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Na Huang,1 Tao Chen,1 Liqiong Chen,2 Ying Zhang,2 Yishuai Lin,2 Xiangkuo Zheng,1 Tieli Zhou,1 Lijiang Chen1 1Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, People’s Republic of China; 2Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, People’s Republic of ChinaCorrespondence: Lijiang Chen; Tieli ZhouDepartment of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of ChinaTel +86-577-8669-9370; +86-577-86689885Email wyychenlijiang@163.com; wyztli@163.comPurpose: This study aimed to evaluate the in vitro activity of meropenem-vaborbactam (MVB) against a collection of carbapenem-resistant Escherichia coli (CREC) isolates and to compare the activity with other antibiotics with regard to different separation sites, carbapenem-resistant mechanisms, and sequence types (STs).Methods: A total of 58 CREC strains were used as the experimental strains from the First Affiliated Hospital of Wenzhou Medical University in southeastern China. The minimum inhibitory concentrations of MVB, ceftazidime-avibactam, and tigecycline against all the experimental strains were determined by the microdilution broth method.Results: MVB exhibited higher antimicrobial activity (83% susceptibility) than that of other antibiotics, except for colistin and tigecycline. The susceptibility of CREC strains towards MVB varied with regard to carbapenem-resistant mechanisms and STs, especially in Klebsiella pneumoniae carbapenemase (KPC)-positive isolates and ST8 isolates.Conclusion: MVB exhibited considerably high activity against KPC-producing and ST8 CREC isolates. It has the great potential to be an alternative for the treatment of infections caused by CREC after determining the type of carbapenemase, the susceptibility to MVB and/or STs.Keywords: meropenem-vaborbactam, carbapenem-resistant Escherichia coli, in vitro activity, KPC-producing, ST8

The study aimed to investigate the occurrence of carbapenem resistant E. coli and P. aeruginosa in apparently healthy, captive blackbucks and leopards of India. Faecal samples of blackbucks (n = 7) and leopards (n = 7) were processed to isolate carbapenem resistant E. coli (CRE) and P. aeruginosa (CRP). Forty (leopards n = 26; blackbuck n = 14) E. coli and two P. aeruginosa (blackbuck n = 2) samples were isolated from the faecal samples (n = 14). Eleven carbapenem resistant isolates were recovered, of which 10 were CRE and one was CRP. The minimum inhibitory concentration (MIC) was determined for meropenem for carbapenem resistant isolates and was between 8 and 64 μg/mL. All the CRE and CRP were phenotypically multidrug resistant, and six CRE were extended-spectrum beta-lactamases (ESBL) producers. On genotypic screening, seven CRE and one CRP were positive for the blaNDM carbapenemase gene. Efflux pump-mediated carbapenem resistance was noticed in four CRE isolates (36.4%, 4/11). Of the six ESBL producing CRE, four isolates carried blaCTX-M-1 genes. The CRE isolates also harbored blaTEM-1, blaAmpC, qnrA, qnrB, qnrS, tetA, tetB and sul1 resistance genes. On Shiga toxin virulence screening, Stx1, Stx2 genes were detected in two and one isolates, respectively. Plasmid typing of CRE revealed that the blaNDM genes were carried on an Incl1 plasmid. The plasmid multilocus sequence typing (pMLST) of the isolates showed the Sequence Type (ST) 297. The occurrence of carbapenem resistance bacteria in captive wildlife should be a major public health priority.

