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Title: Nationwide surveillance of clinical carbapenem-resistant enterobacteriaceae (CRE) strains in China
Authors: Zhang, R
Liu, LZ
Zhou, HW
Chan, EW 
Li, JP
Fang, Y
Li, Y
Liao, K
Chen, S 
Keywords: Carbapenem resistance
Molecular epidemiology
Issue Date: 2017
Publisher: Elsevier
Source: EBioMedicine, 2017, v. 19, p. 98-106 How to cite?
Journal: EBioMedicine 
Abstract: The increasing incidence of carbapenem-resistant Enterobacteriaceae (CRE) - mediated hospital infections in China prompted a need to investigate the genetic basis of emergence of such strains. A nationwide survey was conducted in China covering a total of 1105 CRE strains collected from 25 geographical locales with results showing that acquisition of two carbapenemase genes, bla(KPC-2) and bla(NDM), was responsible for phenotypic resistance in 90% of the CRE strains tested (58% and 32% respectively), among which several major strain types, such as ST11 of K. pneumoniae and ST131/ST167 of E. coli, were identified, suggesting that dissemination of specific resistant clones is mainly responsible for emergence of new CRE strains. Prevalence of the fosA3 gene which mediates fosfomycin resistance, was high, while the colistin resistance determinant mcr-1 was rarely present in these isolates. Consistently, the majority of the bla(NDM)-bearing plasmids recoverable from the test strains belonged to IncX3, which contained a common core structure, bla(NDM)-blaMBL-trpF. Likewise, the core structure of ISKpn27-bla(KPC-2)- ISKpn2 was observed among plasmids harboring the bla(KPC-2) gene, although they were genetically more divergent. In conclusion, the increasing prevalence of CRE strains in China is attributed to dissemination of conservative mobile elements carrying blaNDM or bla(KPC-2) on conjugative and non-conjugative plasmids.
ISSN: 2352-3964
DOI: 10.1016/j.ebiom.2017.04.032
Rights: © 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (
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