Nationwide Surveillance of Clinical Carbapenem-resistant Enterobacteriaceae (CRE) Strains in China

Rong Zhang, Lizhang Liu, Hongwei Zhou, Edward Waichi Chan, Jiaping Li, Ying Fang, Yi Li, Kang Liao, Sheng Chen

Research output: Journal article publicationJournal articleAcademic researchpeer-review

395 Citations (Scopus)


A nationwide survey was conducted in China covering a total of 1105 CRE strains collected from 25 geographical locales with results showing that acquisition of two carbapenemase genes, blaKPC-2and blaNDM, was responsible for phenotypic resistance in 90% of the CRE strains tested (58% and 32% respectively), among which several major strain types, such as ST11 of K. pneumoniae and ST131/ST167 of E. coli, were identified, suggesting that dissemination of specific resistant clones is mainly responsible for emergence of new CRE strains. Prevalence of the fosA3 gene which mediates fosfomycin resistance, was high, while the colistin resistance determinant mcr-1 was rarely present in these isolates. Consistently, the majority of the blaNDM-bearing plasmids recoverable from the test strains belonged to IncX3, which contained a common core structure, blaNDM-blaMBL-trpF. Likewise, the core structure of ISKpn27-blaKPC-2-ISKpn2 was observed among plasmids harboring the blaKPC-2gene, although they were genetically more divergent. In conclusion, the increasing prevalence of CRE strains in China is attributed to dissemination of conservative mobile elements carrying blaNDMor blaKPC-2on conjugative and non-conjugative plasmids.
Original languageEnglish
Pages (from-to)98-106
Number of pages9
Publication statusPublished - 1 May 2017


  • bla KPC-2
  • bla NDM
  • Carbapenem resistance
  • Enterobacteriaceae
  • Molecular epidemiology
  • Plasmid

ASJC Scopus subject areas

  • General Biochemistry,Genetics and Molecular Biology


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