Leclercia adecarboxylata is a Gram-negative bacterium belonging to the Enterobacteriaceae family. To our knowledge, this is the first report of a carbapenem-resistant L. adecarboxylata strain isolated from a healthy newborn. The L. adecarboxylata strain isolated in this study carried four plasmids that may serve as reservoirs for antibiotic resistance genes. Plasmids 2 and 4 did not harbor any antimicrobial resistance genes. Plasmid 3 is a novel plasmid containing three resistance genes. The bla _IMP gene harbored in the strain was most similar to bla _IMP-79 at the nucleotide level, with a similarity of 99.4% (737/741). This case highlights the importance of considering L. adecarboxylata as a potential cause of infections in children.
Infant, Newborn ; Child ; Humans ; Female ; Enterobacteriaceae Infections/microbiology* ; Enterobacteriaceae/genetics* ; Anti-Bacterial Agents/therapeutic use* ; Plasmids

Objective: The study investigated the clinical distribution, antimicrobial resistance and epidemiologic characteristics of hypervirulent Carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) in a hospital in Henan Province to provide a scientific basis for antibiotic use and nosocomial infection prevention and control. Methods: A retrospective analysis of the clinical data from the cases was carried out in this study. Clinical data of patients infected with the CRKP strain isolated from the clinical microbiology laboratory of Henan Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were retrospectively analyzed. A string test, virulence gene screening, serum killing, and a G. mellonella infection model were used to screen hv-CRKP isolates. The clinical characteristics of hv-CRKP and the drug resistance rate of hv-CRKP to twenty-five antibiotics were analyzed using WHONET 5.6. Carbapenemase phenotypic characterization of the hv-CRKP was performed by colloidal gold immunochromatographic assay, and Carbapenemase genotyping, multi-locus sequence typing (MLST) and capsular serotyping of hv-CRKP isolates were performed by PCR and Sanger sequencing. Results: A total of non-duplicate 264 CRKP clinical isolates were detected in the hospital from 2020 to 2022, and 23 hv-CRKP isolates were detected, so the corresponding detection rate of hv-CRKP was 8.71% (23/264). The hv-CRKP isolates in this study were mainly from the intensive care unit (10/23) and neurosurgery department (8/23), and the main sources of hv-CRKP isolates were sputum (10/23) and bronchoalveolar lavage fluid (6/23). The hv-CRKP isolates in this study were highly resistant to β-lactam antibiotics, fluoroquinolones and aminoglycosides, and were only susceptible to colistin, tigecycline and ceftazidime/avibactam. The detection rate of the blaKPC-2 among 23 hv-CRKP isolates was 91.30% (21/23) and none of the class B and class D carbapenemases were detected. Results of MLST and capsular serotypes showed that ST11 type hv-CRKP was the dominant strain in the hospital, accounting for 56.52% (13/23), and K64 (9/13) and KL47 (4/13) were the major capsular serotypes. Conclusion: The hv-CRKP isolates from the hospital are mainly from lower respiratory tract specimens from patients admitted to the intensive care department and the drug resistance is relatively severe. The predominant strains with certain polymorphisms are mainly composed of the KPC-2-producing ST11-K64 and ST11-KL47 hv-CRKP isolates in the hospital.
Humans ; Klebsiella pneumoniae/genetics* ; Multilocus Sequence Typing ; Retrospective Studies ; Klebsiella Infections/drug therapy* ; Anti-Bacterial Agents/therapeutic use* ; Hospitals ; Carbapenem-Resistant Enterobacteriaceae/genetics* ; Microbial Sensitivity Tests ; Carbapenems/pharmacology*

