Research progress in epidemiological characteristics of carbapenem-resistant Enterobacteriaceae / 中华微生物学和免疫学杂志

ABSTRACT

Carbapenem-resistant Enterobacteriaceae (CRE) are defined as bacteria of the Enter-obacteriaceae family exhibiting resistance to any carbapenem antibiotics. As some of the most common patho-gens, Enterobacteriaceae spread worldwide and often cause large-scale outbreaks and transmission in medical institutions or regions. Increasing resistance of these bacteria to clinically common-used anti-infective drugs results in more and more treatment failure and brings enormous challenges to nosocomial infection control and anti-infection treatment. Understanding the distribution and transmission of CRE is of great significance for controlling the spread of such pathogens. This article reviews the progress in the distribution and epidemic characteristics of CRE. Klebsiella pneumoniae carbapenemase ( KPC)-producing Klebsiella pneumoniae (K. pneumoniae) was first isolated in the United States and has become the predominant species of CRE worldwide. In recent years, KPC-2- and KPC-3-producing K. pneumoniae are widely spread in many regions. NDM-1 has been detected worldwide since it was isolated from Escherichia coli (E. coli) and K. pneumoniae in India and Britain in 2010 and become the second most common carbapenemase produced by Enterobacteri-aceae other than KPC. OXA-48, which was first detected from a carbapenem-resistant K. pneumoniae in 2004, has weak hydrolytic activity against carbapenems. Large-scale outbreaks caused by OXA-48-producing Enterobacteriaceae have occurred in many countries such as Turkey, Spain, Morocco and Tunisia. In China, the predominant species of CRE is KPC-producing K. pneumoniae mainly belonging to the sequence type 11 (ST11). In addition, KPC-producing Klebsiella oxytoca (K. oxytoca), E. coli, Enterobacter cloacae (E. clo-acae), Citrobacter freundii (C. freundii), Serratia marcescens, Proteus mirabilis (P. mirabilis), Enterobact-er fluvialis (E. fluvialis) and Morgan morganii have also been reported. The prevalent NDM-producing spe-cies isolated in China are E. coli and K. pneumoniae. Moreover, blaNDM is also carried by E. cloacae, K. oxy-toca, C. freundii, P. mirabilis and Enterobacter aerogenes (E. aerogenes). Small-scale outbreaks caused by OXA-48-producing K. pneumoniae have only been reported in Beijing and Taiwan in China.