Prevalence of carbapenem-resistant Enterobacterales with bla IMP-6 predominance in hospitals from 2018 to 2021 in Nara, Japan.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-08-20 eCollection Date: 2024-08-01 DOI:10.1093/jacamr/dlae135
Rio Kishi, Ryuichi Nakano, Akiyo Nakano, Takehito Harimoto, Ryusei Taniguchi, Sayaka Ando, Yuki Suzuki, Koichi Yamaguchi, Daisuke Kitagawa, Saori Horiuchi, Kousuke Tsubaki, Ryuichi Morita, Takashi Kawabe, Hisakazu Yano
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Abstract

Objectives: Despite the global health risk of carbapenem-resistant Enterobacterales (CRE), especially carbapenemase-producing Enterobacterales (CPE), Japan reports a significantly low frequency of CRE with a predominance of IMP-type carbapenemases. This study aimed to investigate the prevalence and characteristics of CRE isolated from hospitals in the city of Nara, Japan.

Methods: We obtained 171 CRE isolates from 16 791 Enterobacterales isolated at 23 hospitals in Nara between January 2018 and December 2021. Isolates of CPE were characterized through antimicrobial susceptibility testing, the carbapenem inactivation method, PCR and DNA sequencing. Genotypic diversity of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae was determined via MLST and PFGE.

Results: The prevalence of CRE between 2018 and 2021 was 1.02%, gradually decreasing from 1.13% to 0.74%. Ninety-nine isolates were identified as CPE, representing six species. Ninety-seven CPE isolates harboured bla IMP-6, while the remaining two carried either bla IMP-1 or bla IMP-19. Genotype analysis identified ST131 as the dominant genotype for E. coli, but none for K. pneumoniae. PFGE results suggested clonal spread of CPE in Hospital A, where CRE was isolated in high numbers (n = 44).

Conclusions: In this study, CRE prevalence was marginally higher than previously reported in Japan, but still low in frequency. A predominance of Enterobacterales harbouring bla IMP-6 was confirmed in Nara. The spread of CPE at Hospital A suggested the possibility of a nosocomial outbreak due to bla IMP-6 transmission via plasmids or clonal spread. Continued monitoring is crucial for effective management of CRE prevalence in the region.

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2018年至2021年日本奈良医院中以Bla IMP-6为主的耐碳青霉烯类肠杆菌的流行率。
目的:尽管耐碳青霉烯类肠杆菌(CRE),尤其是产碳青霉烯酶肠杆菌(CPE)对全球健康构成威胁,但日本报告的 CRE 感染率却很低,且以 IMP 型碳青霉烯酶为主。本研究旨在调查从日本奈良市医院分离出的 CRE 的流行率和特征:2018年1月至2021年12月期间,我们从奈良23家医院分离的16 791株肠杆菌中获得了171株CRE分离株。我们通过抗菌药敏感性试验、碳青霉烯灭活法、PCR 和 DNA 测序对 CPE 分离物进行了鉴定。通过 MLST 和 PFGE 确定了产碳青霉烯酶大肠埃希菌和肺炎克雷伯菌的基因型多样性:2018年至2021年间,CRE的流行率为1.02%,从1.13%逐渐降至0.74%。99株分离物被鉴定为CPE,代表6个物种。97 株 CPE 分离物携带 bla IMP-6,其余 2 株携带 bla IMP-1 或 bla IMP-19。基因型分析发现,ST131 是大肠杆菌的主要基因型,但没有发现肺炎双球菌的基因型。PFGE 结果表明,CPE 在医院 A 中呈克隆性传播,在医院 A 中分离出大量的 CRE(n = 44):结论:在这项研究中,CRE 的流行率略高于之前在日本的报道,但仍然较低。在奈良,携带 bla IMP-6 的肠杆菌占多数。A 医院 CPE 的传播表明,有可能是由于 bla IMP-6 通过质粒或克隆传播而导致的院内爆发。持续监测对于有效控制该地区的 CRE 感染率至关重要。
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