LAUSR

OBJECTIVES To identify the carbapenemase and colistin resistance genes and epidemiological status of carbapenem resistant Enterobacterales (CRE) among 7 secondary and 11 tertiary hospitals in Henan province, China. METHODS CRE isolates and clinical data of infected patients were collected from 7 secondary and 11 tertiary hospitals in Henan from July to September 2019 and analysed retrospectively. PCR and gene sequencing were performed to detect carbapenemase and colistin resistance genes; multilocus sequence typing was also performed. RESULTS 238 non duplicate CRE isolates were collected mainly from the respiratory tract (54.20%) and blood (18.91%) of CRE infected patients, the half of them aged >65 years (45.80%). Carbapenem resistant Klebsiella pneumoniae (CRKP) was the most common CRE (184 isolates, 77.31%) with constituent ratios of 84.38% and 72.54% in secondary and tertiary hospitals, respectively. In 184 CRKP isolates, blaKPC-2 (89.13%) was the dominant carbapenemase gene, and ST11 (71.74%) was the most prevalent sequence type (ST), with constituent ratios of 83.95% and 62.14% in secondary and tertiary hospitals, respectively. In 29 carbapenem resistant Escherichia coli (CREC) isolates, blaNDM-5 (58.62%) and ST2 (31.03%) were prevalent. Four CRKP isolates and one CREC isolate were colistin resistant, and carried the plasmid mediated mcr-1 gene. CONCLUSIONS Our results showed a wide spread of CRKP-ST11 with KPC-2 carbapenemase in the analysed 18 hospitals. The CRKP constituent ratio, CRKP-STs, and CREC carbapenemase genes between secondary and tertiary hospitals showed significant differences.The emergence of a colistin resistant CRKP with plasmid-mediated resistance gene mcr-1 is of serious concern due to the limited treatment options.