Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae in the USA, 2011–2015

• Type of Material: Article
• Authors: Uzma Ansari, Centers for Disease Control and Prevention; Adrian Lawsin, Centers for Disease Control and Prevention; Davina Campbell, Centers for Disease Control and Prevention; Valerie Albrecht, Centers for Disease Control and Prevention; Gillian McAllister, Centers for Disease Control and Prevention; Sandra Bulens, Centers for Disease Control and Prevention; Maroya Spalding Walters, Centers for Disease Control and Prevention; Jesse Jacob, Emory University; Sarah Satola, Emory University; Lucy E Wilson, Maryland Department of Health and Mental Hygiene; Ruth Lynfield, Minnesota Department of Health; Paula Snippes Vagnone, Minnesota Department of Health; Sarah J. Janelle, Colorado Department of Public Health and Environment; Karen Xavier, Colorado Department of Public Health and Environment; Ghinwa Dumyati, New York Emerging Infections Program at the University of Rochester Medical Center; Dwight Hardy, New York Emerging Infections Program at the University of Rochester Medical Center; Eric C. Phipps, University of New Mexico; Karissa Culbreath, TriCore Reference Laboratories; Zintars Beldavs, Oregon Health Authority; Karim Morey, Oregon Health Authority; Marion A. Kalner, Tennessee Department of Public Health; Sheri Roberts, Tennessee Department of Public Health; Alexander Kallen, Centers for Disease Control and Prevention; J. Kamile Rasheed, Centers for Disease Control and Prevention; Maria S. Karlsson, Centers for Disease Control and Prevention
• Language: English
• Date: 2017-10-04
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofx163.328
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 4
• Issue: suppl_1
• Start Page: S179
• End Page: S179
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Biology, Virology

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as an important cause of healthcare-associated infections. We characterized the molecular epidemiology of CRE in isolates collected through the Emerging Infections Program (EIP) at the Centers for Disease Control and Prevention (CDC). Methods: From 2011–2015, 8 U.S. EIP sites (CO, GA, MD, MN, NY, NM, TN and OR) collected CRE (Escherichia coli, Enterobacter aerogenes, Enterobacter cloacae complex, Klebsiella pneumoniae, and Klebsiella oxytoca) isolated from a normally sterile site or urine. Isolates were sent to CDC for reference antimicrobial susceptibility testing and real-time PCR detection of carbapenemase genes (blaKPC, blaNDM, blaOXA-48). Phenotypically confirmed CRE were analyzed by whole genome sequencing (WGS) using an Illumina MiSeq benchtop sequencer. Results: Among 639 Enterobacteriaceae evaluated, 414 (65%) were phenotypically confirmed as CRE using CDC’s current surveillance definition (resistant to ertapenem, imipenem, doripenem, or meropenem). Among isolates confirmed as CRE, 303 (73%) were carbapenemase-producers (CP-CRE). The majority of CP-CRE originated from GA (39%), MD (35%) and MN (11%); most non-CP-CREs originated from MN (27%), CO (25%) and OR (17%). K. pneumoniae was the predominant carbapenemase-producing species (78%) followed by E. cloacae complex spp (12%), E. coli (7.9%), E. Aerogenes (0.9%) and K. oxytoca (0.6%). The most common carbapenemase genes detected were blaKPC-3 (76%) and blaKPC-2 (19%); blaNDM and blaOXA-48-like genes were detected in 1.6% and 0.3% of isolates, respectively. For carbapenemase-producing K. pneumoniae, Enterobacter spp, and E. coli, the predominant sequence types (ST) were ST258 (65%), ST171 (35%) and ST131 (29%), respectively. Conclusion: The distribution of CP and non-CP-CRE varied across the catchment sites. Among CP-CRE, KPC-producing K. pneumoniae predominated; other carbapenemases were rarely identified in the locations under surveillance. Strain types known to have increased epidemic potential (ST258 and ST131) were common among carbapenemase-producing K. pneumoniae and E. coli isolates, respectively.