z, Zhang J, Wang C, Chen J, Li P, Su J Sci Adv. 2025; 11(5):eado9097.

PMID: 39888998 PMC: 11784837. DOI: 10.1126/sciadv.ado9097.

References

Ariyoshi T, Aoki K, Kubota H, Sadamasu K, Ishii Y, Tateda K . Molecular Characterization of -Carrying IncX3 Plasmids: Likely Emerged from a Mutation of on IncX3 Plasmid. Microbiol Spectr. 2022; 10(4):e0144922. PMC: 9430178. DOI: 10.1128/spectrum.01449-22. View

Zeng G, Pang Y, Zheng J, Zhuo C, Guo Y, Liang J . Colonization with Carbapenem-Resistant Contributes to Unfavorable Outcomes in End-Stage Liver Disease Patients. Antibiotics (Basel). 2022; 11(11). PMC: 9686982. DOI: 10.3390/antibiotics11111667. View

Rui Y, Lu W, Li S, Cheng C, Sun J, Yang Q . Integrons and insertion sequence common region 1 (ISCR1) of carbapenem-non-susceptible Gram-negative bacilli in fecal specimens from 5000 patients in southern China. Int J Antimicrob Agents. 2018; 52(5):571-576. DOI: 10.1016/j.ijantimicag.2018.06.015. View

Magobo R, Ismail H, Lowe M, Strasheim W, Mogokotleng R, Perovic O . Outbreak of NDM-1- and OXA-181-Producing Klebsiella pneumoniae Bloodstream Infections in a Neonatal Unit, South Africa. Emerg Infect Dis. 2023; 29(8):1531-1539. PMC: 10370860. DOI: 10.3201/eid2908.230484. View

Zeng M, Xia J, Zong Z, Shi Y, Ni Y, Hu F . Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli. J Microbiol Immunol Infect. 2023; 56(4):653-671. DOI: 10.1016/j.jmii.2023.01.017. View

Zhu Z, Xie X, Yu H, Jia W, Shan B, Huang B . Epidemiological characteristics and molecular features of carbapenem-resistant strains in China: a multicenter genomic study. Emerg Microbes Infect. 2022; 12(1):2148562. PMC: 9769138. DOI: 10.1080/22221751.2022.2148562. View

Chiotos K, Tamma P, Flett K, Naumann M, Karandikar M, Bilker W . Multicenter Study of the Risk Factors for Colonization or Infection with Carbapenem-Resistant Enterobacteriaceae in Children. Antimicrob Agents Chemother. 2017; 61(12). PMC: 5700345. DOI: 10.1128/AAC.01440-17. View

Potron A, Rondinaud E, Poirel L, Belmonte O, Boyer S, Camiade S . Genetic and biochemical characterisation of OXA-232, a carbapenem-hydrolysing class D β-lactamase from Enterobacteriaceae. Int J Antimicrob Agents. 2013; 41(4):325-9. DOI: 10.1016/j.ijantimicag.2012.11.007. View

Estabrook M, Muyldermans A, Sahm D, Pierard D, Stone G, Utt E . Epidemiology of Resistance Determinants Identified in Meropenem-Nonsusceptible Collected as Part of a Global Surveillance Study, 2018 to 2019. Antimicrob Agents Chemother. 2023; 67(5):e0140622. PMC: 10190273. DOI: 10.1128/aac.01406-22. View

10.

Mannathoko N, Mosepele M, Gross R, Smith R, Alby K, Glaser L . Colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) in healthcare and community settings in Botswana: an antibiotic resistance in communities and hospitals (ARCH) study. Int J Infect Dis. 2022; 122:313-320. DOI: 10.1016/j.ijid.2022.06.004. View

11.

Carattoli A, Bertini A, Villa L, Falbo V, Hopkins K, Threlfall E . Identification of plasmids by PCR-based replicon typing. J Microbiol Methods. 2005; 63(3):219-28. DOI: 10.1016/j.mimet.2005.03.018. View

12.

Liu C, Fang Y, Zeng Y, Lu J, Sun Q, Zhou H . First Report of OXA-181-Producing in China. Infect Drug Resist. 2020; 13:995-998. PMC: 7147608. DOI: 10.2147/IDR.S237793. View

13.

Yee R, Fisher S, Bergman Y, Chambers K, Tamma P, Carroll K . Combined selective culture and molecular methods for the detection of carbapenem-resistant organisms from fecal specimens. Eur J Clin Microbiol Infect Dis. 2021; 40(11):2315-2321. DOI: 10.1007/s10096-021-04281-8. View

14.

Wu Y, Hu X, Wu D, Li R, Wang X, Zhang J . Prevalence and risk factors for colonisation and infection with carbapenem-resistant Enterobacterales in intensive care units: A prospective multicentre study. Intensive Crit Care Nurs. 2023; 79:103491. DOI: 10.1016/j.iccn.2023.103491. View

15.

Yin D, Dong D, Li K, Zhang L, Liang J, Yang Y . Clonal Dissemination of OXA-232 Carbapenemase-Producing Klebsiella pneumoniae in Neonates. Antimicrob Agents Chemother. 2017; 61(8). PMC: 5527636. DOI: 10.1128/AAC.00385-17. View

16.

Tran D, Larsson M, Olson L, Hoang N, Le N, Khu D . High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease. J Infect. 2019; 79(2):115-122. DOI: 10.1016/j.jinf.2019.05.013. View

17.

Shu L, Lu Q, Sun R, Lin L, Sun Q, Hu J . Prevalence and phenotypic characterization of carbapenem-resistant strains recovered from sputum and fecal samples of ICU patients in Zhejiang Province, China. Infect Drug Resist. 2018; 12:11-18. PMC: 6302810. DOI: 10.2147/IDR.S175823. View

18.

Chen D, Jiang Y, Feng D, Wen S, Su D, Yang L . Integron mediated bacterial resistance and virulence on clinical pathogens. Microb Pathog. 2017; 114:453-457. DOI: 10.1016/j.micpath.2017.12.029. View

19.

Salomao M, Freire M, Lazari C, Cury A, Rossi F, Segurado A . Transmission of Carbapenem-Resistant Enterobacterales in an Overcrowded Emergency Department: Controlling the Spread to the Hospital. Clin Infect Dis. 2023; 77(Suppl 1):S46-S52. PMC: 10321690. DOI: 10.1093/cid/ciad263. View

20.

Tinelli M, Rossini A, Scudeller L, Zabzuni D, Errico G, Fogato E . Dynamics of carbapenemase-producing Enterobacterales intestinal colonisation in the elderly population after hospital discharge, Italy, 2018-2020. Int J Antimicrob Agents. 2022; 59(6):106594. DOI: 10.1016/j.ijantimicag.2022.106594. View