Dongdong Yin,1,2,* Yanfeng Lin,1,3,* Zhonghong Li,1,4,* Hui Ma,5,* Lanfen Lu,6 Kaiying Wang,1,3 Lang Yang,1,3 Xinying Du,1 Peng Li,1 Kezong Qi,2 Hongbin Song1,* 1Center for Disease Control and Prevention of PLA, Beijing, People’s Republic of China; 2Anhui Province Key Laboratory of Veterinary Pathobiology and Disease Control College of Animal Science and Technology, Anhui Agricultural University, Hefei, People’s Republic of China; 3Institute for Disease Control and Prevention, AMMS, Beijing, People’s Republic of China; 4College of Environmental and Chemical Engineering, Nanchang Hangkong University, Nanchang, People’s Republic of China; 5The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China; 6Department of Laboratory Diagnosis, Sun Yat-Sen University Affiliated Zhongshan Hospital, Zhongshan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Peng Li; Kezong Qi Email jiekenlee@126.com; qkz@ahau.edu.cnBackground: A carbapenem-resistant Escherichia coli (sequence type 5415) strain was isolated from a male patient through routine surveillance in 2018 in Guangzhou, China.Materials and Methods: Bacteria were isolated from a sputum culture and identified by using the Vitek 2 compact system. The blaNDM-5 gene was amplified and confirmed by sequencing. Antimicrobial susceptibility testing was determined by a Vitek 2 compact system. The blaNDM-5 gene was located by Southern blotting. Whole-genome sequencing was carried out using both Illumina MiSeq and Oxford Nanopore MinION.Results: S1-PFGE and Southern blotting showed that the blaNDM-5 gene was located on a novel 66-kb IncFII [F2:A-:B-] plasmid. Conjugation assays revealed that the blaNDM-5-bearing plasmid was self-transferrable. Genomic sequencing and comparative analysis suggested that plasmid p2947-NDM5 likely originated from a combination of an IncFII-type backbone and the blaNDM-5 flanking genetic elements.Conclusion: This is the first report of an ST5414 E. coli strain expressing an NDM-5 β-lactamase. This study highlights the genetic complexity of blaNDM-5 carrying plasmids and the urgent need for continuous active monitoring.Keywords: Escherichia coli, ST5415, NDM-5, IncFII, carbapenem resistant

The present study was aimed at investigating anti-bacterial effects of Bletilla striata dihydrophenanthrene (DHP) on clinically isolated Escherichia coli (E. coli), including extended spectrum β-lactamases (ESBLs)-carrying E. coli and carbapenem-resistant E. coli (CRE). The minimum inhibitory concentrations (MIC) of two extracts, DHP and residual substances extracted by ethanol and n-butanol (NBE), were determined by the serial dilution method. The light absorption value of macromolecular substances, total leakage rate, and total protein content in the nutrient solution were determined by spectrophotometric analysis. Quantification of protein expression and drug susceptibility verification were determined by mass spectroscopy. In addition, the elimination of drug-resistant plasmids was evaluated. Our data showed that the DHP had a more powerful antibacterial effect on E. coli than that of NBE, with MICs of 0.82–1.38 mg/mL and 1.07–1.51 mg/mL, respectively. In addition, DHP enhanced the absorbance value of macromolecular substances, and increased protein expression in E. coli when compared with NBE. Moreover, NBE increased the total leakage rate of small molecule substances, total protein content, and reversed drug resistance when compared with DHP. Both NBE and DHP eliminated the banding patterns related to multidrugresistant plasmids, selectively inhibited bacterial growth and reversed multidrug resistance by regulating cell membrane permeability and protein expression levels in E. coli. The reversal of drug resistance may be mediated through elimination of drug-resistant plasmids in E. coli. Therefore, DHP and NBE may be promising antibacterial drug candidates, and DHP is more likely.

Background Antimicrobial resistance is exponentially worsening, and the spread of prevalent carbapenem resistant Enterobacteriaceae (CRE) is a major contributor to this global concern. Infection prevention and control strategies are increasingly consolidated key tools to control this worldwide problem. Aim To identify, collect and analyse available evidence regarding the impact of infection prevention and control strategies on prevalent CRE dissemination. Methods Pubmed®, Scopus® and Web of Science® were searched systematically for articles published between 1th January 2017 and 30th June 2020, guided by the research question ‘What are the most effective and efficient strategies to prevent and control infection/colonisation caused by Carbapenem resistant Escherichia coli and Carbapenem resistant Klebsiella pneumoniae?’. Findings Eleven thousand six hundred and thirty-five publications were found, but after applying the inclusion and exclusion criteria, only 30 were selected. The majority of reviewed studies ( n = 24) were performed in outbreak situations, 26 studies occurred in acute care units and of those, 17 in intensive care units . From the set of implemented infection prevention and control measures, in 29 studies surveillance cultures were applied, in 23 studies patients were isolated or cohorted and, in general, all described the implementation of standard and contact precaution measures. Conclusion This systematic review underlines the importance of infection prevention and control strategies in CRE dissemination, standing out the need of further studies outside outbreak and intensive care units contexts. Investment increments and training and educating of all involved are also important contributors to shift this problem, but still with relevant gaps in their implementation, in all types of care units, that need to be addressed.

