{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:57:10Z","timestamp":1791899830113,"version":"4.3.4"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Carbapenem-resistant <jats:italic>Klebsiella aerogenes<\/jats:italic> (CRKA) has posed a serious threat for clinical anti-infective therapy. However, the molecular characteristics of CRKA in Shanghai are rarely reported.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> This study aimed to investigate the resistance profiles, dissemination mechanism, and molecular characteristics of CRKA strains isolated from children in a pediatric hospital, Shanghai.<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> Fifty CRKA isolates were collected in 2019. Antimicrobial susceptibility of the strains was determined by broth microdilution method. The \u03b2-lactamases and outer membrane porin genes were characterized by polymerase chain reaction (PCR). Conjugation experiments were performed to determine the transferability of the plasmids. The plasmids were typed based on their incompatibility group using the PCR-based replicon typing method. Multilocus sequence typing (MLST) and enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) were performed for the genetic relationship.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> All CRKA strains showed high level of resistance to cephalosporins and carbapenems, but still susceptible to aminoglycosides, colistin, and tigecycline. Forty five of fifty isolates carried <jats:italic>bla<\/jats:italic><jats:sub>NDM\u22125<\/jats:sub> genes (45\/50, 90%), alongside with other \u03b2-Lactamase genes including <jats:italic>bla<\/jats:italic><jats:sub>CTX\u2212M\u22121<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>TEM\u22121<\/jats:sub>, and <jats:italic>bla<\/jats:italic><jats:sub>SHV\u221211<\/jats:sub> being detected. Loss of <jats:italic>ompK35<\/jats:italic> and <jats:italic>ompK36<\/jats:italic> genes were observed in 14% (7\/50) and 28% (14\/50), respectively, with 5 isolates lacking both <jats:italic>ompK35<\/jats:italic> and <jats:italic>ompK36<\/jats:italic>. MLST analysis demonstrated that the majority of isolates belonged to ST4 (47\/50, 94%) and ERIC-PCR fingerprinting was performed to identify NDM-5-producing isolates with approximately or more than 80% similarity levels. Plasmids carrying <jats:italic>bla<\/jats:italic><jats:sub>NDM\u22125<\/jats:sub> were successfully transferred to the <jats:italic>E. coli<\/jats:italic> recipient and plasmid typing showed that IncX3 were the prevalent among CRKA isolates.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Our finding revealed the emergence of NDM-5 producing CRKA belonging to ST4 among children in Shanghai. Further attention should be paid to control the horizontal spread of the Class B carbapenemases like NDM in children.<\/jats:p>","DOI":"10.3389\/fpubh.2021.621527","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T07:05:10Z","timestamp":1614236710000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Emergence of NDM-5 Producing Carbapenem-Resistant Klebsiella aerogenes in a Pediatric Hospital in Shanghai, China"],"prefix":"10.3389","volume":"9","author":[{"given":"Fen","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e02577","DOI":"10.1128\/AAC.02577-18","article-title":"Next-Generation-Sequencing-Based Hospital Outbreak Investigation Yields Insight into Klebsiella aerogenes Population Structure and Determinants of Carbapenem Resistance and Pathogenicity","volume":"63","author":"Malek","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"B2","doi-asserted-by":"publisher","first-page":"392","DOI":"10.3389\/fmicb.2015.00392","article-title":"Enterobacter aerogenes and Enterobacter cloacae; versatile bacterial pathogens confronting antibiotic treatment","volume":"6","author":"Davin-Regli","year":"2015","journal-title":"Front Microbiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3283","DOI":"10.2147\/IDR.S221279","article-title":"Outbreak of Klebsiella pneumoniae carbapenemase-producing Klebsiella aerogenes strains in a tertiary hospital in China","volume":"12","author":"Hao","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3883","DOI":"10.2147\/IDR.S228130","article-title":"Coexistence of bla NDM-1 and rmtC on a transferrable plasmid of a Novel ST192 Klebsiella aerogenes clinical isolate","volume":"12","author":"Shen","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.7754\/Clin.Lab.2018.180211","article-title":"Emergence of IMP-4-producing Enterobacter aerogenes clinical isolate","volume":"64","author":"Lee","year":"2018","journal-title":"Clin Lab"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3557","DOI":"10.2147\/IDR.S218945","article-title":"First reported nosocomial outbreak of NDM-5-producing Klebsiella pneumoniae in a neonatal unit in China","volume":"12","author":"Kong","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B7","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1089\/mdr.2014.0226","article-title":"The Role of OmpK35, OmpK36 porins, and production of beta-Lactamases on imipenem susceptibility in Klebsiella pneumoniae clinical isolates, Cairo, Egypt","volume":"21","author":"Wassef","year":"2015","journal-title":"Microb Drug Resist"},{"key":"B8","doi-asserted-by":"publisher","first-page":"124","DOI":"10.12688\/wellcomeopenres.14826.1","article-title":"Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications","volume":"3","author":"Jolley","year":"2018","journal-title":"Wellcome