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Molecular Characterization of Carbapenem-Resistant Enterobacterales Collected in the United States

Maria Karlsson1, Joseph D Lutgring1, Uzma Ansari1

  • 1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Microbial Drug Resistance (Larchmont, N.Y.)
|February 16, 2022
PubMed

Insights

Carbapenem-resistant Enterobacterales (CRE) pose a significant threat, with carbapenemase-producing strains spreading easily. This study analyzed CRE isolates, finding KPC carbapenemase genes in most, with some susceptibility to amikacin and tigecycline.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Genomics

Background:

  • Carbapenem-resistant Enterobacterales (CRE) are a critical global health concern, particularly carbapenemase-producing strains.
  • These resistant organisms can cause severe healthcare-associated infections with high mortality rates.
  • The mobile nature of carbapenemase genes facilitates inter-organismal and inter-species spread.

Purpose of the Study:

  • To characterize the phenotypic and genotypic features of CRE isolates.
  • To identify the prevalence of carbapenemase genes and specific organisms.
  • To understand regional variations and antimicrobial susceptibility patterns.

Main Methods:

  • Phenotypic and genotypic characterization of CRE isolates from eight U.S. surveillance sites.
  • Whole genome sequencing of 419 CRE isolates.
  • Antimicrobial susceptibility testing.

Main Results:

  • The majority of 421 CRE isolates were from urine (83%).
  • Klebsiella pneumoniae (63%), Enterobacter cloacae complex (18%), and Escherichia coli (12%) were the most common species.
  • 73% of isolates harbored carbapenemase genes, predominantly blaKPC variants (97%).
  • Regional variations in carbapenemase-producing K. pneumoniae, E. cloacae complex, and E. coli were observed, with predominant sequence types ST258, ST171, and ST131, respectively.
  • No carbapenemase-producing CRE isolates were resistant to all tested antimicrobials; amikacin and tigecycline susceptibility was generally retained.

Conclusions:

  • Carbapenemase-producing CRE, particularly KPC-variant producers, are prevalent in the U.S.
  • Specific sequence types are dominant within key Enterobacterales species.
  • Retained susceptibility to amikacin and tigecycline offers potential therapeutic options.
Keywords:
KPCcarbapenem-resistant Enterobacteralescarbapenemase

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