Background:Carbapenem-resistant Enterobacterales (CRE) are common causes of healthcare-associated infections and are often multidrug resistant with limited therapeutic options. Additionally, CRE can spread within and between healthcare facilities, amplifying potential harms.Objective:To better understand the burden, risk factors, and source of acquisition of carbapenemase genes in clinical Escherichia coli and Klebsiella spp isolates from patients in Washington to guide prevention efforts.Design:Multicenter prospective surveillance study.Methods:Escherichia coli and Klebsiella spp isolates meeting the Washington state CRE surveillance case definition were solicited from clinical laboratories and tested at Washington Public Health Laboratories using polymerase chain reaction (PCR) for the 5 most common carbapenemase genes: blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48. Case patients positive by PCR were investigated by the public health department.Results:From October 2012 through December 2017, 363 carbapenem-resistant E. coli and Klebsiella spp isolates were tested. Overall, 45 of 115 carbapenem-resistant K. pneumoniae (39%), 1 of 8 K. oxytoca (12.5%), and 28 of 239 carbapenem-resistant E. coli (11.7%) were carbapenemase positive. Of 74 carbapenemase-positive isolates, blaKPC was most common (47%), followed by blaNDM (30%), blaOXA-48 (22%), and blaIMP (1%). Although all cases had healthcare exposure, blaKPC acquisition was associated with US health care, whereas non-blaKPC acquisition was associated with international health care or travel.Conclusions:We report that blaKPC, the most prevalent carbapenemase in the United States, accounts for nearly half of carbapenemase cases in Washington state and that most KPC-cases are likely acquired through in-state health care.

We report the first clinical Escherichia coli strain EC3000 with concomitant chromosomal colistin and carbapenem resistance. A novel in-frame deletion, Δ6-11 (RPISLR), in pmrB that contributes to colistin resistance was verified using recombinant DNA techniques. Although being less fit than the wild-type (WT) strain or EC3000 revertant (chromosomal replacement of WT pmrB in EC3000), a portion of serially passaged EC3000 strains preserving colistin resistance without selective pressure raises the concern for further spread.

Due to their ability to resist endpoint antimicrobials such as carbapenem, it is very important to detect and monitor multi-drug resistant Gram negative strains with plasmids containing genes such as blaNDM-5 by new molecular methods. This study aimed to perform in silico analysis of resistance gene identifiers on human and animal-derived blaNDM-5 plasmids found in open databases, which were analyzed by new whole genome sequencing techniques and to compare these resistance genes. The plasmid genomic sequences of 4 human and 2 animal E. coli strains containing blaNDM-5 genes included in our study were analyzed in Silico using the Resistance Gene Identifier (RGI) option of the comprehensive antibiotic resistance gene database using default values. Human and animal strains included in our study were found to have different antimicrobial resistance genes in addition to blaNDM-5. All plasmids were found to have at least 8 perfect antimicrobial resistance gene sequences matches. When the resistance gene identifiers in all plasmids were examined, 35 resistance gene identifiers were found. Besides blaNDM-5, mphA, qacEdelta1 and sul1 were found in all plasmids. As a conclusion, it was determined by our study results that, regardless of the source, there may be different antimicrobial resistance gene identifiers besides the blaNDM-5 resistance gene in plasmids. We are of the opinion that routine molecular surveillance studies should be carried out considering the one health approach of Gram-negative pathogens such as E. coli, which can contain plasmids that cause multi-drug resistance and can be isolated from all sources., Karbapenem gibi son nokta antimikrobiyallere direnç yetenekleri dolayısıyla, blaNDM-5 gibi genler ihtiva eden plazmidlere sahip çoklu ilaç direnci gösteren Gram negatif kökenlerin yeni moleküler yöntemlerle tespiti önemlidir. Biz de çalışmamızda bu yeni tekniklerle tüm genom sekans analizi yapılan ve açık veritabanlarında bulunan insan ve hayvan kaynaklı blaNDM-5 plazmidleri üstünde bulunan direnç gen tanımlayıcılarının in silico analizini yapmayı ve bu direnç genlerini karşılaştırmayı amaçladık. Çalışmamıza dahil edilen 4 insan ve 2 hayvan kaynaklı, blaNDM-5 geni içeren E.coli kökenlerine ait plazmid genomik dizileri, varsayılan değerler kullanılarak kapsamlı antibiyotik direnç gen veritabanının, direnç geni tanımlayıcı (RGI) seçeneği kullanılarak bilgisayar ortamında analiz edildi. Çalışmamıza dahil edilen insan ve hayvan kaynaklı kökenlerde blaNDM-5 yanında farklı antimikrobiyal direnç genlerinin de olduğu tespit edildi. Tüm plazmidlerin en az 8 mükemmel antimikrobiyal direnç gen dizisi eşleşmesi gösterdiği saptandı. Tüm plazmidlerde bulunan direnç gen tanımlayıcıları incelendiğinde 35 direnç gen tanımlayıcısı saptandı. blaNDM-5 yanında, mphA, qacEdelta1 ve sul1’in bütün plazmidlerde olduğu tespit edildi. Sonuç olarak, kaynak fark etmeksizin, plazmidlerde, blaNDM-5 direnç geni yanında farklı antimikrobiyallere direnç gen tanımlayıcılarının da olabildiği çalışma sonucunda tespit edilmiştir. Çoklu ilaç direncine neden olan plazmidleri ihtiva edebilen ve tüm kaynaklardan izole edilebilen E. coli gibi Gram negatif patojenler üzerinde tek sağlık yaklaşımı düşünülerek rutin moleküler surveyans çalışmalarının yapılması gerektiği kanaatindeyiz.

