Prevalence of mcr-1 in Colonized Inpatients, China, 2011-2019.
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ABSTRACT:
SUBMITTER: Shen C
PROVIDER: S-EPMC8386786 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Mobile colistin resistance (mcr) genes are present mainly in plasmids and can disseminate clonally or horizontally via either plasmids or insertion sequences in different genomic locations among the Enterobacteriaceae. A nationwide large-scale study on mcr prevalence and transmission in nontyphoidal Salmonella isolates is still lacking. Here, we identified 140 mcr-positive Salmonella isolates out of 7,106 isolates from 29 provinces in China from 2011 to 2020. We aligned short reads to putative plasmids from long-read hybrid assemblies and predicted the plasmid backbones of non-long-read sequencing isolates to elucidate mcr transmission patterns. The mcr-1 and mcr-3 genes are transmitted on similar high-risk clones (sequence type 34 [ST34]) but through plasmids of various replicon types. Furthermore, the ban on colistin use in food animals can lead to a decrease in the mcr-positive Salmonella prevalence among diarrheal patients, related mainly to IncHI2A_IncHI2 plasmids. We provide a framework for plasmid data incorporation into genomic surveillance systems, contributing to a better understanding of mcr spread and transmission. IMPORTANCE Nontyphoidal Salmonella is one of four major causative agents of diarrheal diseases globally, with most cases of salmonellosis being mild. Antimicrobial treatments are required for cases of life-threatening infections, and colistin is one of the last-line antibiotics for the treatment of multidrug-resistant Salmonella infections. However, the efficacy of colistin has been compromised by the emergence of various mcr genes. To elucidate the transmission of mcr genes in Salmonella isolates, our study analyzed 7,106 Salmonella strains from 29 provinces in China from 2011 to 2020. The results showed that mcr genes are transmitted on similar high-risk clones (ST34) but through plasmids of various replicon types. In addition, our data illustrated that the ban on the use of colistin in food animals led to a significant decrease in mcr-positive isolates. Our findings offer an essential step toward a more comprehensive understanding of the spread and transmission of mcr genes.
| S-EPMC9927481 | biostudies-literature
Project description:ObjectiveChina is the largest producer of tobacco worldwide. We assessed secular trends in prevalence of smoking, average cigarettes per day, mean age of initiation, and mortality attributable to smoking among the Chinese population between 1991 and 2011.DesignData came from the China Health and Nutrition Survey, conducted eight times between 1991 and 2011. A total of 83,447 participants aged 15years or older were included in this study. Trends in smoking were stratified by sex, age, and region (urban vs. rural).ResultsIn 2011, 311 millions individuals were current smokers in China, with 295 million men and 16 million women, respectively. Between 1991 and 2011, the prevalence of current smoking decreased from 60.6% to 51.6% in men, and from 4.0% to 2.9% in women. However, during this period, the average number of cigarettes smoked per day per smoker increased from 15.0 to 16.5 in males, and from 8.5 to 12.4 in females. Further, age of smoking initiation decreased from 21.9 to 21.4years in men and from 31.4 to 28.4years in women. In 2011, 16.5% of all deaths in men and 1.7% in women were due to smoking. Between 1991 and 2011, the total number of deaths caused by smoking increased from 800,000 to 900,000.ConclusionsDuring the past 20years, a slight decrease in smoking prevalence was observed in the Chinese population. However, cigarette smoking remains a major cause of death in China, especially in men.
| S-EPMC5124560 | biostudies-literature
Project description:Background and purposeNon-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease in China. However, the understanding of NAFLD prevalence among Chinese mental disorder inpatients remains insufficient. We aim to investigate the prevalence of NAFLD among mental disorder inpatients in Beijing, China.MethodsIn this observational study, we included 66,273 mental disorder inpatients between 2014 and 2018, including inpatients with schizophrenia, bipolar disorder, depressive disorder and other mental disorders. Data were obtained from electronic health records of 19 specialized psychiatric hospitals in Beijing. NAFLD was defined by ICD-10 code, excluding other causes of liver disease. We calculated the overall and annual prevalence rates of NAFLD from 2014 to 2018, and compared NAFLD prevalence between sexes, age groups, mental disorders types, antipsychotics use, and comorbidities. Multivariable logistic regression was used to examine risk factors associated with NAFLD. Subgroup analysis was performed in different mental disorder types.ResultsThe prevalence of NAFLD was 17.63% (95% CI 17.34-17.92%) in mental disorder inpatients, increasing from 16.88% in 2014 to 19.07% in 2018. The NAFLD prevalence in participants with schizophrenia (22.44%) was higher than that in participants with bipolar disorder (17.89%), depressive disorder (12.62%), and other mental disorders (12.99%). Women had similar or even higher NAFLD prevalence than men after 50 years. Men, 50-59 years (aOR = 1.71), schizophrenia (aOR = 1.56), bipolar disorder (aOR = 1.47), antipsychotics use (aOR = 1.46), hypertension (aOR = 1.50), diabetes (aOR = 1.83), dyslipidemia (aOR = 2.50) were risk factors for NAFLD in mental disorder inpatients.ConclusionNAFLD was common among Chinese mental disorder inpatients, and increased over years. The prevalence of NAFLD was higher among men, old women, inpatients with schizophrenia, bipolar disorder, antipsychotics, hypertension, diabetes, and dyslipidemia. Fatty liver disease among mental disorder population warrants the attention of psychiatric specialists and health policy-makers.