Open Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"6823","DOI":"10.1093\/nar\/19.24.6823","article-title":"Distribution of repetitive DNA sequences in eubacteria and application to fingerprinting of bacterial genomes","volume":"19","author":"Versalovic","year":"1991","journal-title":"Nucleic Acids Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.mimet.2005.03.018","article-title":"Identification of plasmids by PCR-based replicon typing","volume":"63","author":"Carattoli","year":"2005","journal-title":"J Microbiol Methods"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e22044","DOI":"10.1002\/jcla.22044","article-title":"Detection of New Delhi metallo-beta-lactamase (encoded by blaNDM-1) in Enterobacter aerogenes in China","volume":"31","author":"Shen","year":"2017","journal-title":"J Clin Lab Anal"},{"key":"B12","doi-asserted-by":"publisher","first-page":"5952","DOI":"10.1128\/AAC.05108-11","article-title":"A novel variant, NDM-5, of the New Delhi metallo-beta-lactamase in a multidrug-resistant Escherichia coli ST648 isolate recovered from a patient in the United Kingdom","volume":"55","author":"Hornsey","year":"2011","journal-title":"Antimicrob Agents Chemother"},{"key":"B13","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.ijantimicag.2018.02.020","article-title":"Emergence of NDM-5-producing Escherichia coli sequence type 167 clone in Italy","volume":"52","author":"Giufre","year":"2018","journal-title":"Int J Antimicrob Agents"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e00454","DOI":"10.1128\/AAC.00454-17","article-title":"NDM-5 and OXA-181 beta-lactamases, a significant threat continues to spread in the Americas","volume":"61","author":"Rojas","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"B15","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s13756-018-0349-6","article-title":"Dissemination of blaNDM-5 gene via an IncX3-type plasmid among non-clonal Escherichia coli in China","volume":"7","author":"Li","year":"2018","journal-title":"Antimicrob Resist Infect Control"},{"key":"B16","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.jgar.2019.10.025","article-title":"Genomic characterisation of a Proteus mirabilis clinical isolate from China carrying blaNDM-5 on an IncX3 plasmid","volume":"19","author":"Sun","year":"2019","journal-title":"J Glob Antimicrob Resist"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.3389\/fmicb.2019.01156","article-title":"Detection and genomic characterization of a Morganella morganii isolate from China that produces NDM-5","volume":"10","author":"Guo","year":"2019","journal-title":"Front Microbiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e00685","DOI":"10.1128\/mSphere.00685-18","article-title":"Emergence of New Delhi Metallo-beta-Lactamase (NDM-5) in Klebsiella quasipneumoniae from Neonates in a Nigerian Hospital","volume":"4","author":"Brinkac","year":"2019","journal-title":"mSphere"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1089\/mdr.2019.0382","article-title":"Molecular characteristics of NDM-5-producing Escherichia coli from a cat and a dog in South Korea","volume":"26","author":"Hong","year":"2020","journal-title":"Microb Drug Resist"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2243","DOI":"10.2147\/IDR.S215273","article-title":"Characterization of NDM-5- and CTX-M-55-coproducing Escherichia coli GSH8M-2 isolated from the effluent of a wastewater treatment plant in Tokyo Bay","volume":"12","author":"Sekizuka","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1089\/mdr.2017.0379","article-title":"Porin deficiency in carbapenem-resistant Enterobacter aerogenes strains","volume":"24","author":"Hao","year":"2018","journal-title":"Microb Drug Resist"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3797","DOI":"10.1111\/febs.15005","article-title":"Genomic analysis unveils important aspects of population structure, virulence, and antimicrobial resistance in Klebsiella aerogenes","volume":"286","author":"Passarelli-Araujo","year":"2019","journal-title":"FEBS J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e00699","DOI":"10.1128\/mSphere.00699-19","article-title":"Dissemination of the bla NDM-5 Gene via IncX3-Type Plasmid among Enterobacteriaceae in Children","volume":"5","author":"Tian","year":"2020","journal-title":"mSphere"},{"key":"B24","doi-asserted-by":"publisher","first-page":"511","DOI":"10.2147\/IDR.S192998","article-title":"Characterization of a novel bla NDM-5-harboring IncFII plasmid and an mcr-1-bearing IncI2 plasmid in a single Escherichia coli ST167 clinical isolate","volume":"12","author":"Xu","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B25","doi-asserted-by":"publisher","first-page":"30","DOI":"10.4103\/0255-0857.148373","article-title":"Complete sequencing of an IncX3 plasmid carrying blaNDM-5 allele reveals an early stage in the dissemination of the blaNDM gene","volume":"33","author":"Krishnaraju","year":"2015","journal-title":"Indian J Med Microbiol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.621527\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T07:05:15Z","timestamp":1614236715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.621527\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":25,"alternative-id":["10.3389\/fpubh.2021.621527"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.621527","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"article-number":"621527"}}