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This study aimed to investigate the dissemination and characteristics of  bla  KPC ,  bla  NDM ,  bla  OXA-48- like  ,  bla  IMP , and  bla  VIM  among the carbapenem-resistant  Enterobacteriaceae  (CRE) strains isolated from adult and children patients. A total of 935 non-duplicate CRE strains were collected from 36 hospitals in 24 provinces or cities across China from 2016 to 2018. Antimicrobial susceptibility testing was performed by broth microdilution method and carbapenemase genes  bla  KPC ,  bla  NDM ,  bla  OXA-48- like  ,  bla  IMP , and  bla  VIM  were screened by PCR and confirmed by DNA sequencing. Overall, carbapenemases were produced in 97.4% (911/935) of CRE strains, including KPC-2 (51.6%, 482/935), NDM (35.7%, 334/935), and OXA-48-like carbapenemases (7.3%, 68/935). Overall, the most prevalent carbapenemase gene was  bla  KPC-2  among  Klebsiella pneumoniae  (64.6%, 457/709) and the CRE strains isolated from adult patients (70.3%, 307/437), and  bla  NDM  among  Escherichia coli  (96.0%, 143/149) and the CRE strains from children (49.0%, 247/498). The  bla  OXA-232 -positive carbapenem-resistant  K. pneumoniae  (9.3%, 66/709) were all isolated from children. Sixteen strains were positive for  bla  IMP  and 9 strains produced multiple carbapenemases. No strain was positive for  bla  VIM . Most of the CRE strains (>90%) were resistant to cephalosporins and carbapenems, more than half (>50%) were resistant to aminoglycosides and fluoroquinolones, but the majority (95.8 and 98.4%) were susceptible to polymyxin B and tigecycline. Ceftazidime-avibactam showed excellent  in vitro  activity against  bla  KPC-2  and  bla  OXA-48- like   positive strains (100% susceptible). In China, KPC-2, NDM, and OXA-48-like carbapenemases were predominant among CRE clinical isolates. The most prevalent carbapenemase gene was  bla  KPC-2  among  K. pneumoniae  isolates from adult patients, and  bla  NDM  among  E. coli  isolates from children.

frontiers in cellular and infection microbiology

Dissemination of Carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) Among Carbapenem-Resistant Enterobacteriaceae Isolated From Adult and Children Patients in China