Fecal carriage and molecular characterization of carbapenem-resistant Enterobacteriaceae from hospitalized children in a tertiary hospital of Shandong, China.

IF 4 2区生物学 Q2 MICROBIOLOGY Frontiers in Microbiology Pub Date : 2025-02-18 eCollection Date: 2025-01-01 DOI:10.3389/fmicb.2025.1542207

Xia Deng, Shuyun Wang, Peibin Hou, Na Sun, Ying Yang, Qian Zeng, Juan Wang, Chunping Wang, Xin Lv, Wenqiang Zhang, Ruyue Fan

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Abstract

Background: The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a serious public health problem worldwide, and the data on the fecal carriage of CRE strains in hospitalized children remain limited. This study aimed to investigate the molecular characteristics of intestinal colonization of CRE in hospitalized children in Shandong, China.

Methods: A retrospective study was conducted from August to November 2023. Antimicrobial susceptibility testing was performed by the broth microdilution method. Carbapenemase genes, drug resistance genes, and plasmid replicon types were detected using multiplex real-time PCR and whole-genome sequencing. Multilocus sequence typing (MLST) was used to determine the genetic relationships between strains.

Results: A total of 20 CRE isolates were identified from 432 fecal samples, with a fecal carriage rate of 4.6%. The CRE isolates predominantly consisted of Escherichia coli (E. coli, n = 13) and Klebsiella strains (n = 6). CRE isolates showed a high resistance rate of 90-100% to seven β-lactam antibiotics. Resistance rates for other antibiotics such as trimethoprim-sulfamethoxazole, tetracycline, azithromycin, ciprofloxacin, chloramphenicol, nalidixic acid, and streptomycin were 90, 85, 85, 80, 75, 75, and 75%, respectively. CRE isolates showed low resistance to amikacin (20%), and none of the isolates were resistant to tigecycline. Additionally, the multidrug resistance rate of CRE isolates was 95%. All CRE strains carried sulfonamide antibiotic and β-lactamase resistance genes, of which the most common β-lactamase resistance genes were bla _NDM-1 (n = 9), bla _NDM-5 (n = 7) and bla _OXA-1 (n = 7). Resistance genes to tetracycline and macrolide antibiotics were also widespread among the strains. The study found that IncFIB and IncFII series plasmids were present in 84 and 42% of the CRE strains, respectively. Additionally, Col, IncFIA, IncC, IncHI2, and IncX series plasmids were also detected. MLST analysis revealed diverse sequence types (STs) among CRE isolates, with ST167 being a common ST among E. coli isolates.

Conclusion: This study revealed bla _NDM E. coli were the dominant isolates in fecal samples of hospitalized children in Shandong Province, with a broad multidrug resistance to antibiotics, emphasizing that infection control measures need to be taken to limit the spread of these strains.

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山东省某三级医院住院儿童耐碳青霉烯肠杆菌科的粪便携带及分子特征

背景：碳青霉烯耐药肠杆菌科（CRE）的流行已成为世界范围内严重的公共卫生问题，关于住院儿童CRE菌株粪便携带的数据仍然有限。本研究旨在探讨中国山东住院儿童CRE肠道定植的分子特征。方法：于2023年8月至11月进行回顾性研究。采用微量肉汤稀释法进行药敏试验。采用多重实时PCR和全基因组测序检测碳青霉烯酶基因、耐药基因和质粒复制子类型。采用多位点序列分型（MLST）确定菌株间的遗传关系。结果：从432份粪便中检出CRE分离株20株，粪便携带率为4.6%。CRE菌株主要由大肠杆菌（E. coli, n = 13）和克雷伯菌（n = 6）组成。CRE菌株对7种β-内酰胺类抗生素的耐药率为90 ~ 100%。对甲氧苄啶-磺胺甲恶唑、四环素、阿奇霉素、环丙沙星、氯霉素、萘啶酸、链霉素的耐药率分别为90、85、85、80、75、75、75%。CRE分离株对阿米卡星耐药低（20%），对替加环素无耐药。此外，CRE分离株的多重耐药率为95%。所有CRE菌株均携带磺胺类抗生素和β-内酰胺酶耐药基因，其中最常见的β-内酰胺酶耐药基因为bla NDM-1 （n = 9）、bla NDM-5 （n = 7）和bla OXA-1 （n = 7）。对四环素和大环内酯类抗生素的耐药基因在菌株中也广泛存在。研究发现，IncFIB和IncFII系列质粒分别存在于84%和42%的CRE菌株中。此外，还检测了Col、IncFIA、IncC、incchi2和IncX系列质粒。MLST分析显示CRE分离株存在不同的序列类型（STs），其中ST167是大肠杆菌分离株中常见的ST。结论：本研究显示，bla NDM大肠杆菌是山东省住院儿童粪便样本中的优势菌株，对抗生素具有广泛的多药耐药，需要采取感染控制措施，限制该菌株的传播。

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来源期刊

Frontiers in Microbiology MICROBIOLOGY-

CiteScore

7.70

自引率

9.60%

发文量

4837

审稿时长

14 weeks

期刊介绍： Frontiers in Microbiology is a leading journal in its field, publishing rigorously peer-reviewed research across the entire spectrum of microbiology. Field Chief Editor Martin G. Klotz at Washington State University is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.