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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (2) : 182-188
Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou, China
Yan Yang, Jian Chen, Di Lin, Xujian Xu, Jun Cheng(), Changgui Sun()
Department of Clinical Laboratory Science, The 117th Hospital of PLA, Hangzhou 310013, China
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With the abuse of antimicrobial agents in developing countries, increasing number of carbapenem-resistant Enterobacteriaceae (CRE) attracted considerable public concern. A retrospective study was conducted based on 242 CRE strains from a tertiary hospital in Hangzhou, China to investigate prevalence and drug resistance characteristics of CRE in southeast China. Bacterial species were identified. Antimicrobial susceptibility was examined by broth microdilution method or epsilometer test. Resistant β-lactamase genes were identified by polymerase chain reaction and sequencing. Genotypes were investigated by phylogenetic analysis. Klebsiella pneumoniae and Escherichia coli were the most prevalent types of species, with occurrence in 71.9% and 21.9% of the strains, respectively. All strains exhibited high resistance (>70%) against β-lactam antibiotics, ciprofloxacin, trimethoprim–sulfamethoxazole, and nitrofurantoin but exhibited low resistance against tigecycline (0.8%) and minocycline (8.3%). A total of 123 strains harbored more than two kinds of β-lactamase genes. blaKPC-2, blaSHV-11, blaTEM-1, and blaCTX-M-14 were the predominant genotypes, with detection rates of 60.3%, 61.6%, 43.4%, and 16.5%, respectively, and were highly identical with reference sequences in different countries, indicating potential horizontal dissemination. IMP-4 was the most frequent class B metallo-lactamases in this study. In conclusion, continuous surveillance and effective prevention should be emphasized to reduce spread of CRE.

Keywords Enterobacteriaceae      carbapenem      β-lactamase genes      phylogenetic analysis     
Corresponding Authors: Jun Cheng,Changgui Sun   
Just Accepted Date: 02 June 2017   Online First Date: 10 July 2017    Issue Date: 02 April 2018
 Cite this article:   
Yan Yang,Jian Chen,Di Lin, et al. Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou, China[J]. Front. Med., 2018, 12(2): 182-188.
Antimicrobial agent Two major species in CRE strains Total strains
(n = 242)
Escherichia coli (n = 53) K. pneumoniae (n = 174) P value
Tigecycline 0 (0) 2 (1.1) 1.000 2 (0.8)
Minocycline 4 (7.5) 16 (9.2) 0.925 20 (8.3)
Amikacin 9 (17.0) 89 (51.1) 0.000* 102 (42.1)
Tobramycin 19 (35.8) 107 (61.5) 0.001* 132 (54.5)
Tetracycline 44 (83.0) 98 (56.3) 0.000* 151 (62.4)
Nitrofurantoin 3 (5.7) 161 (92.5) 0.000* 173 (71.49)
Trimethoprim–sulfamethoxazole 45 (84.9) 141 (81.0) 0.521 192 (79.3)
Ciprofloxacin 48 (90.6) 157 (90.2) 0.942 212 (87.6)
Cefoxitin 30 (56.6) 170 (97.7) 0.000* 215 (88.8)
Cefepime 38 (71.7) 167 (96.0) 0.000* 215 (88.8)
Ceftazidime 37 (69.8) 169 (97.1) 0.000* 218 (90.1)
Imipenem 47 (88.7) 165 (94.8) 0.207 224 (92.6)
Aztreonam 50 (94.3) 167 (96.0) 0.899 228 (94.2)
Ertapenem 52 (98.1) 166 (95.4) 0.629 233 (96.28)
Amoxicillin clavulanate 50 (94.3) 171 (98.3) 0.282 236 (97.5)
Cefotaxime 52 (98.1) 173 (99.4) 0.413 240 (99.2)
Tab.1  Antimicrobial resistance of 242 carbapenem-resistant Enterobacteriaceae (CRE) strains
Fig.1  The blue circle denotes the primary founder. The yellow circle denotes the subgroup founder. The pink number denotes the ST type detected in this study and in Zhejiang. Green numbers denote ST types detected only in this study. Circle area is proportional to abundance of ST.
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