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Plasmid-mediated, transmissible, tigecycline-inactivating enzyme Tet(X) has attracted considerable public attention. However, so far studies have not addressed its impact on public health and the ecosystem. Herein, we report the prevalence and molecular epidemiology of tet(X)-positive bacteria (TPB) from diverse sources, investigate the host-specificity of TPB and the transferability of tet(X). Sample collection was conducted between 2018 and 2020 in 30 provinces in China. PCR screening suggested tet(X) was prevalent among freshwater fishes (24.7%, 95% CI 19.4-30.7%), followed by chickens (23.6%, 21.2-26.2%), cattle (19.3%, 16.4-22.5%), healthy individuals (6.2%, 5.4-7.1%), and patients (0.3%, 0.0-1.1%). Soil and freshwater samples all tested negative for tet(X). A total of 289 TPB were isolated from 7516 samples (120/1181 chicken, 82/669 cattle, 68/3229 healthy individual, 17/239 freshwater fish and 2/2121 clinical samples). TPB distributed in six major families of bacteria including Moraxellaceae (n = 99, 34.3%), Flavobacteriaceae (n = 95, 32.9%), Enterobacteriaceae (n = 83, 28.7%), Pseudomonadaceae (n = 9, 3.1%), Sphingobacteriaceae (n = 2, 0.7%) and unclassified Gammaproteobacteria (n = 1, 0.3%). Diverse tet(X) genes including tet(X2), tet(X3), tet(X4), tet(X5) and tet(X6) were identified from different TPB. The tet(X)-positive bacteria were highly diverse, with ST10 complex belonging to the dominant E. coli clone. Novel hosts of tet(X) including Enterobacter hormaechei, Ignatzschineria indica and Oblitimonas alkaliphila were identified. Isolates from different families exhibited different antimicrobial resistance profiles. Co-existence of tet(X) with other resistance genes such as floR (66.8%) and carbapenemase genes (33.2%) was commonly observed. tet(X) could be transferred among E. coli isolates at frequencies from 10 -4 to 10 -10 . Species other than E. coli failed to transfer tet(X) gene to the E. coli recipient via conjugation. Discriminant analysis of principal components analysis suggested inter-host transmission of tet(X)-positive E. coli among diverse hosts was not observed. Future studies are needed to monitor the transmission trend as well as the impact of this resistance gene in clinical infection control., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Mobile colistin resistance gene mcr-1 and extended-spectrum β -lactamase gene bla CTX-M are highly prevalent in human - and pet-derived bacteria. Isolation of identical strains of mcr-1 -positive Escherichia coli (MCRPEC) or bla CTX-M -positive E. coli (CTX-MPEC) from pets and humans highlighted the potential for co-colonization of antibiotic-resistant bacteria which can be a risk for dissemination of resistance genes. In this study, the prevalence of mcr-1 and bla CTX-M carriage from rectal swabs in 299 families (dogs and their owners) were 2.7 and 5.3%, respectively. We identified a significant association of mcr-1 carriage between dogs and their owners. Whilst antibiotic use in the previous three months was associated with bla CTX-M carriage in dogs. Only one instance of dog and owner carrying identical CTX-MPEC was observed. Although the prevalence of identical strains in one family is rare, the huge number of dog ownership worldwide suggest that this threat should not be underestimated.

We isolated 47 Acinetobacter strains carrying tet (X3) and 4 ST767 E. coli strains carrying tet (X4) from 296 rectal swab samples from dairy cows on a Chinese farm. tet (X3) was located on chromosomes or diverse plasmids, and tet (X4) was located on IncFIBκ/FIA(HI1)/X1 nontransferable plasmid. The coexistence of tet (X3) and carbapenemase genes, including bla OXA-58 and bla NDM-1 , was detected in 9 Acinetobacter spp. These findings suggested that the use of tetracycline and other antibiotics in food production warrants urgent attention., (Copyright © 2020 American Society for Microbiology.)

Background: Following the discovery and emergence of the plasmid-mediated colistin resistance gene, mcr-1, the Chinese government formally banned colistin as an animal growth promoter on April 30, 2017. Herein, we report patterns in colistin resistance and mcr-1 abundance in Escherichia coli from animals and humans between 2015 and 2019, to evaluate the effects of the colistin withdrawal., Methods: We did an epidemiology comparative study to investigate: annual production and sales of colistin in agriculture across mainland China according to data from the China Veterinary Drug Association from 2015 to 2018; the prevalence of colistin-resistant E coli (CREC) in pigs and chickens in 23 Chinese provinces and municipalities as reported in the China Surveillance on Antimicrobial Resistance of Animal Origin database from Jan 1, 2015, to Dec 31, 2016, and Jan 1, 2017, to Dec 31, 2018; the presence of residual colistin and mcr-1 in faeces from 118 animal farms (60 pig, 29 chicken, and 29 cattle) across four provinces over July 1, 2017, to August 31, 2017, and July 1, 2018 to August 31, 2018; the prevalence of mcr-1-positive E coli (MCRPEC) carriage in healthy individuals attending routine hospital examinations across 24 provinces and municipalities from June 1 to July 30, 2019, comparing with equivalent 2016 data (June 1 to September 30) from our previous study in the same hospitals; and the patterns in CREC prevalence among hospital E coli infections across 26 provinces and municipalities from Jan 1, 2015, to Dec 31, 2016, and Jan 1, 2018, to Dec 31, 2019, reported on the China Antimicrobial Surveillance Network., Findings: After the ban on colistin as a growth promoter, marked reductions were observed in the production (27 170 tonnes in 2015 vs 2497 tonnes in 2018) and sale (US$71·5 million in 2015 vs US$8·0 million in 2018) of colistin sulfate premix. Across 118 farms in four provinces, mean colistin residue concentration was 191·1 μg/kg (SD 934·1) in 2017 versus 7·5 μg/kg (50·0) in 2018 (p<0·0001), and the median relative abundance of mcr-1 per 16S RNA was 0·0009 [IQR 0·0001-0·0059] in 2017 versus 0·0002 [0·0000-0·0020] in 2018 (p=0·0001). Across 23 provinces and municipalities, CREC was identified in pig faeces in 1153 (34·0%) of 3396 samples in 2015-16 versus 142 (5·1%) of 2781 in 2017-18 (p<0·0001); and in chickens in 474 (18·1%) of 2614 samples in 2015-16 versus 143 (5·0%) of 2887 in 2017-18 (p<0·0001). In hospitals across 24 provincial capital cities and municipalities, human carriage of MCRPEC was identified in 644 (14·3%) of 4498 samples in 2016 versus 357 (6·3%) of 5657 in 2019 (p<0·0001). Clinical CREC infections in 26 provinces and municipalities comprised 1059 (1·7%) of 62 737 E coli infections in 2015-16 versus 794 (1·3%) of 59 385 in 2018-19 (p<0·0001)., Interpretation: The colistin withdrawal policy and the decreasing use of colistin in agriculture have had a significant effect on reducing colistin resistance in both animals and humans in China. However, continuous colistin monitoring is essential, in particular to act as an early warning system for colistin stewardship in Chinese hospitals., Funding: National Key Research and Development Program of China, National Natural Science Foundation of China, and UK Medical Research Council., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Public health interventions to control the recent emergence of plasmid-mediated tigecycline resistance genes rely on a comprehensive understanding of its epidemiology and distribution over a wide range of geographical scales. Here we analysed an Escherichia coli collection isolated from pigs and chickens in China in 2018, and ascertained that the tet(X4) gene was not present at high prevalence across China, but was highly endemic in northwestern China. Genomic analysis of tet(X4)-positive E. coli demonstrated a recent and regional dissemination of tet(X4) among various clonal backgrounds and plasmids in northwestern China, whereas a parallel epidemic coincided with the independent acquisition of tet(X4) in E. coli from the remaining provinces. The high genetic similarity of tet(X4)-positive E. coli and human commensal E. coli suggests the possibility of its spreading into humans. Our study provides a systematic analysis of the current epidemiology of tet(X4) and identifies priorities for optimising timely intervention strategies.

