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CRE species, resistance mechanisms more diverse than previously thought
Carbapenem-resistant Enterobacteriaceae, or CRE, exist in a wide variety of species and have many easily-transferred genetic traits that enable antibiotic resistance, study data show.
Researchers suggested increasing genomic surveillance of CRE because the bacteria may be spread asymptomatically.
“While the typical focus has been on treating sick patients with CRE-related infections, our new findings suggest that CRE is spreading beyond the obvious cases of disease,” William Hanage, PhD, of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health, Boston, said in a press release. “We need to look harder for this unobserved transmission within our communities and health care facilities if we want to stamp it out.”
Researchers reviewed genomic sequences of 122 carbapenem nonsusceptible and 141 susceptible isolates from three hospitals in Boston and one in California. Hanage and colleagues reported finding a “riot of diversity” in both the number of CRE species and the number of genes carrying resistant traits, and described finding “only a limited subset of closely related strains” among all the hospitals included in the surveys. They also found previously unknown resistance mechanisms, suggesting that still more resistance mechanisms have yet to be discovered.
Hanage and colleagues wrote that care was needed, as more mechanisms for resistance were likely to emerge in the future. They also recommended expanding the scope of studying CRE.
“Ultimately, to combat CRE, we need to continue whole-genome-based surveillance studies, such as this one, to better define the expanse of the problem with respect to CRE strain diversity and the molecular mechanisms driving resistance,” the researchers wrote. “However, studies based on clinical cultures from hospitalized patients alone are insufficient to fully identify and interrupt transmission; therefore, we must extend these studies further to include isolates from outside of tertiary hospital settings and from asymptomatic carriers.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.