High rates of human fecal carriage of mcr-1-positive multidrug-resistant enterobacteriaceae emerge in China in association with successful plasmid families

Lan Lan Zhong, Hang T.T. Phan, Cong Shen, Karina Doris Vihta, Anna E. Sheppard, Xi Huang, Kun Jiao Zeng, Hong Yu Li, Xue Fei Zhang, Sandip Patil, Derrick W. Crook, A. Sarah Walker, Yong Xing, Jia Lin Lin, Lian Qiang Feng, Yohei Doi, Yong Xia, Nicole Stoesser, Guo Bao Tian

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Abstract

Background. mcr-1-mediated colistin resistance in Enterobacteriaceae is concerning, as colistin is used in treating multidrug- resistant Enterobacteriaceae infections. We identified trends in human fecal mcr-1-positivity rates and colonization with mcr-1- positive, third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae in Guangzhou, China, and investigated the genetic contexts of mcr-1 in mcr-1-positive 3GC-R strains. Methods. Fecal samples were collected from in-/out-patients submitting specimens to 3 hospitals (2011-2016). mcr-1 carriage trends were assessed using iterative sequential regression. A subset of mcr-1-positive isolates was sequenced (whole-genome sequencing [WGS], Illumina), and genetic contexts (flanking regions, plasmids) of mcr-1 were characterized. Results. Of 8022 fecal samples collected, 497 (6.2%) were mcr-1 positive, and 182 (2.3%) harbored mcr-1-positive 3GC-R Enterobacteriaceae. We observed marked increases in mcr-1 (0% [April 2011] to 31% [March 2016]) and more recent (since January 2014; 0% [April 2011] to 15% [March 2016]) increases in human colonization with mcr-1-positive 3GC-R Enterobacteriaceae (P < .001). mcr-1-positive 3GC-R isolates were commonly multidrug resistant. WGS of mcr-1-positive 3GC-R isolates (70 Escherichia coli, 3 Klebsiella pneumoniae) demonstrated bacterial strain diversity; mcr-1 in association with common plasmid backbones (IncI, IncHI2/HI2A, IncX4) and sometimes in multiple plasmids; frequent mcr-1 chromosomal integration; and high mobility of the mcr-1-associated insertion sequence ISApl1. Sequence data were consistent with plasmid spread among animal/ human reservoirs. Conclusions. The high prevalence of mcr-1 in multidrug-resistant E. coli colonizing humans is a clinical threat; diverse genetic mechanisms (strains/plasmids/insertion sequences) have contributed to the dissemination of mcr-1, and will facilitate its persistence.

Original languageEnglish
Pages (from-to)676-685
Number of pages10
JournalClinical Infectious Diseases
Volume66
Issue number5
DOIs
Publication statusPublished - 01-03-2018

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Enterobacteriaceae
China
Plasmids
Colistin
Insertional Mutagenesis
Enterobacteriaceae Infections
Genome
Escherichia coli
Klebsiella pneumoniae
Cephalosporins
Outpatients