While carbapenem use is prohibited in the poultry production chain and carbapenem-resistant Enterobacteriaceae (CRE) are absent from hatchery farms, New Delhi metallo-β-lactamase-producing CRE contamination of commercial broiler chicken farms (grow-out farms) can occur via living hosts such as flies. However, it is not known whether the inanimate factors from in-house environment play a role in the persistence of CRE on commercial farms. Herein, we monitored one typical broiler house in Hebei Province, China, from January 2017 to April 2018. We collected 350 cloacal samples from four broiler batches along with 582 environmental samples (194 in the raising period and 388 in the vacancy period) from sites including the surfaces of drooping boards, feeding troughs, nipple drinkers, corridor floors, sewage trenches, and air. All samples were screened for bla NDM and cultured for NDM-producing isolates. The resistance profiles, genotypes, and genetic context of bla NDM in CRE isolates were further characterized. Results showed that 1-day-old broilers, which were transferred from a hatchery farm and negative for CRE, acquired bla NDM within 24 h of transfer (2 days of age), with a detection rate of up to 18.6%. High bla NDM detection rates (26.8%-31.4%) were obtained among all environmental samples except air after standard cleaning and disinfection during the vacancy period. bla NDM carriage rates (52.9%-72.9%) within the flocks remain stable and high across the next three broiler batches. Overall, 279 NDM-producing bacteria, including 259 Enterobacteriaceae (8 species), 14 Morganellaceae (3 species), three Alcaligenes faecalis and three Pseudomonas putida isolates, were recovered from 85 (24.3%) cloacal and 101 (17.4%) environmental samples. Three NDM variants, including NDM-5 (n = 181), NDM-1 (n = 92), and NDM-9 (n = 3), and a novel NDM-like-metallo-β-lactamase (NLM, n = 3) were identified among the samples. The predominant NDM-producing CRE species among the samples were Klebsiella pneumoniae (CRKP; 32.6%, n = 91) and Escherichia coli (CREC; 27.2%, n = 76). Both clonal and horizontal transmission of bla NDM and an overlap of sequence types (STs) were observed in both CREC and CRKP from chicken and environmental samples. Notably, ST6751 CREC and ST37 CRKP persisted throughout the 16-month surveillance period. IncX3 (n = 197, 7 species), IncA/C 2 (n = 41, 5 species), and IncFII (n = 8, E. coli) were the three major bla NDM -carrying plasmid types among the isolates. Although routine cleaning and disinfection procedures and "all-in/all-out" management were performed, once introduced to the farm environment, a diverse range of NDM-positive isolates may survive and persist, becoming an important reservoir of NDM-positive CRE for broiler chickens. Therefore, cleaning and disinfection procedures should be improved on poultry farms to avoid cross-contamination of NDM-producing bacteria between different batches of chickens, as well as further downstream in the poultry production chain., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The rapidly increasing dissemination of carbapenem-resistant Enterobacteriaceae (CRE) in both humans and animals poses a global threat to public health. However, the transmission of CRE between humans and animals has not yet been well studied., Objectives: We investigated the prevalence, risk factors, and drivers of CRE transmission between humans and their backyard animals in rural China., Methods: We conducted a comprehensive sampling strategy in 12 villages in Shandong, China. Using the household [residents and their backyard animals (farm and companion animals)] as a single surveillance unit, we assessed the prevalence of CRE at the household level and examined the factors associated with CRE carriage through a detailed questionnaire. Genetic relationships among human- and animal-derived CRE were assessed using whole-genome sequencing-based molecular methods., Results: A total of 88 New Delhi metallo- β -lactamases -type carbapenem-resistant Escherichia coli (NDM-EC), including 17 from humans, 44 from pigs, 12 from chickens, 1 from cattle, and 2 from dogs, were isolated from 65 of the 746 households examined. The remaining 12 NDM-EC were from flies in the immediate backyard environment. The NDM-EC colonization in households was significantly associated with a ) the number of species of backyard animals raised/kept in the same household, and b ) the use of human and/or animal feces as fertilizer. Discriminant analysis of principal components (DAPC) revealed that a large proportion of the core genomes of the NDM-EC belonged to strains from hosts other than their own, and several human isolates shared closely related core single-nucleotide polymorphisms and b l a NDM genetic contexts with isolates from backyard animals., Conclusions: To our knowledge, we are the first to report evidence of direct transmission of NDM-EC between humans and animals. Given the rise of NDM-EC in community and hospital infections, combating NDM-EC transmission in backyard farm systems is needed. https://doi.org/10.1289/EHP5251.

