1. Antimicrob Agents Chemother. 2018 Jan 25;62(2). pii: e01882-17. doi: 10.1128/AAC.01882-17. Print 2018 Feb.
Epidemiology of Carbapenem-Resistant Enterobacteriaceae Infections: Report from the China CRE Network.
Zhang Y(#)(1), Wang Q(#)(1), Yin Y(1), Chen H(1), Jin L(1), Gu B(2), Xie L(3), Yang C(4), Ma X(5), Li H(6), Li W(7), Zhang X(8), Liao K(9), Man S(10), Wang S(11), Wen H(12), Li B(13), Guo Z(14), Tian J(15), Pei F(16), Liu L(17), Zhang L(18), Zou C(19), Hu T(20), Cai J(21), Yang H(22), Huang J(23), Jia X(24), Huang W(25), Cao B(26), Wang H(27).
Author information: (1)Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China. (2)Department of Clinical Laboratory, Medical Technology Institute of Xuzhou Medical University, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. (3)Department of Clinical Laboratory, Hunan Provincial People's Hospital, Changsha, Hunan, China. (4)Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. (5)Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China. (6)Department of Respiratory, Zhongshan Hospital Fudan University, Shanghai, China. (7)Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China. (8)Department of Clinical Laboratory, Henan Province Hospital of TCM, Zhengzhou, Henan, China. (9)Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. (10)Department of Clinical Laboratory, Tengzhou Central People's Hospital, Tengzhou, Shandong, China. (11)Department of Children's Medical Laboratory Diagnosis Center, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China. (12)Department of Clinical Laboratory, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China. (13)Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, and National Clinical Research Center for Respiratory Diseases, Beijing, China. (14)Department of Clinical Laboratory, Dongguan Tungwah Hospital, Dongguan, Guangdong, China. (15)Department of Clinical Laboratory, The Second People's Hospital of Liaocheng, Liaocheng, Shandong, China. (16)Department of Clinical Microbiology, Jinan Central Hospital, Jinan, Shandong, China. (17)Department of Clinical Laboratory, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, China. (18)Department of Clinical Laboratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. (19)Department of Clinical Laboratory, The First Affiliated People's Hospital of Yinchuan, Yinchuan, Ningxia, China. (20)Department of Clinical Laboratory, The First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China. (21)Department of Clinical Laboratory, Chongqing Armed Corps Police Hospital, Chongqing, China. (22)Department of Clinical Laboratory, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China. (23)Department of Clinical Laboratory, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China. (24)Department of Clinical Laboratory, The People's Hospital of Xuchang, Xuchang, Henan, China. (25)Department of Clinical Laboratory, Affiliated Hospital of Qinghai University, Xining, Qinghai, China. (26)Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, and National Clinical Research Center for Respiratory Diseases, Beijing, China caobin_ben@vip.163.com whuibj@163.com. (27)Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China caobin_ben@vip.163.com whuibj@163.com. (#)Contributed equally
Carbapenem-resistant Enterobacteriaceae (CRE) infection is highly endemic in China, but estimates of the infection burden are lacking. We established the incidence of CRE infection from a multicenter study that covered 25 tertiary hospitals in 14 provinces. CRE cases defined as carbapenem-nonsusceptible Citrobacter freundii, Escherichia coli, Enterobacter cloacae, or Klebsiella pneumoniae infections during January to December 2015 were collected and reviewed from medical records. Antimicrobial susceptibility testing and carbapenemase gene identification were performed. Among 664 CRE cases, most were caused by K. pneumoniae (73.9%), followed by E. coli (16.6%) and E. cloacae (7.1%). The overall CRE infection incidence per 10,000 discharges was 4.0 and differed significantly by region, with the highest in Jiangsu (14.97) and the lowest in Qinghai (0.34). Underlying comorbidities were found in 83.8% of patients; the median patient age was 62 years (range, 45 to 74 years), and 450 (67.8%) patients were male. Lower respiratory tract infections (65.4%) were the most common, followed by urinary tract infection (16.6%), intra-abdominal infection (7.7%), and bacteremia (7.7%). The overall hospital mortality rate was 33.5%. All isolates showed nonsusceptibility to carbapenems and cephalosporins. The susceptibility rate of polymyxin B was >90%. Tigecycline demonstrated a higher susceptibility rate against E. coli than against K. pneumoniae (90.9% versus 40.2%). Of 155 clinical isolates analyzed, 89% produced carbapenemases, with a majority of isolates producing KPC (50%) or NDM (33.5%)-type beta-lactamases among K. pneumoniae and E. coli The incidence of CRE infection in China was 4.0 per 10,000 discharges. The patient-based disease burden in tertiary hospitals in China is severe, suggesting an urgent need to enhance infection control.
Copyright © 2018 American Society for Microbiology.
DOI: 10.1128/AAC.01882-17 PMCID: PMC5786810 PMID: 29203488
