Molecular Epidemiology of Emerging Carbapenem Resistance in and in Taiwan, 2010 to 2014.

This study investigated the molecular epidemiology of carbapenem-resistant and (ANAP). Clinical isolates of spp. collected by the biennial nationwide Taiwan Surveillance of Antimicrobial Resistance program from 2010 to 2014 were subjected to species identification, antimicrobial susceptibility testing, and PCR for detection of carbapenemase genes. Whole-genome sequencing or PCR mapping was performed to study the genetic surroundings of the carbapenemase genes. Among 1,041 isolates, the proportion of ANAP increased from 11% in 2010 to 22% in 2014. The rate of carbapenem resistance in these isolates increased from 7.5% (3/40) to 22% (14/64), with a concomitant increase in their resistance to other antibiotics. The and genes were highly prevalent in carbapenem-resistant ANAP. Various genetic structures were found upstream of in different plasmids. Among the plasmids found to contain flanked by XerC/XerD, pAB-NCGM253-like was identified in 8 of 10 isolates. Conjugations of plasmids carrying or to were successful. In addition, three isolates with chromosome-located embedded in AbGRI1-type structure with disruption of genes other than were detected. Two highly similar plasmids carrying class I integron containing and aminoglycoside resistance genes were also found. The universal presence of on chromosomes and their lack of contribution to carbapenem resistance indicate its potential to be a marker for species identification. The increase of ANAP, along with their diverse mechanisms of carbapenem resistance, may herald their further spread and warrants close monitoring.