Objective: The study investigated the clinical distribution, antimicrobial resistance and epidemiologic characteristics of hypervirulent Carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) in a hospital in Henan Province to provide a scientific basis for antibiotic use and nosocomial infection prevention and control. Methods: A retrospective analysis of the clinical data from the cases was carried out in this study. Clinical data of patients infected with the CRKP strain isolated from the clinical microbiology laboratory of Henan Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were retrospectively analyzed. A string test, virulence gene screening, serum killing, and a G. mellonella infection model were used to screen hv-CRKP isolates. The clinical characteristics of hv-CRKP and the drug resistance rate of hv-CRKP to twenty-five antibiotics were analyzed using WHONET 5.6. Carbapenemase phenotypic characterization of the hv-CRKP was performed by colloidal gold immunochromatographic assay, and Carbapenemase genotyping, multi-locus sequence typing (MLST) and capsular serotyping of hv-CRKP isolates were performed by PCR and Sanger sequencing. Results: A total of non-duplicate 264 CRKP clinical isolates were detected in the hospital from 2020 to 2022, and 23 hv-CRKP isolates were detected, so the corresponding detection rate of hv-CRKP was 8.71% (23/264). The hv-CRKP isolates in this study were mainly from the intensive care unit (10/23) and neurosurgery department (8/23), and the main sources of hv-CRKP isolates were sputum (10/23) and bronchoalveolar lavage fluid (6/23). The hv-CRKP isolates in this study were highly resistant to β-lactam antibiotics, fluoroquinolones and aminoglycosides, and were only susceptible to colistin, tigecycline and ceftazidime/avibactam. The detection rate of the blaKPC-2 among 23 hv-CRKP isolates was 91.30% (21/23) and none of the class B and class D carbapenemases were detected. Results of MLST and capsular serotypes showed that ST11 type hv-CRKP was the dominant strain in the hospital, accounting for 56.52% (13/23), and K64 (9/13) and KL47 (4/13) were the major capsular serotypes. Conclusion: The hv-CRKP isolates from the hospital are mainly from lower respiratory tract specimens from patients admitted to the intensive care department and the drug resistance is relatively severe. The predominant strains with certain polymorphisms are mainly composed of the KPC-2-producing ST11-K64 and ST11-KL47 hv-CRKP isolates in the hospital.
Humans ; Klebsiella pneumoniae/genetics* ; Multilocus Sequence Typing ; Retrospective Studies ; Klebsiella Infections/drug therapy* ; Anti-Bacterial Agents/therapeutic use* ; Hospitals ; Carbapenem-Resistant Enterobacteriaceae/genetics* ; Microbial Sensitivity Tests ; Carbapenems/pharmacology*

OBJECTIVES: To systematically assess the risk factors for the colonization or infection of carbapenem-resistant Enterobacteriaceae in children. METHODS: PubMed, Web of Science, China National Knowledge Infrastructure Database, Wanfang Data, China Biology Medicine disc were searched to obtain the articles on risk factors for the colonization or infection of carbapenem-resistant Enterobacteriaceae in children published up to May 31, 2021. RevMan 5.3 software was used to perform the Meta analysis. RESULTS: A total of 13 articles were included, with 1 501 samples in total. The Meta analysis showed that indwelling gastric tube (OR=4.91), tracheal intubation (OR=5.03), central venous catheterization (OR=3.75), indwelling urinary catheterization (OR=4.11), mechanical ventilation (OR=3.09), history of hospitalization in the intensive care unit (OR=2.39), history of surgical operation (OR=3.22), previous use of third-generation cephalosporins (OR=2.62), previous use of carbapenem antibiotics (OR=3.82), previous use of glycopeptide antibiotics (OR=3.48), previous use of β-lactamase inhibitors (OR=2.87), previous use of antifungal drugs (OR=2.48), previous use of aminoglycoside antibiotics (OR=2.54), and Apgar score ≤7 at 1 minute after birth (OR=2.10) were risk factors for the colonization or infection of carbapenem-resistant Enterobacteriaceae in children (P<0.05). CONCLUSIONS Invasive operations, history of hospitalization in the intensive care unit, previous use of antibiotics such as carbapenem antibiotics, and Apgar score ≤7 at 1 minute after birth are risk factors for the colonization or infection of carbapenem-resistant Enterobacteriaceae in children.
Anti-Bacterial Agents/therapeutic use* ; Carbapenem-Resistant Enterobacteriaceae ; Carbapenems/pharmacology* ; Child ; Enterobacteriaceae Infections/microbiology* ; Humans ; Risk Factors