The aim of this study was to assess the presence of mobile colistin resistance in bacteria isolated from the swine production environment and to analyze the genomic environment of the new colistin resistance gene mcr-3. Anal swabs and environmental samples were collected from a commercial pig farm. Direct sample testing (DST) for mcr genes and isolation of colistin-resistant isolates was performed. The mcr-3-positive isolates were subjected to whole genome sequencing (WGS). Transferability and genomic location analyses of mcr-3 gene were performed using conjugation and S1 nuclease-PFGE with Southern blotting assays, respectively. The antimicrobial susceptibility profiles of the mcr-carrying isolates were determined using the agar dilution method. A total of 65 samples were collected. The DST rates of mcr-1 (64.6%, 42/65) and mcr-3 (40.0%, 26/65) were considerably higher than the rates of mcr-1-positive E. coli (49.2%, 32/65) and mcr-3-positive E. coli (7.7%, 5/65) isolated from these samples, respectively. The five mcr-3-positive isolates were derived from different sources (pig, fly and soil) and four of the five isolates were also positive for mcr-1. The mcr-3 genes were located on IncP-1 plasmids in three isolates or IncHI2 plasmids in two isolates. Several mobile elements, including IS4321, ΔTnAs2 or ISKpn40, were identified in the flanking regions of mcr-3 in the E. coli isolates. In conclusion, the mobile colistin resistance genes mcr-1 and mcr-3 are prevalent in the monitored pig farm and its surrounding environment. Due to their location on broad-host range IncP-1 plasmids and their proximity to different IS sequences, mcr-3 gene might have excellent opportunities for transmission., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The recent emergence of plasmid-mediated tigecycline resistance genes, tet (X3) and tet (X4), in animals and humans in China would pose a foreseeable threat to public health. To illustrate this paradigm shift in tigecycline resistance, here, covering the period 2008-2018, we retrospectively analysed a national strain collection of Escherichia coli (n = 2254), obtained from chickens and pigs, in six representative provinces of China. The gene tet (X4) was identified in five pig isolates collected in 2016 and 2018 from the provinces of Sichuan (3/15, 2018), Henan (1/25, 2018) and Guangdong (1/28, 2016), but not in the isolates prior to 2016. None of the isolates was detected harbouring tet (X3). All tet (X4)-positive E. coli exhibited high levels of tigecycline resistance (MICs, 16-64 mg/L), and two were confirmed as colistin resistant, harbouring chromosome-borne mcr-1 gene. The gene tet (X4) was detected on a plasmid in all five isolates, whereas a co-location of tet (X4) on the chromosome of one isolate was observed. Diverse host strains and novel plasmids related to the tet (X4) gene were observed. Our timely findings of the recent emergence of tet (X4) gene in food animal support the rapid surveillance and eradication of this gene before it is established.

MCR-1-positve Escherichia coli (MCRPEC) have been reported in humans worldwide; however, thus far, their prevalence is low and potential sources for human mcr-1 carriage have not yet been identified. Here, we analyse a nationwide epidemiological dataset on MCRPEC in humans throughout China and assess the factors associated with MCRPEC carriage using natural and national anthropogenic data. We identified 774 non-duplicate MCRPEC isolates from 774 stool samples collected from 5,159 healthy individuals in 30 provinces and municipalities in 2016, with a prevalence of MCRPEC ranging from 3.7 to 32.7% (average: 15.0%)-substantially higher than previously reported. MCRPEC carriage was associated with provincial regions, the production of sheep and freshwater aquaculture, annual consumption of total meat, pork and mutton, and daily intake of aquaculture products. MCRPEC was significantly more prevalent in provinces with higher aquaculture industries. Whole-genome sequencing analysis revealed that the MCRPEC isolates were clustered into four distinct lineages, two of which were dominant and harboured most of the MCRPEC isolates. The high prevalence of MCRPEC in the community poses a substantial risk for colistin usage in clinical practice and suggests the need for intestinal screening of mcr-1 carriers in intensive care units in Chinese hospitals. Furthermore, our data suggest that aquaculture is a significant reservoir of mcr-1.

The recent emergence of a transferable colistin resistance mechanism, MCR-1, has gained global attention because of its threat to clinical treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, the possible transmission route of mcr-1 among Enterobacteriaceae species in clinical settings is largely unknown. Here, we present a comprehensive genomic analysis of Escherichia coli isolates collected in a hospital in Hangzhou, China. We found that mcr-1 -carrying isolates from clinical infections and feces of inpatients and healthy volunteers were genetically diverse and were not closely related phylogenetically, suggesting that clonal expansion is not involved in the spread of mcr-1 The mcr-1 gene was found on either chromosomes or plasmids, but in most of the E. coli isolates, mcr-1 was carried on plasmids. The genetic context of the plasmids showed considerable diversity as evidenced by the different functional insertion sequence (IS) elements, toxin-antitoxin (TA) systems, heavy metal resistance determinants, and Rep proteins of broad-host-range plasmids. Additionally, the genomic analysis revealed nosocomial transmission of mcr-1 and the coexistence of mcr-1 with other genes encoding β-lactamases and fluoroquinolone resistance in the E. coli isolates. These findings indicate that mcr-1 is heterogeneously disseminated in both commensal and pathogenic strains of E. coli , suggest the high flexibility of this gene in its association with diverse genetic backgrounds of the hosts, and provide new insights into the genome epidemiology of mcr-1 among hospital-associated E. coli strains. IMPORTANCE Colistin represents one of the very few available drugs for treating infections caused by extensively multidrug-resistant Gram-negative bacteria. The recently emergent mcr-1 colistin resistance gene threatens the clinical utility of colistin and has gained global attention. How mcr-1 spreads in hospital settings remains unknown and was investigated by whole-genome sequencing of mcr-1 -carrying Escherichia coli in this study. The findings revealed extraordinary flexibility of mcr-1 in its spread among genetically diverse E. coli hosts and plasmids, nosocomial transmission of mcr-1 -carrying E. coli , and the continuous emergence of novel Inc types of plasmids carrying mcr-1 and new mcr-1 variants. Additionally, mcr-1 was found to be frequently associated with other genes encoding β-lactams and fluoroquinolone resistance. These findings provide important information on the transmission and epidemiology of mcr-1 and are of significant public health importance as the information is expected to facilitate the control of this significant antibiotic resistance threat., (Copyright © 2018 Shen et al.)