Background The widespread resistance to carbapenem via Enterobacteriaceae is a major public health concern. To investigate the reason for the change of Escherichia coli from carbapenem-susceptible to carbapenem-resistant status after antibiotic therapy, whole-genome sequencing was applied for the analysis of genetic difference between the two isolates. The genome of the two isolates of Escherichia coli with distinct resistant phenotypes recovered from one patient was sequenced and compared. Single-nucleotide polymorphisms and insertions/deletions were analyzed using software MUMmer (http://mummer.sourceforge.net/). Results The homology of chromosomes, plasmid 1, and plasmid 2 between the two isolates was very high (>99.5%). However, the coverage ratio of plasmid 3 was only 7.13%. This plasmid harbored the IMP-4 carbapenemase-coding gene. The upstream of blaIMP-4 was the plasmid mobilization relaxosome protein Mobe gene and the downstream were class 1 integrom integrase IntI1 and IS6 family transposase IS15DIV, which may be related to carbapenemase gene capture. Conclusions Single-nucleotide mutation, insertion, and deletion could not result in the development of resistance to carbapenem, whereas acquisition of the IMP-4-encoding gene may be the reason for changes in resistance to carbapenem.

Escherichia coli sequence type 131 (ST131) is well known for its multidrug resistance profile. Carbapenems have been considered the treatment of choice for E. coli ST131 infections and resistance to carbapenems is now emerging due to the acquisition of carbapenemase. 45 carbapenem-resistant E. coli isolates were collected in a hospital. The resistance mechanisms, plasmid profiles and genetic relatedness of these strains were determined. Phylogenetic relationships between these strains were assessed by molecular profiling and aligned with patient clinical details. The genetic context of blaKPC-2 was analyzed to trace the potential dissemination of blaKPC-2.45 carbapenem-resistant E. coli ST131strains are closely related. Initially prevalent only in the ward E02, ST131 subsequently spread to other wards and multiple lineages evolved independently, resulting in a respiratory infection outbreak of carbapenem-resistant E. coli ST131. Eight of the 30 patients died within 28 days of the first E. coli ST131 isolation. The blaKPC-2 positive plasmid profiles suggest that the carbapenem resistance was due to the acquisition of transmissible plasmids pE0272_KPC and pE0171_KPC carrying blaKPC-2 by E. coli ST131. Additionally, diverse multidrug resistance elements were transferred and rearranged between these plasmids mediated by IS26. E. coli ST131 has become a multidrug resistant epidemic clone that can cause hospital-acquired respiratory infections resulting in mortality. Our research indicates that clinical attention should be paid to the importance of E. coli ST131 in respiratory infections. The emergence of blaKPC in E. coli ST131 may herald the beginning of the high prevalence of carbapenem resistance in Chinese communities and hospitals.

Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent antibiotic resistant threat. Only sporadic reports of CRE in companion animals have been described. Our objective was to identify risk factors associated with the acquisition of a blaNDM-5 CR-Escherichia coli strain as part of an outbreak investigation at a tertiary veterinary hospital in the United States. A matched case–control study was conducted among companion animals admitted during July 1, 2018, through June 30, 2019. The 15 identified blaNDM-5 CR-E coli cases were matched 1:2 with controls (culture negative for blaNDM-5 CR-E coli) based on species and number of days of hospitalization before bacterial culture sample collection. The association between exposure to various procedures and hospital services and the acquisition of blaNDM-5 CR-E. coli was assessed through conditional logistic regression. Case patients had significantly higher odds of exposure to the anesthesia service (odds ratio [OR] = 12.8, P = .017), the surgical service (OR = 4.0, P = .046), and to endotracheal intubation (OR = 10.0, P = .03). Veterinary hospitals should be aware of the potential for transmission of CRE via anesthetic and surgical procedures, especially those that require the placement of endotracheal tubes.

Background The increasing emergence of carbapenem resistant Escherichia coli (CREC) poses a potential threat to public health, hence genomic characterization of isolates is needed for a better understanding of its transmission and implementation of infection control measures. Materials and methods Eleven CREC isolates were collected in 2015 from 6 hospitals in Nanjing, China, and analyzed using whole genome sequencing. Resistance determinants, virulence elements, multi-locus sequence type (MLST), serotypes, phylogeny and fimH types were determined. Results All of the CREC carried at least one carbapenemase. NDM-5 (n = 9) was the most frequent carbapenemase, followed by KPC-2 (n = 3) and NDM-1 (n = 2); three isolates produced NDM-5 and KPC-2. Ten out of the 11 isolates co-carried blaCTX-M variants. MLST analysis found 7 distinct STs, including ST410 (n = 2), ST3489 (n = 1), ST156 (n = 1), ST683 (n = 1), ST297 (n = 1), ST167 (n = 1), and ST361 (n = 1). Six distinct serotypes and 8 Fim types were identified. A great diversity of plasmid profiles was observed with plasmid replicon IncX3 being the most frequent (n = 11). Phylogenetic analysis showed great diversity between the 11 CREC isolates and also between 6 additional isolates co-carrying blaNDM and blaKPC which were selected from the strains collection of Nanjing Drum Tower Hospital for comparison. Conjugation assays demonstrated that blaNDM was transferable. Conclusion NDM is the major carbapenemase among CREC, with NDM-5 being the main variant which can be horizontally disseminated by IncX3 plasmids. These isolates displayed genetic diversity by MLST, Fim typing and serotyping. We herein provided the first report on emergence of NDM-5 producing E. coli ST297, ST683, ST3489, and NDM-1 producing E. coli ST361.

We report the first clinical Escherichia coli strain EC3000 with concomitant chromosomal colistin and carbapenem resistance. A novel in-frame deletion, Δ6-11 (RPISLR), in pmrB that contributes to colistin resistance was verified using recombinant DNA techniques. Although being less fit than the wild-type (WT) strain or EC3000 revertant (chromosomal replacement of WT pmrB in EC3000), a portion of serially passaged EC3000 strains preserving colistin resistance without selective pressure raises the concern for further spread.

We describe a case of carbapenem resistant E. coli isolated from urine in an 87-year-old woman with recurrent urinary tract infections. Using whole genome sequencing (WGS), we identified the carbapenem resistance mechanism to be a combination of ompC porin loss and plasmid-mediated AmpC gene blaCMY-2 , which was not detected by routine molecular and phenotypic carbapenemase assays. Our case raises a concern for the limitation of current CRE screening tools for emerging resistance mechanisms and demonstrates the utility of WGS as a better tool for characterization of CRE in the clinical setting.