Anti-Bacterial Agents/therapeutic use* ; Asian Continental Ancestry Group ; Carbapenem-Resistant Enterobacteriaceae ; Consensus ; Enterobacteriaceae Infections/drug therapy* ; Hematologic Neoplasms/therapy* ; Humans

Anti-Bacterial Agents/therapeutic use* ; Carbapenem-Resistant Enterobacteriaceae ; Carbapenems ; Child ; Cross Infection/epidemiology* ; Enterobacteriaceae Infections/epidemiology* ; Humans ; Microbial Sensitivity Tests ; Risk Factors ; beta-Lactamases

Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(
Anti-Bacterial Agents ; Carbapenem-Resistant Enterobacteriaceae ; Central Venous Catheters/adverse effects* ; Humans ; Hyperglycemia ; Hypoproteinemia ; Klebsiella Infections ; Klebsiella pneumoniae ; Methicillin-Resistant Staphylococcus aureus ; Mycoses ; Prognosis ; Pseudomonas Infections ; Retrospective Studies ; Risk Factors ; Sepsis/mortality*

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. bla, bla, bla, and bla 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.
Anti-Bacterial Agents ; therapeutic use ; Carbapenem-Resistant Enterobacteriaceae ; drug effects ; enzymology ; genetics ; China ; epidemiology ; Enterobacteriaceae Infections ; epidemiology ; microbiology ; Genotype ; Humans ; Microbial Sensitivity Tests ; Phylogeny ; Prevalence ; Retrospective Studies ; beta-Lactam Resistance ; beta-Lactamases ; genetics

Objective: To analyze the hints role of surveillance cultures of Carbapenem-resistant Enterobacteriaceae (CRE) by perianal swabs in patients with hematological diseases, and seek risk factors of CRE bloodstream infection. Methods: The resistance of CRE from 2 914 patients with hematological diseases who cultured perianal swabs, CRE bloodstream infection and risk factors were analyzed during January 2016 to December 2017. Results: In this study, perianal swabs from 2 914 patients with hematological diseases were cultured, 74 patients were CRE positive, and bloodstream infection with CRE was found in 13 of these patients. A total of 87 CRE strains were isolated (The same patient only keep the first one for the same location), including 31 Klebsiella pheuminiae, 43 Escherichia coli, 8 Enterobacter cloacae and 6 other Enterobacteriaceae. The resistance rates to piperacillin / tazobactam, imipenem, meropenam, amikacin, levofloxacin, tigecycline were 91.9%, 74.4%, 98.8%, 17.6%, 74.4% and 8.0%, respectively. Resistance to carbapenem, aminoglycoside, quinolones and tegacycline were highly consistent between two sites from 13 patients, whose both perianal swabs and blood were positive in CRE cultures. Febrile neutropenic time, digestive tract symptoms and perianal infection were independent risk factors for bloodstream infection in patients with perianal swabs positive results, the odds ratios (OR) were 1.10 (P=0.029), 1.13 (P=0.005) and 1.23 (P=0.016), respectively. Conclusion: Perianal swabs surveillance cultures of CRE can be hints for CRE bloodstream infection in patients with hematological diseases, and also can provide suggestions for antibiotics. Long time of febrile neutropenic, digestive tract symptoms and perianal infection can be the early warning for CRE bloodstream infections.
Anti-Bacterial Agents ; Bacteremia ; Carbapenem-Resistant Enterobacteriaceae ; Carbapenems ; Enterobacteriaceae Infections ; Hematologic Diseases ; Humans

BACKGROUND: Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). RESULTS: Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. CONCLUSION: Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.
Amikacin ; Anti-Bacterial Agents ; Carbapenems ; Cefotaxime ; Community-Acquired Infections ; Enterobacteriaceae* ; Escherichia coli ; Fluoroquinolones ; Humans ; Imipenem ; Korea* ; Medical Records ; Retrospective Studies ; Seoul ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract Infections* ; Urinary Tract*