Objectives: To evaluate the prevalence of clinical mcr-1-positive Escherichia coli and Klebsiella pneumoniae and characterize the antimicrobial resistance profiles of mcr-1-positive E. coli and mcr-1-negative E. coli in China., Methods: A total of 6264 clinical E. coli (n = 3854) and K. pneumoniae (n = 2410) were collected from hospitalized patients from 18 to 20 hospitals as part of the China Antimicrobial Resistance Surveillance Trial (CARST) between January 2007 and June 2016. PCR was used to screen for the mcr-1 gene among all isolates. Antibiotic susceptibility testing was performed using the broth microdilution method. mcr-1-positive pathogens were then characterized by MLST and minimum spanning tree analysis using the BURST algorithm for related STs., Results: We examined 39 (0.62%) clinical isolates of mcr-1-positive E. coli and K. pneumoniae over a 10 year period. Resistance to antimicrobial agents was significantly more severe in mcr-1-positive isolates than mcr-1-negative isolates, particularly piperacillin (P = 0.008), amikacin (P < 0.0001), nitrofurantoin (P < 0.004) and fosfomycin (P < 0.0001). Among mcr-1-carrying isolates, ESBL production was as high as 84.6% (33 of 39) and 92.3% (36 of 39) of them displayed an MDR phenotype. STs suggested ubiquitous dissemination of mcr-1-carrying pathogens., Conclusions: mcr-1-carrying E. coli and K. pneumoniae displayed a lower prevalence and abundant phylogenetic diversity in mainland China. mcr-1-positive E. coli showed significant differences in antimicrobial resistance profiles compared with mcr-1-negative E. coli strains, suggesting physicians may consider prescribing different antibiotics when faced with infections caused by mcr-1-positive pathogens.

Objectives: This study characterised a bla NDM-1 -producing Escherichia coli isolate from a companion dog., Methods: The E. coli strain was isolated from a surveillance study of carbapenem-resistant Gram-negative bacteria from companion animals in the Animal Teaching Hospital of China Agricultural University (Beijing, China) in 2013. Species identification was performed using an API 20E system and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). Minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined by agar dilution. Multilocus sequence typing (MLST) was performed and various carbapenemase genes, including bla NDM , bla IMP , bla VIM , bla SME , bla IMI , bla KPC , bla GES , bla SPM , bla GIM , bla NMC , bla DIM , bla SIM , bla OXA-23 , bla OXA-24 , bla OXA-48 , bla OXA-51 and bla OXA-58 were screened by PCR. S1 nuclease pulsed-field gel electrophoresis (S1-PFGE) and Southern blotting as well as a modified random primer walking strategy were performed to analyse the location and genetic environment of bla NDM-1 ., Results: An E. coli isolate belonging to ST167 was found to be positive for the bla NDM-1 gene and exhibited resistance to β-lactams, tetracycline, gentamicin, fosfomycin and ciprofloxacin. The bla NDM-1 gene in this strain was located on an ca. 150-kb plasmid and the flanking sequences of the bla NDM-1 -carrying region (a common gene cluster, ΔISAba125-bla NDM-1 -ble-trpF-ΔdsbC) exhibited >99% identity to the corresponding regions of bla CTX-M-15 -harboring plasmids in nosocomial E. coli ST131 isolates., Conclusions: This is the first report of bla NDM-1 -producing ST167 E. coli in a companion dog. Companion animals harbouring carbapenemase-producing isolates are an upcoming public health threat and it is worthy paying attention to the emergence of carbapenem resistance in companion animals., (Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) strains are emerging around the world as a source of resistance to β-lactam antibiotics such as ampicillin, cefotaxime, and ceftazidime. mcr-1 is a novel plasmid-mediated gene conferring resistance to colistin. The aim of this study was to investigate the prevalence of ESBL-EC mcr-1 of chicken origin in the different provinces of China during 2008-2014. Overall, 341 of 821 isolates were determined to be ESBL-EC strains, and the proportion of ESBL-positive strains almost doubled from 2008 to 2014. The findings of our study revealed regional differences, with significantly more ESBL-EC isolates from stockbreeding in concentrated poultry industry areas in Shandong than from the other four provinces. The ESBL type analysis showed that bla CTX-M was the most prevalent ESBL-encoding gene (92.7%). In total, twelve subtypes of CTX-M genes were detected, among which, bla CTX-M-55 (34.3%) and bla CTX-M-65 (17.9%) were the major identified genotypes. In addition, bla TEM and pAmpC genes were carried by 86.0% and 8.5% of isolates, respectively. In this study, we also observed 44 E. coli isolates with multiple ST types (ST46, ST1286, ST10, ST29, ST101, and ST354) carrying mcr-1, and the majority of mcr-1-carrying plasmids were IncI2. The whole-genome sequencing analysis indicated the co-existence of bla CTX-M and mcr-1 in ESBL-EC of both animal and human origin, and phylogenetic analysis further revealed their close relationship, especially several isolates sharing a small number of SNPs, which suggested the increasing trend of co-existence and transmission of ESBL and mcr-1 in both clinical medicine and veterinary medicine.

