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Abstract：
Carbapenem-resistant Enterobacterales (CRE) is a global concern. This study investigated the prevalence of fecal colonization carriage and clonal dissemination of CRE among population in four provinces of China. A total of 685 stool samples were collected from four provinces in China. Among these samples, 141 and 544 were obtained from healthy and hospitalized individuals, respectively. The overall fecal carriage rate was 9.6% (65/685) with 4.26% (95% CI: 0.9-7.6) in healthy individuals and 10.84% (95% CI: 8.2-13.5) in hospitalized patients. The highest prevalence was in Henan province (18.35%, 95% CI: 9%-18.7%). Sixty-six CRE isolates were identified in Escherichia coli (56.06%, 37/66), Klebsiella (15.15%, 10/66), Citrobacter (13.63%, 9/66), Enterobacter (12.12%, 8/66), and Atlantibacter (1.51%, 1/66). All CRE strains carried carbapenemase genes and multiple antibiotics resistance genes, blaNDM-5 (77.27%, 51/66) was the most common carbapenemase gene, followed by blaNDM-1 (19.69%, 13/66). Antibiotic resistance genes, including blaIMP-4, and the colistin colistin resistance (mcr-1) gene were also identified. All CRE isolates belonged to different sequence types (STs). ST206 (36.84%, 14/38) in E. coli and ST2270 (60%, 6/10) in Klebsiella were significantly dominant clones. The results indicated the prevalence of CRE fecal carriage among adults of China, mostly blaNDM-producing E coli, which pose significant challenges for clinical management. Screening for CRE colonization is necessary to control infection.
摘要：
耐碳青霉烯类肠杆菌(CRE)是全球关注的问题。本研究调查了中国四个省份人群中粪便定植携带和CRE克隆传播的患病率。从中国四个省份共收集了685份粪便样本。在这些样本中，141和544来自健康和住院的个体，分别。健康个体的总粪便携带率为9.6％（65/685），其中4.26％（95％CI：0.9-7.6），住院患者为10.84％（95％CI：8.2-13.5）。患病率最高的是河南省(18.35%,95%CI：9%-18.7%）。在大肠杆菌中鉴定出66株CRE分离株(56.06%，37/66),克雷伯菌（15.15%，10/66),柠檬酸杆菌（13.63%，9/66)，肠杆菌（12.12%，8/66)，和Atlantibacter(1.51%，1/66).所有CRE菌株都携带碳青霉烯酶基因和多种抗生素抗性基因，blaNDM-5（77.27%，51/66)是最常见的碳青霉烯酶基因，其次是blaNDM-1（19.69%，13/66)。抗生素抗性基因，还鉴定了包括blaIMP-4和粘菌素粘菌素抗性(mcr-1)基因。所有CRE分离株属于不同的序列类型(STs)。ST206（36.84%，14/38）在大肠杆菌和ST2270（60%，6/10)在克雷伯菌属中呈显著的优势克隆。结果表明，中国成年人中CRE粪便携带的患病率，主要是产生blaNDM的大肠杆菌，这对临床管理提出了重大挑战。筛选CRE定植是控制感染所必需的。