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Zhong, Lan Lan ; Phan, Hang T.T. ; Shen, Cong ; Vihta, Karina Doris ; Sheppard, Anna E. ; Huang, Xi ; Zeng, Kun Jiao ; Li, Hong Yu ; Zhang, Xue Fei ; Patil, Sandip ; Crook, Derrick W. ; Walker, A. Sarah ; Xing, Yong ; Lin, Jia Lin ; Feng, Lian Qiang ; Doi, Yohei ; Xia, Yong ; Stoesser, Nicole ; Tian, Guo Bao. / High rates of human fecal carriage of mcr-1-positive multidrug-resistant enterobacteriaceae emerge in China in association with successful plasmid families. In: Clinical Infectious Diseases. 2018 ; Vol. 66, No. 5. pp. 676-685.
@article{64387eb08e2448ef98f332fd2de33f9d,
title = "High rates of human fecal carriage of mcr-1-positive multidrug-resistant enterobacteriaceae emerge in China in association with successful plasmid families",
abstract = "Background. mcr-1-mediated colistin resistance in Enterobacteriaceae is concerning, as colistin is used in treating multidrug- resistant Enterobacteriaceae infections. We identified trends in human fecal mcr-1-positivity rates and colonization with mcr-1- positive, third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae in Guangzhou, China, and investigated the genetic contexts of mcr-1 in mcr-1-positive 3GC-R strains. Methods. Fecal samples were collected from in-/out-patients submitting specimens to 3 hospitals (2011-2016). mcr-1 carriage trends were assessed using iterative sequential regression. A subset of mcr-1-positive isolates was sequenced (whole-genome sequencing [WGS], Illumina), and genetic contexts (flanking regions, plasmids) of mcr-1 were characterized. Results. Of 8022 fecal samples collected, 497 (6.2{\%}) were mcr-1 positive, and 182 (2.3{\%}) harbored mcr-1-positive 3GC-R Enterobacteriaceae. We observed marked increases in mcr-1 (0{\%} [April 2011] to 31{\%} [March 2016]) and more recent (since January 2014; 0{\%} [April 2011] to 15{\%} [March 2016]) increases in human colonization with mcr-1-positive 3GC-R Enterobacteriaceae (P < .001). mcr-1-positive 3GC-R isolates were commonly multidrug resistant. WGS of mcr-1-positive 3GC-R isolates (70 Escherichia coli, 3 Klebsiella pneumoniae) demonstrated bacterial strain diversity; mcr-1 in association with common plasmid backbones (IncI, IncHI2/HI2A, IncX4) and sometimes in multiple plasmids; frequent mcr-1 chromosomal integration; and high mobility of the mcr-1-associated insertion sequence ISApl1. Sequence data were consistent with plasmid spread among animal/ human reservoirs. Conclusions. The high prevalence of mcr-1 in multidrug-resistant E. coli colonizing humans is a clinical threat; diverse genetic mechanisms (strains/plasmids/insertion sequences) have contributed to the dissemination of mcr-1, and will facilitate its persistence.",
author = "Zhong, {Lan Lan} and Phan, {Hang T.T.} and Cong Shen and Vihta, {Karina Doris} and Sheppard, {Anna E.} and Xi Huang and Zeng, {Kun Jiao} and Li, {Hong Yu} and Zhang, {Xue Fei} and Sandip Patil and Crook, {Derrick W.} and Walker, {A. Sarah} and Yong Xing and Lin, {Jia Lin} and Feng, {Lian Qiang} and Yohei Doi and Yong Xia and Nicole Stoesser and Tian, {Guo Bao}",
year = "2018",
month = "3",
day = "1",
doi = "10.1093/cid/cix885",
language = "English",
volume = "66",
pages = "676--685",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "5",

}

Zhong, LL, Phan, HTT, Shen, C, Vihta, KD, Sheppard, AE, Huang, X, Zeng, KJ, Li, HY, Zhang, XF, Patil, S, Crook, DW, Walker, AS, Xing, Y, Lin, JL, Feng, LQ, Doi, Y, Xia, Y, Stoesser, N & Tian, GB 2018, 'High rates of human fecal carriage of mcr-1-positive multidrug-resistant enterobacteriaceae emerge in China in association with successful plasmid families', Clinical Infectious Diseases, vol. 66, no. 5, pp. 676-685. https://doi.org/10.1093/cid/cix885

High rates of human fecal carriage of mcr-1-positive multidrug-resistant enterobacteriaceae emerge in China in association with successful plasmid families. / Zhong, Lan Lan; Phan, Hang T.T.; Shen, Cong; Vihta, Karina Doris; Sheppard, Anna E.; Huang, Xi; Zeng, Kun Jiao; Li, Hong Yu; Zhang, Xue Fei; Patil, Sandip; Crook, Derrick W.; Walker, A. Sarah; Xing, Yong; Lin, Jia Lin; Feng, Lian Qiang; Doi, Yohei; Xia, Yong; Stoesser, Nicole; Tian, Guo Bao.

In: Clinical Infectious Diseases, Vol. 66, No. 5, 01.03.2018, p. 676-685.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High rates of human fecal carriage of mcr-1-positive multidrug-resistant enterobacteriaceae emerge in China in association with successful plasmid families

AU - Zhong, Lan Lan

AU - Phan, Hang T.T.

AU - Shen, Cong

AU - Vihta, Karina Doris

AU - Sheppard, Anna E.

AU - Huang, Xi

AU - Zeng, Kun Jiao

AU - Li, Hong Yu

AU - Zhang, Xue Fei

AU - Patil, Sandip

AU - Crook, Derrick W.

