Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018

Alicia Shugart; Garrett Mahon; Jennifer Y Huang; Maria Karlsson; Ann Valley; Megan Lasure; Annastasia Gross; Brittany Pattee; Elisabeth Vaeth; Richard Brooks; Tyler Maruca; Catherine E Dominguez; David Torpey; Drew Francis; Rachana Bhattarai; Marion A Kainer; Allison Chan; Heather Dubendris; Shermalyn R Greene; Sara J Blosser; D J Shannon; Kelly Jones; Brenda Brennan; Sopheay Hun; Marisa D'Angeli; Caitlin N Murphy; Maureen Tierney; Natashia Reese; Amelia Bhatnagar; Alex Kallen; Allison C Brown; Maroya Spalding Walters

doi:10.1093/jacamr/dlab137

Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018

JAC Antimicrob Resist. 2021 Sep 4;3(3):dlab137. doi: 10.1093/jacamr/dlab137. eCollection 2021 Sep.

Authors

Alicia Shugart¹, Garrett Mahon¹, Jennifer Y Huang¹, Maria Karlsson¹, Ann Valley², Megan Lasure², Annastasia Gross³, Brittany Pattee³, Elisabeth Vaeth⁴, Richard Brooks^{1

4}, Tyler Maruca⁴, Catherine E Dominguez⁴, David Torpey⁴, Drew Francis⁵, Rachana Bhattarai⁵, Marion A Kainer⁶, Allison Chan⁶, Heather Dubendris⁷, Shermalyn R Greene⁷, Sara J Blosser⁸, D J Shannon⁸, Kelly Jones⁹, Brenda Brennan⁹, Sopheay Hun¹⁰, Marisa D'Angeli¹⁰, Caitlin N Murphy¹¹, Maureen Tierney¹², Natashia Reese¹, Amelia Bhatnagar^{1

13}, Alex Kallen¹, Allison C Brown¹, Maroya Spalding Walters¹

Affiliations

¹ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.
² Wisconsin State Laboratory of Hygiene, Madison, WI, USA.
³ Minnesota Department of Health, St Paul, MN, USA.
⁴ Maryland Department of Health, Baltimore, MD, USA.
⁵ Arizona Department of Health Services, Phoenix, AZ, USA.
⁶ Tennessee Department of Health, Nashville, TN, USA.
⁷ North Carolina Department of Health and Human Services, Raleigh, NC, USA.
⁸ Indiana State Department of Health, Indianapolis, IN, USA.
⁹ Michigan Department of Health and Human Services, Lansing, MI, USA.
¹⁰ Washington State Department of Health, Tumwater, WA, USA.
¹¹ University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, NE, USA.
¹² Nebraska Department of Health and Human Services, Lincoln, NE, USA.
¹³ Goldbelt C6 Inc, Juneau, AK, USA.

Abstract

Background: Historically, United States' carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread.

Objectives: From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE.

Methods: State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (bla _KPC, bla _NDM, bla _VIM, bla _IMP, or bla _OXA-48-like) was detected.

Results: SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than bla _KPC.

Conclusions: Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.

Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy 2021. This work is written by a US Government employee and is in the public domain in the US.