Clinical characteristics of patients with bacteraemia due to the emergence of mcr-1-harbouring Enterobacteriaceae in humans and pigs in Taiwan
Journal
International Journal of Antimicrobial Agents
Journal Volume
52
Journal Issue
5
Pages
651-657
Date Issued
2018
Author(s)
Lai C.-C.
Lin Y.-T.
Lin Y.-T.
Lu M.-C.
Shi Z.-Y.
Chen Y.-S.
Wang L.-S.
Tseng S.-H.
Lin C.-N.
Chen Y.-H.
Ko W.-C.
Wang F.-D.
Infection Control Society of Taiwan
Abstract
This nationwide surveillance was conducted in 2017 to investigate the prevalence and clinical characteristics of patients with bacteraemia due to mcr-1-harbouring Enterobacteriaceae as well as the presence of mcr-1-harbouring Escherichia coli in pigs. Non-duplicate, consecutive bacterial isolates were collected from patients treated at 16 hospitals in Taiwan. All E. coli (n = 686) and Klebsiella pneumoniae (n = 673) isolates from humans were obtained from patients with bacteraemia; for Salmonella spp. isolates (n = 221), 52.5% were obtained from blood samples and 26.2% from stool samples. The rates of mcr-1-harbouring bacteraemic isolates were 0.9% (6/686), 0.4% (3/673) and 0.9% (1/116) for E. coli, K. pneumoniae and Salmonella spp., respectively. Among the 16 E. coli isolates collected from 16 pigs, 12 (75.0%) were positive for mcr-1. Two mcr-1-positive K. pneumoniae isolates, one possessing K. pneumoniae carbapenemase (KPC) only and the other possessing both KPC and OXA-48, exhibited high-level resistance to carbapenems [minimum inhibitory concentrations (MICs) ?64 mg/L]. The 12 mcr-1-positive E. coli isolates from pigs were all susceptible to carbapenems. Pulsotypes of the six human mcr-1-positive E. coli isolates were different from each other and also varied from those of the porcine isolates. Among the ten patients with bacteraemia caused by mcr-1-harbouring isolates, five had community-acquired infections and five had hospital-acquired infections. Sepsis-related mortality occurred in four patients (40.0%) with bacteraemia. These findings indicate the importance of regular screening for the presence of mcr-1 in Enterobacteriaceae in humans and animals to prevent the spread of infection in hospitals and the community. ? 2018 Elsevier B.V. and International Society of Chemotherapy
SDGs
Other Subjects
amikacin; amoxicillin plus clavulanic acid; ampicillin; avibactam plus ceftazidime; carbapenem; cefazolin; cefepime; cefoperazone plus sulbactam; cefoxitin; ceftazidime; ceftolozane plus tazobactam; ceftriaxone; cefuroxime; ciprofloxacin; colistin; cotrimoxazole; doripenem; ertapenem; flomoxef; gentamicin; imipenem; levofloxacin; meropenem; moxifloxacin; piperacillin plus tazobactam; tigecycline; antiinfective agent; Escherichia coli protein; MCR-1 protein, E coli; adult; aged; antibiotic resistance; antibiotic sensitivity; Article; bacteremia; bacterial gene; bacterium isolate; biliary tract infection; blood analysis; carbapenemase producing Enterobacteriaceae; clinical article; community acquired infection; empyema; Enterobacteriaceae; Escherichia coli; feces analysis; female; hospital infection; human; Klebsiella pneumoniae; liver abscess; male; mcr 1 gene; minimum inhibitory concentration; mortality rate; nonhuman; pneumonia; priority journal; Salmonella; sepsis; Taiwan; urinary tract infection; uterine cervicitis; very elderly; animal; bacteremia; clinical trial; Enterobacteriaceae infection; genetics; hospital; isolation and purification; microbial sensitivity test; microbiology; middle aged; molecular typing; multicenter study; pig; prevalence; pulsed field gel electrophoresis; swine disease; veterinary medicine; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Bacteremia; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Proteins; Female; Hospitals; Humans; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Typing; Prevalence; Salmonella; Swine; Swine Diseases; Taiwan
Type
journal article