Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018

Details

• Alternative Title:
  JAC Antimicrob Resist
• Personal Author:
  Shugart, Alicia ; Mahon, Garrett ; Huang, Jennifer Y ; Karlsson, Maria ; Valley, Ann ; Lasure, Megan ; Gross, Annastasia ; Pattee, Brittany ; Vaeth, Elisabeth ; Brooks, Richard ; Maruca, Tyler ; Dominguez, Catherine E ; Torpey, David ; Francis, Drew ; Bhattarai, Rachana ; Kainer, Marion A ; Chan, Allison ; Dubendris, Heather ; Greene, Shermalyn R ; Blosser, Sara J ; Shannon, D J ; Jones, Kelly ; Brennan, Brenda ; Hun, Sopheay ; D’Angeli, Marisa ; Murphy, Caitlin N ; Tierney, Maureen ; Reese, Natashia ; Bhatnagar, Amelia ; Kallen, Alex ; Brown, Allison C ; Spalding Walters, Maroya
• Description:
  Background
  
  Historically, United States’ carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread.
  
  Objectives
  
  From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE.
  
  Methods
  
  State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (blaKPC, blaNDM, blaVIM, blaIMP, or blaOXA-48-like) was detected.
  
  Results
  
  SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than blaKPC.
  
  Conclusions
  
  Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.
  
  
• Subjects:
  AcademicSubjects/MED00740 Original Article
• Source:
  JAC Antimicrob Resist. 2021; 3(3)
• Pubmed ID:
  34514407
• Pubmed Central ID:
  PMC8417453
• Document Type:
  Journal Article
• Volume:
  3
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d952f630bb2c00b62976f6d003a7083e07b5f4b56812e2f46c0f83fb70ad4ada
• Download URL:
  https://stacks.cdc.gov/view/cdc/111646/cdc_111646_DS1.pdf
• File Type:
  [PDF - 237.29 KB ]