Cargando…

Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas

BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) pose a significant global public health threat. Resistance among CRE is particularly complex, owing to numerous possible resistance mechanisms and broad definitions. We aimed to characterize the clinical and molecular profiles of CRE in the Sou...

Descripción completa

Detalles Bibliográficos
Autores principales: Black, Cody A., So, Wonhee, Dallas, Steven S., Gawrys, Gerard, Benavides, Raymond, Aguilar, Samantha, Chen, Chang-Jui, Shurko, James F., Lee, Grace C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902696/
https://www.ncbi.nlm.nih.gov/pubmed/33643226
http://dx.doi.org/10.3389/fmicb.2020.623574
_version_ 1783654582638870528
author Black, Cody A.
So, Wonhee
Dallas, Steven S.
Gawrys, Gerard
Benavides, Raymond
Aguilar, Samantha
Chen, Chang-Jui
Shurko, James F.
Lee, Grace C.
author_facet Black, Cody A.
So, Wonhee
Dallas, Steven S.
Gawrys, Gerard
Benavides, Raymond
Aguilar, Samantha
Chen, Chang-Jui
Shurko, James F.
Lee, Grace C.
author_sort Black, Cody A.
collection PubMed
description BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) pose a significant global public health threat. Resistance among CRE is particularly complex, owing to numerous possible resistance mechanisms and broad definitions. We aimed to characterize the clinical and molecular profiles of CRE in the South Texas region. MATERIALS AND METHODS: We compared the clinical, genotypic, and phenotypic profiles of carbapenemase producing Enterobacterales (CPE) with those of non-carbapenemase producers (NCPE) isolated from South Texas, United States between 2011 and 2019. Molecular characteristics and resistance mechanisms were analyzed using whole-genome sequences. RESULTS: The majority (59%) of the CRE isolates were NCPE while 41% of isolates harbored carbapenemases, predmonantly bla(KPC)-type. The most common CPE was Klebsiella pneumoniae while majority of Enterobacter cloacae and Escherichia coli were NCPE Among K. pneumoniae, the clonal group 307 has emerged as a predmoninant group and was associated with as many CRE infections as the previous common clonal group 258. Patients with NCPE compared to CPE infections were associated with higher antimicrobial exposure prior to culture collection (days of therapy, 795 vs. 242; p < 0.001) and emergency department visits within past 90 days (22% vs. 4%; p = 0.011). The all cause 30-day mortality was 21%. CONCLUSIONS: This study highlights the diversity of resistance mechanisms underlying CRE in South Texas, with 59% not harboring a carbapenemase. Individuals with NCPE infections were more likely to have had prior antimicrobial therapy and emergency department visits compared to those with CPE. Identification and distinction of these mechanisms by rapid identification of species and carbapenemase would allow for optimal treatment and infection control efforts.
format Online
Article
Text
id pubmed-7902696
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-79026962021-02-25 Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas Black, Cody A. So, Wonhee Dallas, Steven S. Gawrys, Gerard Benavides, Raymond Aguilar, Samantha Chen, Chang-Jui Shurko, James F. Lee, Grace C. Front Microbiol Microbiology BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) pose a significant global public health threat. Resistance among CRE is particularly complex, owing to numerous possible resistance mechanisms and broad definitions. We aimed to characterize the clinical and molecular profiles of CRE in the South Texas region. MATERIALS AND METHODS: We compared the clinical, genotypic, and phenotypic profiles of carbapenemase producing Enterobacterales (CPE) with those of non-carbapenemase producers (NCPE) isolated from South Texas, United States between 2011 and 2019. Molecular characteristics and resistance mechanisms were analyzed using whole-genome sequences. RESULTS: The majority (59%) of the CRE isolates were NCPE while 41% of isolates harbored carbapenemases, predmonantly bla(KPC)-type. The most common CPE was Klebsiella pneumoniae while majority of Enterobacter cloacae and Escherichia coli were NCPE Among K. pneumoniae, the clonal group 307 has emerged as a predmoninant group and was associated with as many CRE infections as the previous common clonal group 258. Patients with NCPE compared to CPE infections were associated with higher antimicrobial exposure prior to culture collection (days of therapy, 795 vs. 242; p < 0.001) and emergency department visits within past 90 days (22% vs. 4%; p = 0.011). The all cause 30-day mortality was 21%. CONCLUSIONS: This study highlights the diversity of resistance mechanisms underlying CRE in South Texas, with 59% not harboring a carbapenemase. Individuals with NCPE infections were more likely to have had prior antimicrobial therapy and emergency department visits compared to those with CPE. Identification and distinction of these mechanisms by rapid identification of species and carbapenemase would allow for optimal treatment and infection control efforts. Frontiers Media S.A. 2021-02-10 /pmc/articles/PMC7902696/ /pubmed/33643226 http://dx.doi.org/10.3389/fmicb.2020.623574 Text en Copyright © 2021 Black, So, Dallas, Gawrys, Benavides, Aguilar, Chen, Shurko and Lee. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Microbiology
Black, Cody A.
So, Wonhee
Dallas, Steven S.
Gawrys, Gerard
Benavides, Raymond
Aguilar, Samantha
Chen, Chang-Jui
Shurko, James F.
Lee, Grace C.
Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas
title Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas
title_full Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas
title_fullStr Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas
title_full_unstemmed Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas
title_short Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas
title_sort predominance of non-carbapenemase producing carbapenem-resistant enterobacterales in south texas
topic Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902696/
https://www.ncbi.nlm.nih.gov/pubmed/33643226
http://dx.doi.org/10.3389/fmicb.2020.623574
work_keys_str_mv AT blackcodya predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT sowonhee predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT dallasstevens predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT gawrysgerard predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT benavidesraymond predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT aguilarsamantha predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT chenchangjui predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT shurkojamesf predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas
AT leegracec predominanceofnoncarbapenemaseproducingcarbapenemresistantenterobacteralesinsouthtexas