The objective of this study was to investigate the antimicrobial resistance trend in Escherichia coli from food animals in China. During 2008-2015, a total of 15,130 E. coli were isolated from chicken and swine from seven provinces. The susceptibilities of these isolates to nine classes of antimicrobial agents were determined using broth microdilution susceptibility method. The findings of this study include: (1) multi-drug resistance was highly prevalent in E. coli; (2) these E. coli isolates showed high resistant rate (>80%) to several old drugs, including ampicillin, tetracycline and sulfisoxazole; (3) increasing resistance to colistin, florfenicol and ceftiofur was observed; (4) the E. coli isolates from different provinces had different resistance patterns. All these data highlight the rising problem of antimicrobial resistance. It is urgent to improve the management of animal production and enhance the proper use of antimicrobials in China as well as the other countries., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Carbapenem-resistant Enterobacteriaceae (CRE) have spread worldwide, leaving very few treatment options available. New Delhi metallo-beta-lactamase (NDM) is the main carbapenemase mediating CRE resistance and is of increasing concern. NDM-positive Enterobacteriaceae of human origin are frequently identified; however, the emergence of NDM, and particularly novel variants, in bacteria of food animal origin has never been reported. Here, we characterize a novel NDM variant (assigned NDM-17) identified in a β-lactam-resistant sequence type 48 (ST48) Escherichia coli strain that was isolated from a chicken in China. Compared to NDM-1, NDM-17 had three amino acid substitutions (V88L, M154L, and E170K) that confer significantly enhanced carbapenemase activity. Compared to NDM-5, NDM-17 had only one amino acid substitution (E170K) and slightly increased isolate resistance to carbapenem, as indicated by increased MIC values. The gene encoding NDM-17 ( bla NDM-17 ) was located on an IncX3 plasmid, which was readily transferrable to recipient E. coli strain J53 by conjugation, suggesting the possibility of the rapid dissemination of bla NDM-17 Enzyme kinetics showed that NDM-17 could hydrolyze all β-lactams tested, except for aztreonam, and had a significantly higher affinity for all β-lactams tested than did NDM-5. The emergence of this novel NDM variant could pose a threat to public health because of its transferability and enhanced carbapenemase activity., (Copyright © 2017 American Society for Microbiology.)

By 2030, the global population will be 8.5 billion, placing pressure on international poultry production, of which China is a key producer 1 . From April 2017, China will implement the withdrawal of colistin as a growth promoter, removing over 8,000 tonnes per year from the Chinese farming sector 2 . To understand the impact of banning colistin and the epidemiology of multi-drug-resistant (MDR) Escherichia coli (using bla NDM and mcr-1 as marker genes), we sampled poultry, dogs, sewage, wild birds and flies. Here, we show that mcr-1, but not bla NDM , is prevalent in hatcheries, but bla NDM quickly contaminates flocks through dogs, flies and wild birds. We also screened samples directly for resistance genes to understand the true breadth and depth of the environmental and animal resistome. Direct sample testing for bla NDM and mcr-1 in hatcheries, commercial farms, a slaughterhouse and supermarkets revealed considerably higher levels of positive samples than the bla NDM - and mcr-1-positive E. coli, indicating a substantial segment of unseen resistome-a phenomenon we have termed the 'phantom resistome'. Whole-genome sequencing identified common bla NDM -positive E. coli shared among farms, flies, dogs and farmers, providing direct evidence of carbapenem-resistant E. coli transmission and environmental contamination.

The isolation and identification, genetic typing, antibiotic sensitivity, and biofilm formation of avian Escherichia coli in central China was studied. A total of 256 isolates of E. coli were obtained, and classified into groups: A (50.78%, 130/256), B1 (11.72%, 30/256), B2 (17.58%, 45/256), and D (19.92%, 51/256). Drug susceptibility testing revealed that the strains showed a high drug resistance rate against penicillin, aztreonam, rifampicin, kanamycin, clindamycin, and gentamicin, with 92.19% of strains exhibiting multi-drug resistance. A biofilm assay revealed that 81.64% of isolates could form biofilms. Of the total isolates, 25.39% of isolates showed strong biofilm-formation ability, 31.25% showed moderate biofilm-formation ability, 28.90% showed weak biofilm-formation ability, and 18.36% were unable to form biofilms. Most adhesion-associated genes were distributed among 5 or 8 genes in strong biofilm-forming ability isolates. However, adhesion-associated genes distributed among 1 or 4 genes were found in weak biofilm-forming ability isolates and non-ability isolates. The results showed a high drug resistance rate and biofilm formation ability in E.coli strains isolated from poultry. The isolates which have strong biofilm-forming ability were mostly belong to pathogenic E. coli (B2, D). Furthermore, it was the first report to demonstrate a positive correlation between adhesion-encoding genes and biofilms phenotype., (© 2016 Poultry Science Association Inc.)