This study was undertaken to detect the presence of blaNDM-1 gene among the carbapenem resistant Escherichia coli and Klebsiella pneumoniae isolates, confirmed through using Modified Hodge Test (MHT). During the six months of this study (November, 2016 – April, 2017), a total of 1503 clinical samples including urine, blood, wound swabs and Cerebrospinal fluid (CSF) were collected and processed at Microbiology Laboratory, International Friendship Children’s Hospital, Kathmandu, Nepal. Among the E. coli and K. pneumoniae isolates, 14.1%, 17.1% were resistant to meropenem, whereas 11.28%, 17.1% were resistant to imipenem, respectively. From the pool of 94 E. coli and 35 K. pneumoniae isolates, 34 E. coli and 18 K. pneumoniae were screened as possible carbapenemase producers. For screening of carbapenemase enzyme production among these isolates, resistances to third generation cephalosporins and carbapenems were taken into consideration. Two isolates of E. coli and 3 isolates of K. pneumoniae were confirmed as carbapenemase producers by MHT. Furthermore, Polymerase chain reaction (PCR) was carried out among the MHT positive bacteria for detection of blaNDM-1 gene. Genetic analysis of MHT positive isolates showed that 1\2 E. coli and 2\3 K. pneumoniae isolates were New Delhi metallo-β-lactamase producers (NDM-1). Results of this study demonstrated the presence of blaNDM-1 gene among the carbapenemase producing E. coli and K. pneumoniae isolates, and were recorded to be 50% and 66.6%, respectively.

The emergence and dissemination of carbapenem-resistant Escherichia coli (E. coli) strains is a main risk for global public health, but little is known of carbapenemase producing E. coli in Henan, China. The study was undertaken to investigate the prevalence and mechanism of carbapenem-resistant E. coli strains in a hospital in Xinxiang, Henan, China, 2014. A total of 5 carbapenemase-producing E. coli strains were screened from 1014 isolates. We found that they were all resistant to meropenem and imipenem. Amikacin showed the best sensitivity, with gentamicin coming up next. The positive rate of blaNDM was 80% (4/5). The sequencing results showed that two isolates belonged to blaNDM-1 whereas other 2 isolates carried the blaNDM-5. Other carbapenemase genes including blaIMP, blaVIM, blaKPC and blaOXA-48 were not detected. The blaCTX-M-15, blaTEM-1, sul2, aad, and aac(6”)–Ib–cr were also detected. MLST analysis showed that NDM-producing E. coli were sporadic. Conjugation test indicated blaNDM could be transferred. In conclusion, the blaNDM was the principal resistance mechanism of carbapenem-resistant E. coli in the hospital, Henan, China. Keywords: blaNDM, Carbapenem-resistant, Escherichia coli

Limited studies have characterized multiple carbapenem-resistant Escherichia coli isolates and compared their genetic characteristics through whole-genome sequencing (WGS) because of the scarcity of these isolates. In this study, we determined the prevalence of carbapenem resistance in 2,993 E. coli isolates collected from three Chinese hospitals. The carbapenem-resistant isolates were further characterized by WGS, and the molecular epidemiological characters and resistance mechanisms were explored through the publicly available platforms from the Center for Genomic Epidemiology. Twenty-four carbapenem-resistant E. coli isolates were screened out from 2,993 E. coli clinical isolates and all carbapenem-resistant isolates showed multiple drug-resistant phenotypes. The main serotypes identified among carbapenem-resistant isolates through WGS included E. coli O8:H21 (n = 6), E. coli O102:H6 (n = 6), and E. coli O25:H4 (n = 3), and the dominant sequence types (ST) were ST410 (n = 8), ST405 (n = 6), and ST131 (n = 3). Carbapenemase encoding genes, including bla

Introduction: One of the most common mechanisms in the development of carbapenem resistance is acquiring carbapenemases. A new and different carbapenemase, Klebsiella pneumoniae carbapenemase (KPC), has recently emerged in Turkey. Klebsiella pneumoniae carbapenemases are encoded by the blaKPC gene and can be transferred between different species. Reports showing the presence of blaKPC gene in isolates from Turkey are limited. The current study aimed to investigate the presence of blaKPC gene in carbapenem resistant K. pneumoniae and Escherichia coli isolates in a tertiary care hospital in Turkey. Materials and Methods: Patient samples from various clinical units in Adana Numune Training and Research Hospital between November 2013 and October 2014 were sent to our laboratory at the same hospital. K. pneumoniae and E. coli strains isolated from different clinical samples were identified using both conventional methods and the VITEK® 2.0 automated identification system (bioMérieux, France). Imipenem-cilastatin, meropenem, and ertapenem susceptibility was analyzed using a VITEK® 2.0 antibiotic susceptibility testing system (bioMérieux, France). The presence of blaKPC gene was investigated by polymerase chain reaction. Results: A total of 49 resistant K. pneumoniae and 33 E. coli isolates were included in the study. Most were isolated from urine specimens. Among the carbapenems we tested, highest resistance rates were to ertapenem (98.0% in K. pneumoniae and 84.8% in E. coli isolates). One K. pneumoniae isolate was found positive for the blaKPC gene. Conclusion: According to our literature survey, this study is among the first reports from Turkey presenting the isolation of KPC-producing K. pneumoniae. This finding indicates the need to monitor carbapenem resistance arising from blaKPC, which may spread horizontally. Moreover, surveillance of antibiotic sensitivity rates and observation of regional differences will be useful guidelines in determining infection control and antimicrobial use management policies.

