High incidence and endemic spread of NDM-1-positive Enterobacteriaceae in Henan Province, China.
The emergence and spread of New Delhi metallo-β-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla(NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla(NDM-1), and the gene was found to be carried on plasmids of various sizes (∼ 55 to ∼ 360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla(NDM-1)-positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla(NDM-1)-positive CRE isolate, the bla(NDM-1) gene was downstream of an intact ISAba125 element and upstream of the bleMBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla(NDM-1)-containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
Shangshang
S
Qin
Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Ying
Y
Fu
Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA.
Qijing
Q
Zhang
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
Hui
H
Qi
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Jian Guo
JG
Wen
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Hui
H
Xu
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Lijuan
L
Xu
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Li
L
Zeng
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Hao
H
Tian
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Lijuan
L
Rong
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
Yonghong
Y
Li
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
Lihong
L
Shan
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
Hongde
H
Xu
Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Yunsong
Y
Yu
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China xjfeng62688@163.com liuhm@zzu.edu.cn.
Xianju
X
Feng
School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China xjfeng62688@163.com liuhm@zzu.edu.cn.
Hong-Min
HM
Liu
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D003227:Conjugation, Genetic; D004269:DNA, Bacterial / Q000235:genetics*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D062665:Epidemiological Monitoring; D005578:Fosfomycin / Q000494:pharmacology; D005838:Genotype; D006801:Humans; D015994:Incidence; D058885:Multilocus Sequence Typing; D010957:Plasmids / Q000737:chemistry* / Q000378:metabolism; D001618:beta-Lactamases / Q000235:genetics*
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004269:DNA, Bacterial; D005578:Fosfomycin; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1