This study investigated the in vitro efficacy of mequindox against enteropathogenic Escherichia coli (EPEC), and characterized the oqxAB genes as the main mequindox resistance determinant in E. coli strains of animal origin. A total of 1123 E. coli isolates were collected from domestic animals in China from the 1970s to 2013, and mequindox susceptibility was tested by broth microdilution. The percentage of E. coli isolates with increased mequindox MICs of ≥ 64 μg/ml showed a rising trend each year throughout the study period. Mequindox showed good bactericidal activity in vitro towards 20 EPEC strains, although it had a wide mutant selection window. All 1123 E. coli isolates were tested for the presence of the oqxAB genes, and the operon was detected in 322 isolates, which accounted for 94.4% (322/341) of isolates with increased MICs to mequindox (MIC ≥ 64 μg/ml). Of the isolates with mequindox MIC ≤ 32 μg/ml, 98.8% (773/782) were oqxAB negative. Polymerase chain reaction-based stability testing revealed that the IS26-oqxAB circular intermediate was present in 93.4% (309/331) of the oqxAB-positive strains, indicating that this IS26-flanked Tn6010 element was unstable and prone to excision via IS26-mediated recombination. Functional analysis of the oqxAB genes confirmed that this operon alone is sufficient to confer resistance or increased MICs to multiple antimicrobials, including mequindox. This is the first study to investigate the relationship between mequindox susceptibility and oqxAB genotype, and may provide the basis for establishing the resistance breakpoint for mequindox against E. coli., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The aim of this study was to investigate the trends and the diversity of CTX-M types of extended-spectrum β-lactamase (ESBL) in Escherichia coli isolated from food animals in China over a ten-year period. From 2003 to 2012, 2815 E. coli isolates collected from diseased animals (chickens, pigs, and waterfowl) were screened for the prevalence of CTX-M genes. CTX-M-positive isolates were tested for their susceptibilities to 10 antimicrobial agents and the clonal relationship of CTX-M-producing E. coli isolates was also assessed. Overall, 677 (20.1%) of the 2815 E. coli isolates carried CTX-M genes. Eighteen different types of CTX-M ESBLs were identified, with CTX-M-14, CTX-M-55, and CTX-M-65 being the most dominant genotypes. The occurrence of CTX-M-producing E. coli increased significantly from 5.7% in 2003-2005 to 35.3% in 2009-2012 (p<0.0001). High genetic heterogeneities were observed in the CTX-M-producing E. coli isolates. Most CTX-M-producing strains were also resistant to other classes of antimicrobials. Compared to isolates carrying CTX-M-9 subgroup of ESBLs, isolates carrying CTX-M-1 subgroup ESBLs showed significantly higher resistance rates to ceftazidime, amikacin, and fosfomycin (p<0.01). The study reported the dramatic increase of CTX-M ESBLs in E. coli isolated from animals overtime in China. The increasing incidence of CTX-M-55 with high hydrolytic activity against ceftazidime and the widely spread co-resistance in CTX-M-producing isolates alarm the serious antimicrobial resistance situation in China and highlight the need for urgent control strategies to limit the dissemination of those resistant genes in China., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The aim of this study is to characterize the prevalence of extended-spectrum β-lactamases (ESBLs) and plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli from captive non-human primates. A total of 206 E. coli isolates were collected from primates in six zoos in China in 2009 and their susceptibility to 10 antimicrobials were tested by broth microdilution. The susceptibility patterns of E. coli strains varied greatly among different zoos reflecting different backgrounds of antimicrobial usage. Both the ESBL-encoding genes and the PMQR genes were detected by PCR. Of the 206 strains, 65 (32%) were confirmed as phenotypic ESBL producers with bla(CTX-M) (27%, bla(CTX-M-15), n=31, bla(CTX-M-3), n=23 and bla(CTX-M-14), n=2) mainly mediating the ESBL phenotype. qnrS1 (18%, n=36) and oqxAB (15%, n=31) were the predominant PMQR genes and the prevalence of PMQR genes was much higher among phenotypic ESBL producers than that among phenotypic non-ESBL producers from any zoo. Notably, the PMQR genes qnrS1 and oqxAB and β-lactamase genes bla(TEM-1) and bla(CTX-M-3) were found together in 23 E. coli isolates in two zoos in Shanghai. PFGE analysis of these 23 isolates demonstrated nearly identical PFGE profiles (similarity matrix >97%) indicating this specific E. coli genotype was prevalent in these two zoos. To the best of our knowledge, this is the first report of these four genes coexisting in an E. coli genotype and the first report of antimicrobial resistance profiles in E. coli isolated from primates in China., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The prevalence of β-lactamase, 16S rRNA methylase genes, and plasmid-mediated fluoroquinolone-resistance (PMQR) determinants (qnrC and qnrD) was determined by polymerase chain reaction in fluoroquinolone-resistant Escherichia coli isolated from a chicken farm, a pig farm, and a hospital in Shandong, China in 2007. The bla(TEM) and bla(CTX-M) were the most prevalent β-lactamase genes in isolates from chickens (88.4%, 175/198 and 81.3%, 161/198) and hospitalized patients (87.8%, 122/139 and 69.1%, 96/139). The bla(TEM) was the most prevalent β-lactamase gene observed in isolates from pigs (98.5%, 135/137). The gene bla(CMY-2) was also predominant among isolates from chickens (20.2%, 40/198). The bla(LAP-1) gene was first detected in one strain from chickens and humans (pig farm workers) in China. Only one strain from hospitalized patients was found to possess bla(SHV). The rmtB was the most prevalent 16S rRNA methylase gene detected in isolates from chickens (19.7%, 39/198) and hospitalized patients (15.8%, 22/139). To our knowledge, this is the first report of the detection of the qnrD gene in E. coli from chickens and pigs in China. The qnrC and bla(KPC) genes were not detected in any of the isolates. Results of southern hybridization revealed that PMQR determinants, β-lactamases, and 16S rRNA methylase genes were located on the same plasmid in E. coli strains derived from patients. Also, PMQR determinants and β-lactamase genes were localized on the same plasmid in an E. coli strain of animal origin. Results of conjugation experiments revealed that all of these plasmid-based resistance genes can be transferred by conjugation through horizontal transmission.

The aim of this study is to investigate the trend of antimicrobial resistance of 696 Escherichia coli strains of chicken origin in China during 1970-2007, and to characterize the beta-lactamase determinants of these strains. Minimum inhibitory concentrations (MICs) of these strains against 11 antimicrobials were determined by the broth microdilution method. Quinolone-resistant, and first-generation cephalosporin-resistant strains have emerged since the 1990s; third-generation cephalosporin-resistant strains were not detected until 2003. Afterwards these resistant strains increased rapidly, and an obvious increase of isolates with decreased susceptibility to forfenicol was also observed. Three classes of beta-lactamase genes in E. coli strains were detected by PCR and confirmed by DNA sequencing. The detection rate of narrow-spectrum beta-lactamase genes decreased from 71.2% in the 1970s to 28.8% during 2004-2007. Extended-spectrum beta-lactamase (ESBL) genes did not emerge until 2004 and the detection rate was 18.5% between 2004 and 2007. The detection rate of bla(CMY-2), which emerged between 2000 and 2003, climbed to 6.6% during 2004-2007. bla(CTX-M) was the dominant genotype (75%) in ESBL gene-harboring E. coli strains. Fifty strains (17.6%), co-harboring multiple kinds of beta-lactamase genes, were detected in 284 beta-lactamase-producing strains. Southern hybridization revealed that two- or three kinds of ESBL and/or CMY-2 genes co-located on one plasmid in 9 strains. The rising trend of antimicrobial resistance and the high prevalence of beta-lactamase determinants in E. coli strains of chicken origin might be attributed to overuse of antimicrobials, especially beta-lactams, in poultry production., (Copyright 2010 Elsevier B.V. All rights reserved.)