The carbapenem resistance gene blaNDM-5 was identified in an Escherichia coli strain isolated from a dog. We report here the complete genome sequence of this E. coli strain; the blaNDM-5 gene was present on a large IncFII multidrug-resistant plasmid. This is the first blaNDM-5-carrying E. coli strain from an animal in the United States.

We determined the prevalence and types of extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Escherichia coli in raw retail beef, chicken, pork, fruit and vegetables in five UK regions in 2013-14. Raw meat (n=397), and fruit and vegetable samples (n=400) were purchased from retail stores in London, East Anglia, North West England, Scotland and Wales. Samples were tested for the presence of ESBL-producing E. coli by plating enriched samples on CHROMagar CTX and CHROMagar ESBL, for AmpC-type E. coli by plating on "CHROMagar FOX" (CHROMagar ECC+16mg/L cefoxitin), and for carbapenem-resistant E. coli by plating on CHROMagar KPC. Additionally, pre-enrichment counts were performed on the above agars, and on CHROMagar ECC. Isolates of interest were characterised by MALDI-ToF to confirm identification, by PCR for blaCIT,blaCTX-M,blaOXA, blaSHV and blaTEM genes; ESBL or blaCIT genes were sequenced. Only 1.9% and 2.5% of beef and pork samples, respectively were positive for ESBL-producing E. coli after enrichment compared with 65.4% of chicken samples. 85.6% positive samples from chicken meat carried blaCTX-M-1; blaCTX-M-15 was not detected. None of the fruits or vegetables yielded ESBL-producing E. coli and none of the meat, fruit or vegetable samples yielded carbapenem-resistant E. coli. Retail chicken was more frequently a source of ESBL-producing E. coli than were beef, pork, fruit or vegetables. None of the foodstuffs yielded E. coli with CTX-M-15 ESBL, which dominates in human clinical isolates in the UK, and none yielded carbapenem-resistant E. coli.

Carbapenemase-mediated carbapenem resistance is a major concern across the world. Rapid detection of carbapenemase-producing organisms is of great importance in clinical settings. However, it is essential to have a test with good sensitivity and specificity. The aim of the study was to compare the performance of RAPIDEC® CARBA NP and modified carbapenem inactivation method (mCIM) recommended by Clinical and Laboratory Standards Institute guideline 2017. A total of ninety carbapenem resistant Escherichia coli and Klebsiella pneumoniae have been tested. The presence of various carbapenemases was screened by conventional multiplex polymerase chain reaction. RAPIDEC® CARBA NP detected 90%, whereas mCIM detected 99% of the study isolates tested. Although RAPIDEC® CARBA NP is a rapid test, the sensitivity is reduced for blaOxa-48Likedetection; while mCIM could pick up blaOxa-48Likeenzymes with excellent sensitivity. Further, organisms producing low carbapenemase activity enzymes, thickness of the inoculum and the disc potency are likely to influence the test results of mCIM with an overnight delay.

This study reports the increasing prevalence of clinical Escherichia coli of sequence type 167 (ST167) carrying both bla NDM-1 and bla NDM-5 on the conjugative IncX3 plasmid in various parts of China. Close surveillance is needed to monitor the future dissemination of ST167 strains that harbor bla NDM-5 or other bla NDM -like genes.

Herein, we report a 70-year-old male patient, with recurrent multiple hepatic abscesses, that was admitted to the internal medicine department for treatment of Carbapenem Resistant Escherichia Coli (CRE) bacteremia. The patient was treated with Tigecycline; few days later, he developed qDisseminated Intravascular Coagulation (DIC)q like coagulation study abnormality that seemed to be related to Tigecycline treatment. Upon discontinuing it, the DIC-like condition was resolved. Tigecycline should be considered as a possible etiological factor in patients with DIC-like, and this therapy should be withdrawn immediately in suspected cases.

