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. 2021 Feb 10:11:623574.
doi: 10.3389/fmicb.2020.623574. eCollection 2020.

Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas

Cody A Black  1   2   3 , Wonhee So  4 , Steven S Dallas  2   3 , Gerard Gawrys  1   5 , Raymond Benavides  1   2 , Samantha Aguilar  1   2   3 , Chang-Jui Chen  1   2 , James F Shurko  1   2 , Grace C Lee  1   2
Affiliations

Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas

Cody A Black et al. Front Microbiol. .

Abstract

Background: Carbapenem-resistant Enterobacterales (CRE) pose a significant global public health threat. Resistance among CRE is particularly complex, owing to numerous possible resistance mechanisms and broad definitions. We aimed to characterize the clinical and molecular profiles of CRE in the South Texas region.

Materials and methods: We compared the clinical, genotypic, and phenotypic profiles of carbapenemase producing Enterobacterales (CPE) with those of non-carbapenemase producers (NCPE) isolated from South Texas, United States between 2011 and 2019. Molecular characteristics and resistance mechanisms were analyzed using whole-genome sequences.

Results: The majority (59%) of the CRE isolates were NCPE while 41% of isolates harbored carbapenemases, predmonantly bla KPC-type. The most common CPE was Klebsiella pneumoniae while majority of Enterobacter cloacae and Escherichia coli were NCPE Among K. pneumoniae, the clonal group 307 has emerged as a predmoninant group and was associated with as many CRE infections as the previous common clonal group 258. Patients with NCPE compared to CPE infections were associated with higher antimicrobial exposure prior to culture collection (days of therapy, 795 vs. 242; p < 0.001) and emergency department visits within past 90 days (22% vs. 4%; p = 0.011). The all cause 30-day mortality was 21%.

Conclusions: This study highlights the diversity of resistance mechanisms underlying CRE in South Texas, with 59% not harboring a carbapenemase. Individuals with NCPE infections were more likely to have had prior antimicrobial therapy and emergency department visits compared to those with CPE. Identification and distinction of these mechanisms by rapid identification of species and carbapenemase would allow for optimal treatment and infection control efforts.

Keywords: Enterobacterales; carbapenem; epidemiology; outcomes; resistance.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Phylogenetic reconstruction of K. pneumoniae. Distribution of isolates using SNP-based core genome alignments. Node color indicates CPE or NCPE. Layer 1 shows carbapenemase types. Layer 2 shows clonal groups by MLST.
FIGURE 2
FIGURE 2
Phylogenetic reconstruction of E. coli. Distribution of isolates using SNP-based core genome alignments. Node color indicates CPE or NCPE. Layer 1 shows carbapenemase types. Layer 2 shows clonal groups by MLST.
See this image and copyright information in PMC

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