Nationwide surveillance in Thailand revealed genotype-dependent dissemination of carbapenem-resistant Enterobacterales
Dan Takeuchi, Anusak Kerdsin, Yukihiro Akeda, Yo Sugawara, Noriko Sakamoto, Yuki Matsumoto, Daisuke Motooka, Takuma Ishihara, Isao Nishi, Warawut Laolerd, Pitak Santanirand, Norihisa Yamamoto, Kazunori Tomono, Shigeyuki Hamada
Abstract
Carbapenem-resistant Enterobacterales (CRE) are a serious public health threat because of their rapid dissemination. To determine the epidemiological and genetic characteristics of CRE infections in Thailand, we performed whole-genome sequencing of 577 carbapenem-resistant Klebsiella pneumoniae isolates and 170 carbapenem-resistant Escherichia coli isolates from hospitals across the nation. The four most prevalent carbapenemase genes harboured by these bacteria were bla NDM-1 , bla NDM-5 , bla OXA-181 and bla OXA-232 . The gene bla NDM-1 was identified in diverse sequence types. The gene bla NDM-5 was identified almost exclusively in E. coli . The genes bla OXA-181 , bla OXA-232 , and co-carriage of bla NDM-1 and bla OXA-232 were found in specific sequence types from certain provinces. Replicon typing revealed the diverse backbones of bla NDM-1 - and bla NDM-5 -harbouring plasmids and successful expansion of bla NDM-1 -harbouring IncN2-type plasmids. Core-genome single-nucleotide polymorphism analysis suggested that bla OXA-181 -, bla OXA-232 -, bla NDM-5 -, and co-carriage of bla NDM-1 and bla OXA-232 -associated sub-clonal lineages have recently predominated in the provinces from where these isolates were isolated. Thus, we demonstrate genotype-dependent dissemination of CRE in Thailand, which is helpful for establishing infection-control strategies in CRE-endemic areas.