Antimicrobial resistance (AMR) is a big challenge threatening public health worldwide. Every year, AMR-associated bacterial infections result in over 70,000 people deaths in the United States [1,2]...

Introduction:During the past decade, the rate of carbapenem resistance among Enterobacteriaceae, mostly in Escherichia coli and Klebsiella pneumoniae, has significantly increased worldwide. It is a great challenge for the choice of drug treatment especially in children.Tigecycline is the fir

Carbapenem resistance has been encountered globally with poor outcome of infected patients. NDM-1 (New Delhi metallo-beta-lactamase) gene containing organisms have emerged and are now spreading in all continents. This is the first report of Iraqi patients referred to Lebanon from whom carbapenem resistant Enterobacteriaceae were recovered. The genes involved in carbapenem resistance were bla-OXA-48 and the novel NDM-1. This report highlights the alarming introduction of such resistance among Enterobacteriaecae to this country.

A novel New Delhi metallo-β-lactamase variant, NDM-12, was identified in a carbapenem-resistant Escherichia coli clinical isolate obtained from a urine sample from a patient in Nepal. NDM-12 differed from NDM-1 by two amino acid substitutions (M154L and G222D). The enzymatic activities of NDM-12 against β-lactams were similar to those of NDM-1, although NDM-12 showed lower k cat / K m ratios for all β-lactams tested except doripenem. The bla NDM-12 gene was located in a plasmid of 160 kb.

Carbapenem resistance among gram-negative bacilli is an emerging threat worldwide. The objective of this study was to identify risk factors for the acquisition of carbapenem-resistant Escherichia coli (CRE).We conducted a matched case-control study comprising 57 cases of acquisition of CRE and 114 controls (1:2 matched) selected from patients with a culture of carbapenem-susceptible E coli between January 2006 and December 2010 at a 2000-bed tertiary care center in South Korea.On univariate analysis, previous use of carbapenem (P.01), fluoroquinolone (P.01), and glycopeptide (P.01), as well as length of hospital stay (P.05), were significantly associated with CRE acquisition. On multivariate analysis, previous use of carbapenem (odds ratio [OR], 4.56; 95% confidence interval [CI] 1.44-14.46; P = .01) and previous use of fluoroquinolone (OR, 2.81; 95% CI, 1.14-6.99; P = .03) were independent risk factors.At this institute, the antibiotic selective pressure of carbapenems and fluoroquinolones was shown to be an important risk factor for the acquisition of CRE.

Carbapenem resistance among Gram-negative bacilli has become an increasingly serious problem worldwide, and the emergence and spread of carbapenem-resistant Escherichia coli (CREC) is also becoming a serious problem. To date, however, risk factors for CREC acquisition have not been determined, so we decided to evaluate this in hospitalized patients through matched case-control study. Nosocomially acquired CREC was isolated from 46 patients between January 1997 and December 2007. For each patient, 3 matched-control subjects were selected. Previous use of carbapenem (adjusted odds ratio [AOR], 6.50) and metronidazole (AOR, 4.25), the presence of biliary drainage catheter (AOR, 4.59), and prior hospital stay (AOR 1.02) were found as independent risk factors for CREC. Our results suggest that the nosocomial acquisition of CREC may be favored by the selection pressure of carbapenems and metronidazole and also related to prior hospital stay and the presence of biliary drainage catheter.

Emergence of Gram-negative pathogens carrying the New Delhi metallo-beta-lactamase 1 gene (NDM-1) conveying carbapenem resistance is an urgent and global concern. After the first reported case in 2007, multiple countries around the world reported the presence of NDM-1-positive Gram-negative bacteria

J.-W. Decousser, L. Poirel, M. Desroches, A. Jayol, E. Denamur and P. Nordmann 1) Department of Virology, Bacteriology— Infection Control, ParasitologyMycology, Assistance Publique-Hopitaux de Paris (AP-HP), University Hospital Henri Mondor, Creteil, 2) IAME, UMR 1137, INSERM, F-75018 Paris, France, 3) Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland, 4) INSERM U914 “Emerging Antibiotic Resistance”, 5) Centre National Associe—Centre de Reference des Resistances aux Antibiotiques, K.-Bicetre, France and 6) Hopital Fribourgeois—hopital Cantonal, Fribourg, Switzerland