The epidemiology and clinical characteristics of carbapenem-resistant Enterobacteriaceae (CRE) isolates from children in eastern China.

INTRODUCTION

Carbapenem-resistant Enterobacteriaceae (CRE) is the most common clinical pathogens. Investigating the antimicrobial resistance, hypervirulence and clinical characteristics of CRE isolated from children is helpful to guide for anti-infection treatments.

METHODS

Nonduplicated CRE clinical strains were isolated and mass spectrometry was applied to identify clinical isolated strains. VITEK 2 Compact system and Kirby-Bauer method were used to analyze the antimicrobial susceptibility. Besides, the drug resistance and hypervirulence associated genes were detected by polymerase chain reaction (PCR) and sequencing.

RESULTS

A total of 281 non-duplicated CRE strains were identified in this study. Klebsiella pneumoniae (55.87%), Escherichia coli (36.65%) and Klebsiella aerogenes (3.20%) were the top 3 CRE strains. These strains showed high resistance to most of antimicrobial agents and carried carbapenemase genes, including bla OXA-232 (38.08%), bla KPC-2 (20.28%), bla OXA-1 (17.08%), bla NDM-5 (10.32%) and bla NDM-1 (8.90%). In addition, bla TEM-1 (98.93%), bla CTX-M-14 (88.61%) and bla SHV-11 (87.54%) were the prevalent extended-spectrum β-lactamase (ESBL) genes in these strains, while the detection rate of AmpC cephalosporinase genes were not high. Besides, 45 (28.66%) carbapenem-resistant Klebsiella pneumoniae (CRKP) strains carried hypervirulence associated genes iucA (24.84%), prmpA (17.83%), peg-344 (17.20%), and prmpA2 (9.55%). Among them, 22 (14.01%) CRKP strains were also identified as carbapenem-resistant and hypervirulent Klebsiella pneumoniae (CR-HVKP). What's worse, the patients infected with CR-HVKP had a worse prognosis overall.

CONCLUSION

This study revealed the drug resistance, hypervirulence and epidemiology of CRE strains in pediatric patients in Suzhou of eastern China. Unfortunately, CR-HVKP strains with more several infection were also identified, which should be of great concern to clinicians.