A total of 182 Escherichia coli isolates from animals, environment and workers of dairy cattle, swine and chicken farms in Shandong which locates in Eastern China, were investigated for antimicrobial resistance as well as prevalence and the transfer mechanisms of integrons. The results revealed isolates from swine and chicken farm exhibited high levels of resistance to antimicrobial agents. The positive rate of gene cassette of class 1 integron in dairy cattle, swine and chicken farms was 5%, 20% and 41.94%, respectively. Only four isolates possessed class 2 integron, all of which were from chicken farm. Nine distinct cassette arrays were detected and two novel gene cassette arrays yheSDelta-yheR-kefBDelta and chrADelta-sul1-qacEDelta1-orf5-aadA5-dfrA17 were identified in class 1 integron for the first time. Class 1 integrons were found to be located mostly in both chromosomal and conjugative plasmid through southern hybridization and conjugation. PFGE revealed clonal relatedness among the isolates from different sources, especially within the same farm. The results confirmed the antimicrobial resistance and prevalence of integrons were strongly associated with the selection pressure of antimicrobial agents, and resistance genes in animal farms were probably spread by both vertical and horizontal transfer.

China banned colistin as growth promoter for animals in the year of 2017. A decrease of colistin-resistant Escherichia coli (COREC) and mcr-1-positive Escherichia coli (MCRPEC) were observed in livestock (pigs and chickens) and humans after the ban policy. However, the prevalence of COREC among Chinese companion animals after the ban policy has not been investigated. Here, we recovered 771 E. coli isolates from the China Antimicrobial Resistance Surveillance Network for Pets (CARPet) surveillance system (19 provinces/municipalities) from 2018 to 2021. We identified 12 COREC from eight dogs and four cats, among which one feline and three canine isolates were MCRPEC. The prevalence of COREC and MCRPEC in pets from 2018–2021 (1.1%–2.2% and 0.8%–1.1%) were lower than those from 2012–2016 (7.1%–17.8% and 6.1%–14.3%). The phylogenetic analysis revealed that the four MCRPEC isolates displayed genetic diversity, while one canine isolate exhibited only 26 SNPs difference with one human MCRPEC isolate in the same city, suggesting the exchange of MCRPEC isolates between companion animals and humans. In three MCRPEC isolates, mcr-1 was located on an IncI2 plasmid, which exhibited 99.5%–99.9% nucleotide sequence identity with plasmid pHNSD133-MCR from E. coli of chicken origin. In the remaining MCRPEC, mcr-1 was chromosomally located flanked by intact ISApl1 elements forming a unit of ISApl1-mcr-1-pap2-ISApl1. Despite the low prevalence of COREC and MCRPEC observed in companion animals after the ban policy, the association of pet-derived MCRPEC and mcr-carrying plasmids with those from humans and farm animals suggest that annual surveillance of colistin resistance in bacteria of pet origin is essential. [ABSTRACT FROM AUTHOR]

Objectives: To report a novel tigecycline resistance gene, tet(X6), and its variants in four bacterial species isolated from chickens and pigs in China.Methods: WGS was conducted to identify the suspected resistance genes in the tigecycline-resistant Myroides phaeus 18QD1AZ29W. Functional cloning, homology modelling and molecular docking were performed to compare the function with other Tet(X) variants. Retrospective screening for tet(X6) was conducted for 80 isolates in our WGS data collection, and all genomic environments of tet(X6)-positive isolates were analysed.Results: The tigecycline-resistant M. phaeus 18QD1AZ29W isolated from a pig farm in Shandong in 2018 was positive for tet(X2) and a novel tet(X) gene, designated tet(X6). Tet(X6) could increase the MICs of all tested tetracyclines/glycylcyclines for Escherichia coli only 2- to 4-fold, which was possibly due to a lower tetracycline binding capacity of Tet(X6) compared with that of other Tet(X) variants. Retrospective screening showed that seven other isolates (7/80, 8.8%), comprising four Proteus spp. and three Acinetobacter spp. from chickens and pigs in Shandong and Guangdong, were positive for three different variants of tet(X6). The analysis of the genomic environment revealed that two tet(X6)-positive isolates from M. phaeus and Proteus cibarius, respectively, contained ISCR2, which may play a role in tet(X6) transmission.Conclusions: This study identified a novel type of tigecycline resistance gene, tet(X6), in Myroides, Acinetobacter and Proteus from chickens and swine. Tet(X6) conferred lower tetracycline/glycylcycline MICs than other Tet(X) variants, and ISCR2 may play a role in the transmission of tet(X6). [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the prevalence of clinical mcr-1-positive Escherichia coli and Klebsiella pneumoniae and characterize the antimicrobial resistance profiles of mcr-1-positive E. coli and mcr-1-negative E. coli in China.Methods: A total of 6264 clinical E. coli (n = 3854) and K. pneumoniae (n = 2410) were collected from hospitalized patients from 18 to 20 hospitals as part of the China Antimicrobial Resistance Surveillance Trial (CARST) between January 2007 and June 2016. PCR was used to screen for the mcr-1 gene among all isolates. Antibiotic susceptibility testing was performed using the broth microdilution method. mcr-1-positive pathogens were then characterized by MLST and minimum spanning tree analysis using the BURST algorithm for related STs.Results: We examined 39 (0.62%) clinical isolates of mcr-1-positive E. coli and K. pneumoniae over a 10 year period. Resistance to antimicrobial agents was significantly more severe in mcr-1-positive isolates than mcr-1-negative isolates, particularly piperacillin (P = 0.008), amikacin (P < 0.0001), nitrofurantoin (P < 0.004) and fosfomycin (P < 0.0001). Among mcr-1-carrying isolates, ESBL production was as high as 84.6% (33 of 39) and 92.3% (36 of 39) of them displayed an MDR phenotype. STs suggested ubiquitous dissemination of mcr-1-carrying pathogens.Conclusions: mcr-1-carrying E. coli and K. pneumoniae displayed a lower prevalence and abundant phylogenetic diversity in mainland China. mcr-1-positive E. coli showed significant differences in antimicrobial resistance profiles compared with mcr-1-negative E. coli strains, suggesting physicians may consider prescribing different antibiotics when faced with infections caused by mcr-1-positive pathogens. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the location of Tn3-associated rmtB together with qnrS1, aac(6')-Ib-cr and blaCTX-M-15 on an F49:A-:B- plasmid in an Escherichia coli ST10 strain isolated from cows in China. Study authors found that Tn3-associated rmtB together with qnrS1, aac(6')-Ib-cr and blaCTX-M-15 are co-located on an Escherichia coli plasmid from cows. It also described the presence of rmtB gene in food-producing animal.

