Epidemiology and clinical characteristics of infection/colonization due to carbapenemase-producing Enterobacterales in neonatal patients.

BACKGROUND: The aim of this study was to elucidate the epidemiological features of carbapenemase-producing Enterobacterales (CPE) in the pediatric and neonatal patients, to describe clinical characteristics of neonatal patients with CPE infections, and to assess risk factors for neonatal rectal colonization with CPE. RESULTS: A total of 439 carbapenem-resistant Enterobacterales (CRE) isolates recovered from 367 infant patients were characterised, including 397 isolates of Klebsiella pneumoniae (KP) and 42 isolates of Escherichia coli (EC). Carbapenemase gene blaNDM-1 was the most commonly detected, accounting for 86.56% (n = 380), followed by blaKPC-2 (9.11%, 40) and blaIMP-4 (4.33%, 19). MLST analysis showed 17 different STs detected within CPKP isolates, with ST20, ST2068, ST36 and ST17 being the most frequently isolated types. Eleven STs were identified within CPEC isolates, with ST325 being the dominant types. Eight isolates of NDM-1 producing KP, belonging to ST23, were identified as having hypervirulent traits. The main infections caused by CPE were pneumonia (n = 90) and sepsis (n = 16). All infected patients received monotherapy, with meropenem and ciprofloxacin being the most commonly used antibiotics. All pneumonia patients were cured or improved after treatment. Of the 16 patients with sepsis, 9 were cured or improved, 3 died, and 4 abandoned treatment without any clinical improvement. The rectal prevalences of CPE in the 0-3 days old (DO), the 4-28 DO, and the 29 DO-1 year old groups were decreased from 15.31%, 27.37% and 14.29% in the first stool screening period to 11.78%, 19.59% and 4.07% in the second stool screening period, respectively. Multivariate analysis showed that cesarean section, acidosis, respiration failure, gastric lavage and enema were independent risk factors for rectal colonization in the 0-3 DO group, whereas cesarean section, cephalosporins, gastric lavage and residence in rural area were independently associated with rectal colonization in the 4-28 DO group. The implementation of a series of evidence-based control measures eventually contained the CPE transmission. CONCLUSIONS: Continued vigilance, epidemiological studies, and multimodal infection prevention strategies are urgently needed due to frequent importations.

Clonal spread of carbapenemase-producing Enterobacteriaceae in a region, China.

BACKGROUND: The increasing number of carbapenemase-producing Enterobacterales (CPE) has become a serious problem globally. This study aimed to elucidate their geographically epidemiological characteristics. METHODS: Resistance genes were identified by polymerase chain reaction (PCR) and sequencing. Bacterial genotyping was studied using multilocus sequence typing (MLST) and wzi typing. The transferability of carbapenemase genes was determined by a broth mating method. The relationships between the rates of antimicrobial consumption and the prevalence of CRE were performed by Pearson's or Spearman's correlation analyses. RESULTS: A total of 930 phenotypically confirmed carbapenem-resistant Enterobacterales (CRE) isolates collected from 19 hospitals were genotypically characterized. K. pneumoniae (KP) and E. coli isolates were 785 (85.14%) and 96 (10.41%) among 922 CPE isolates. Two major carbapenemase genes blaKPC-2 and blaNDM in CPE isolates accounted for 84.6% (n = 780) and 13.77% (n = 127). ST11 comprised 86.83% (633/729) of KPC-2 KP isolates. Different combinations of extended spectrum-ß-lactamase (ESBL) genes of blaSHV, blaCTX, and blaTEM were found in KPC-2 producing KP isolates, and blaCTM-M-14/15, blaSHV-11/12 and blaTEM-1 were common ESBL genotypes. The wzi typing method could further subdivide ST11 KP group into at least five subgroups, among which wzi209 (69.83%, 442/633) was the most frequently isolated, followed by wzi141 (25.28%, 160/633). Conjugation assays showed that high conjugation rates were observed in CPE (15.24%, 32/210) for NDM plasmids, but relatively low (8.1%, 17/210) for KPC-2 plasmids. Different STs, different wzis and temperature could influence plasmid conjugation efficiency. No associations between the rates of antibiotics consumption and CPE prevalence were observed. The number of intra-hospital and inter-hospital transfers of CPE patients increased gradually from 18 (17.82%, 101) and 12 (11.88%, 101) in 2015 to 63 (30.73%, 205) and 51 (24.88%, 205) in 2018 (p = 0.016 and p = 0.008), respectively. Evidence-based measures could effectively reduce the prevalence of ST11-wzi209 clone but failed to control the dissemination of ST11-wzi141 KP clone. CONCLUSIONS: Clonal spread of CPE, especially KPC-2 ST11 KP was the key factor contributing to the CPE increase in the region. Continued vigilance for the importations should be maintained. Coordinated regional interventions are urgently needed to reduce CPE threat.

[Correlations between tumor infiltrating Th17 cells and clinicopathological parameters in patients with colorectal cancer].

OBJECTIVE: To observe the correlations between the percentage of tumor infiltrating Th17 cells and clinicopathological parameters in patients with colorectal cancer (CRC). METHODS: Tumor and normal mucosal tissues were collected from 28 CRC patients. The proportions of Th17 cells in lymphocytes were detected by flow cytometry. The supernatant levels of IL-17A in cultured normal and tumor tissues were measured by ELISA. The correlations between the proportions of tumor infiltrating Th17 cells as well as the tumor supernatant levels of IL-17A and clinicopathological parameters in CRC patients were further analyzed. RESULTS: There was no significant difference in the expression of Th17 cells between normal tissues (2.24 ± 0.24)% and tumor tissues (2.47 ± 0.34)% (P>0.05). Compared with normal tissues, the supernatant levels of IL-17A in tumor tissues were significantly up-regulated [(257.74±31.36) pg/mL vs (163.53±12.62)pg/mL, P<0.05]. The proportions of tumor infiltrating Th17 cells and the tumor supernatant levels of IL-17A had no associations with age, gender, tumor location, tumor size and growth characteristics (P>0.05), but they were correlated with tumor differentiation, lymph node metastasis and TNM stage (P<0.05). No associations between the proportions of infiltrating Th17 cells as well as the supernatant levels of IL-17A in the normal tissues and all clinicopathological parameters were found (P>0.05). CONCLUSION: Th17 cells may be involved in the immunopathogenesis of the development of CRC.