AU - Walker, A. Sarah

AU - Xing, Yong

AU - Lin, Jia Lin

AU - Feng, Lian Qiang

AU - Doi, Yohei

AU - Xia, Yong

AU - Stoesser, Nicole

AU - Tian, Guo Bao

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background. mcr-1-mediated colistin resistance in Enterobacteriaceae is concerning, as colistin is used in treating multidrug- resistant Enterobacteriaceae infections. We identified trends in human fecal mcr-1-positivity rates and colonization with mcr-1- positive, third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae in Guangzhou, China, and investigated the genetic contexts of mcr-1 in mcr-1-positive 3GC-R strains. Methods. Fecal samples were collected from in-/out-patients submitting specimens to 3 hospitals (2011-2016). mcr-1 carriage trends were assessed using iterative sequential regression. A subset of mcr-1-positive isolates was sequenced (whole-genome sequencing [WGS], Illumina), and genetic contexts (flanking regions, plasmids) of mcr-1 were characterized. Results. Of 8022 fecal samples collected, 497 (6.2%) were mcr-1 positive, and 182 (2.3%) harbored mcr-1-positive 3GC-R Enterobacteriaceae. We observed marked increases in mcr-1 (0% [April 2011] to 31% [March 2016]) and more recent (since January 2014; 0% [April 2011] to 15% [March 2016]) increases in human colonization with mcr-1-positive 3GC-R Enterobacteriaceae (P < .001). mcr-1-positive 3GC-R isolates were commonly multidrug resistant. WGS of mcr-1-positive 3GC-R isolates (70 Escherichia coli, 3 Klebsiella pneumoniae) demonstrated bacterial strain diversity; mcr-1 in association with common plasmid backbones (IncI, IncHI2/HI2A, IncX4) and sometimes in multiple plasmids; frequent mcr-1 chromosomal integration; and high mobility of the mcr-1-associated insertion sequence ISApl1. Sequence data were consistent with plasmid spread among animal/ human reservoirs. Conclusions. The high prevalence of mcr-1 in multidrug-resistant E. coli colonizing humans is a clinical threat; diverse genetic mechanisms (strains/plasmids/insertion sequences) have contributed to the dissemination of mcr-1, and will facilitate its persistence.

AB - Background. mcr-1-mediated colistin resistance in Enterobacteriaceae is concerning, as colistin is used in treating multidrug- resistant Enterobacteriaceae infections. We identified trends in human fecal mcr-1-positivity rates and colonization with mcr-1- positive, third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae in Guangzhou, China, and investigated the genetic contexts of mcr-1 in mcr-1-positive 3GC-R strains. Methods. Fecal samples were collected from in-/out-patients submitting specimens to 3 hospitals (2011-2016). mcr-1 carriage trends were assessed using iterative sequential regression. A subset of mcr-1-positive isolates was sequenced (whole-genome sequencing [WGS], Illumina), and genetic contexts (flanking regions, plasmids) of mcr-1 were characterized. Results. Of 8022 fecal samples collected, 497 (6.2%) were mcr-1 positive, and 182 (2.3%) harbored mcr-1-positive 3GC-R Enterobacteriaceae. We observed marked increases in mcr-1 (0% [April 2011] to 31% [March 2016]) and more recent (since January 2014; 0% [April 2011] to 15% [March 2016]) increases in human colonization with mcr-1-positive 3GC-R Enterobacteriaceae (P < .001). mcr-1-positive 3GC-R isolates were commonly multidrug resistant. WGS of mcr-1-positive 3GC-R isolates (70 Escherichia coli, 3 Klebsiella pneumoniae) demonstrated bacterial strain diversity; mcr-1 in association with common plasmid backbones (IncI, IncHI2/HI2A, IncX4) and sometimes in multiple plasmids; frequent mcr-1 chromosomal integration; and high mobility of the mcr-1-associated insertion sequence ISApl1. Sequence data were consistent with plasmid spread among animal/ human reservoirs. Conclusions. The high prevalence of mcr-1 in multidrug-resistant E. coli colonizing humans is a clinical threat; diverse genetic mechanisms (strains/plasmids/insertion sequences) have contributed to the dissemination of mcr-1, and will facilitate its persistence.

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