The wide dissemination of New Delhi metallo-β-lactamase genes (blaNDM) has resulted in the treatment failure of most available β-lactam antibiotics, with IncX3-type blaNDM-5-carrying plasmids recognised as having spread worldwide. In China, bacteria carrying these plasmids are increasingly being detected from diverse samples, including hospitals, communities, livestock and poultry, and the environment, suggesting that IncX3 plasmids are becoming a vital vehicle for blaNDM dissemination. To elucidate the fitness cost of these plasmids on the bacterial host, we collected blaNDM-negative strains from different sources and tested their ability to acquire the blaNDM-5-harboring p3R-IncX3 plasmid. We then measured changes in antimicrobial susceptibility, growth kinetics, and biofilm formation following plasmid acquisition. Overall, 70.7% (29/41) of our Enterobacteriaceae recipients successfully acquired the blaNDM-5-harboring p3R-IncX3 plasmid. Contrary to previous plasmid burden theory, 75.9% (22/29) of the transconjugates showed little fitness cost as a result of plasmid acquisition, with 6.9% (2/29) of strains exhibiting enhanced growth compared with their respective wild-type strains. Following plasmid acquisition, all transconjugates demonstrated resistance to most β-lactams, while several strains showed enhanced biofilm formation, further complicating treatment and prevention measures. Moreover, the highly virulent Escherichia coli sequence type 131 strain that already harbored mcr-1 also demonstrated the ability to acquire the blaNDM-5-carrying p3R-IncX3 plasmid, resulting in further limited therapeutic options. This low fitness cost may partly explain the rapid global dissemination of blaNDM-5-harboring IncX3 plasmids. Our study highlights the growing threat of IncX3 plasmids in spreading blaNDM-5. [ABSTRACT FROM AUTHOR]

China banned the use of colistin as animal growth promoter in April 2017. Herein, we report the prevalence of mcr-1 in the intestine of healthy humans and risk factors associated with mcr-1 carriage after the implementation of the ban. We recruited 719 healthy volunteers from Shenzhen City from 1 March 2018 to 31 December 2019 to investigate the prevalence of mcr-1 in human intestine, and undertook a case–control study to ascertain the risk factors associated with the mcr-1 -positive population. A further comparative study was conducted to identify differences between genetic characteristics of mcr-1 -positive and mcr-1 -negative Escherichia coli. Overall, 56 (7.8%, 95% CI 5.9%–10.0%, n = 719) individual faecal samples were positive for mcr-1 , and prevalence of mcr-1 among individuals in 2019 (2.4%, 95% CI 8.7%–15.0%, 7/294) was significantly lower than that in 2018 (11.5%, 95% CI 1.0%–4.8%, 49/425) (p < 0.0001). After the colistin ban, animal-derived food (pork and chicken meat) was no longer a risk factor for mcr-1 carriage in human intestine, whereas a higher intake of fish and seafood (>75 g/day) and whole grains (>150 g/day) was associated with higher and lower risk of mcr-1 carriage, respectively (OR 2.175, 95% CI 1.047–4.517; OR 0.045, 95% CI 0.004–0.567). Compared with mcr-1 -negative E. coli , the mcr-1 -positive E. coli had different patterns of resistance genes and genetic heterogeneity. Our study implicates aquatic food as beeing associated with mcr-1 carriage in the healthy population, even after the ban on colistin. Dietary modification (e.g. whole grains) may help to combat mcr-1 -positive bacterial colonization of the gut. [ABSTRACT FROM AUTHOR]

To investigate the characteristics of tet (X4)-carrying E. coli from retail raw meat, three hundred and eleven retail raw meat samples including chicken, pork, duck, and beef were collected for screening for tigecycline resistant isolates in Sichuan Province, China. We detected 25 (8.0%, 95%CI: 5.3%–11.6%) tet (X4) positive E. coli isolates from 311 retail meat with the highest prevalence (13.4%, 95%CI: 7.3%–21.8%) observed in pork. All the tet (X)-carrying isolates were analyzed by antimicrobial susceptibility testing, S1 nuclease pulsed-field gel electrophoresis (S1-PFGE), conjugation experiments, and whole genome sequencing (WGS) to study the phylogenetic relationship and genomic characteristics. Conjugation and S1-PFGE profiling showed 6 isolates (24.0%) successfully transferred the resistant phenotype with frequencies from 3.63 × 10−5 to 7.68 × 10−2. Simultaneously, tet (X4), floR , and the characteristic structure of adjacent abh gene and cassette flanked by IS CR2 were identified in all 25 isolates, and a structure of abh - tet (X4)-IS CR2 - virD2 - floR was aligned as an important genetic pattern around tet (X4). Two dominant sequence types (STs) ST1638 (n = 4) and ST48 (n = 4) were identified by in silico MLST. Single nucleotide polymorphisms analysis revealed two potential clone-like transmission clusters which showed high concordance with the local spatio-temporal epidemiology, suggesting that clonal transmission events were very likely. The presence of tet (X4) in multiple different clone complexes (CCs) and the identification of two clone-like transmission indicates its potentially extensive and successful spread among different food-producing animals. • tet (X4) gene was more commonly found in E. coli from pork than other raw meat. • Close relationship between tet (X4) and floR was observed. • tet (X4)-carrying strains could spread and evolve across hosts and environments. [ABSTRACT FROM AUTHOR]