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Emergence of an NDM-5-Producing Escherichia coli Sequence Type 410 Clone in Infants in a Children’s Hospital in China

Authors Li J, Yu T, Tao XY, Hu YM, Wang HC, Liu JL, Zhou HJ, Zou MX

Received 6 January 2020

Accepted for publication 15 February 2020

Published 28 February 2020 Volume 2020:13 Pages 703—710


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Sahil Khanna

Jun Li, 1 Ting Yu, 1 Xiao-Yan Tao, 1 Yong-Mei Hu, 1 Hai-Chen Wang, 1 Jian-Long Liu, 2 Hai-Jian Zhou, 3 Ming-Xiang Zou 1

1Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People’s Republic of China; 2Department of Clinical Laboratory, Hunan Children’s Hospital, Changsha, Hunan 410007, People’s Republic of China; 3State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, People’s Republic of China

Correspondence: Ming-Xiang Zou
Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People’s Republic of China
Tel +86 13907496278

Purpose: Outbreaks of infection due to carbapenem-resistant Enterobacterales (CRE), including New Delhi metallo-β-lactamase (NDM)-producing Escherichia coli, have been increasingly reported worldwide, primarily in adults and rarely in children. The goal of this study was to characterize an outbreak of infection caused by NDM-5-producing E. coli in a children’s hospital in China.
Methods: A total of 86 CRE isolates were collected from 85 hospitalized children between June 2017 and May 2018. These isolates were subjected to multiple phenotypic and molecular tests, including in vitro antimicrobial susceptibility testing, PCR, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and whole-genome sequencing (WGS).
Results: Among the 86 CRE isolates, we identified 9 NDM-5-producing E. coli isolates, with 5 of them sharing the same PFGE pattern, same MLST type (ST410), same plasmid replicon type (IncFII), and nearly the same set of additional resistance genes. All 9 isolates were resistant to most antimicrobial agents, including carbapenems, cephalosporins, and levofloxacin, while being sensitive to trimethoprim/sulfamethoxazole, amikacin, tigecycline, and colistin. According to the clinical background, all 9 isolates were collected in a period of < 3 months from infants among whom there was overlap in the time of hospitalization. None of them had a travel history.
Conclusion: Our analysis suggests an outbreak of clonal dissemination, presumably due to nosocomial transmission. This study represents the first documented outbreak of NDM-5-producing E. coli mediated by IncFII in infants. Close monitoring is urgently needed to prevent and control the spread of this difficult-to-treat superbug.

Keywords: Enterobacterales, carbapenem resistance, blaNDM-5, IncFII

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