| S-EPMC7886739 | biostudies-literature
Project description:ObjectiveTo 1) determine current intravenous (IV) acetaminophen use in pediatric inpatients; and 2) determine the association between opioid medication duration when used with or without IV acetaminophen.MethodsA retrospective analysis of pediatric inpatients exposed to IV acetaminophen from January 2011 to June 2016, using the national database Health Facts.ResultsEighteen thousand one hundred ninety-seven (2.0%) of 893,293 pediatric inpatients received IV acetaminophen for a median of 14 doses per patient (IQR, 8-56). A greater proportion of IV acetaminophen patients were admitted to the intensive care unit (ICU) (14.8% vs 5.1%, p < 0.0001), received positive pressure ventilation (2.0% vs 1.5%, p < 0.0001), had a higher hospital mortality rate (0.9% vs 0.3%, p < 0.0001), and were operative (35.5% vs 12.8%, p < 0.001) than those not receiving IV acetaminophen. The most common operations associated with IV acetaminophen use were musculoskeletal and digestive system operations. Prescription of IV acetaminophen increased over time, both in prescription rates and number of per patient doses. Of the 18,197 patients prescribed IV acetaminophen, 16,241 (89.2%) also were prescribed opioids during their hospitalization. A multivariate analysis revealed patients prescribed both IV acetaminophen and opioids had a 54.8% increase in opioid duration as compared with patients who received opioids alone.ConclusionsThis is the first study to assess IV acetaminophen prescription practices for pediatric inpatients. Intravenous acetaminophen prescription was greater in the non-operative pediatric inpatient population than operative patients. Intravenous acetaminophen prescription was associated with an increase in opioid duration as compared with patients who received opioids alone, suggesting that it is commonly used to supplement opioids for pain relief.
| S-EPMC9088446 | biostudies-literature
Project description:IntroductionLow-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking.MethodsUsing data from CDC's annual Behavioral Risk Factor Surveillance System 2011-2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18-64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL).ResultsRegression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08).ConclusionsExpanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.
| S-EPMC8336658 | biostudies-literature
Project description:The recently discovered colistin resistance element, mcr-1, adds to the list of antimicrobial resistance genes that rapidly erode the antimicrobial efficacy of not only the commonly used antibiotics but also the last-line agents of carbapenems and colistin. This study investigated the prevalence of the mobile colistin resistance determinant mcr-1 in Salmonella strains recovered from clinical settings in China and the transmission potential of mcr-1-bearing mobile elements harbored by such isolates. The mcr-1 gene was recoverable in 1.4% of clinical isolates tested, with the majority of them belonging to Salmonella enterica serotype Typhimurium. These isolates exhibited diverse pulsed-field gel electrophoresis (PFGE) profiles and high resistance to antibiotics other than colistin and particularly to cephalosporins. Plasmid analysis showed that mcr-1 was carried on a variety of plasmids with sizes ranging from ∼30 to ∼250 kb, among which there were conjugative plasmids of ∼30 kb, ∼60 kb, and ∼250 kb and nonconjugative plasmids of ∼140 kb, ∼180 kb, and ∼240 kb. Sequencing of representative mcr-1-carrying plasmids revealed that all conjugative plasmids belonged to the IncX4, IncI2, and IncHI2 types and were highly similar to the corresponding types of plasmids reported previously. Nonconjugative plasmids all belonged to the IncHI2 type, and the nontransferability of these plasmids was attributed to the loss of a region carrying partial or complete tra genes. Our data revealed that, similar to the situation in Escherichia coli, mcr-1 transmission in Salmonella was accelerated by various plasmids, suggesting that transmission of mcr-1-carrying plasmids between different species of Enterobacteriaceae may be a common event.
| S-EPMC5404577 | biostudies-literature
Project description:To investigate whether introduction of colistin into the clinical settings selected colistin-resistant CRE, we performed molecular epidemiological study of 1868 CRE strains collected from different geographical locales in China during the period 2014-2019. 1755 (96.18%) isolates carried the carbapenemase genes blaKPC and blaNDM; 14 Escherichia coli isolates (0.75%) carrying mcr-1 and blaNDM (MCR-CREC) were also identified. Importantly, the number and relative prevalence of MCR-CREC isolates increased from 5 (0.41%) to 9 (1.38%) after introduction of polymyxin into clinical practice. Consistently, results of genetic analysis indicated that MCR-CREC strains collected before December 2017 were genetically diverse, yet those collected after that date exhibited more closely related genetic profiles, indicating that specific MCR-CREC strains were rapidly selected as a result of increased usage of colistin in clinical settings. The resistance level of MCR-CREC isolates to colistin increased after the introduction of polymyxin into clinical use with the MIC to colistin from <2 mg/L in 80% strains to 2 mg/L in 100% strains. Further dissemination of MCR-CREC strains, which exhibit resistance to the last-line drugs of carbapenems and colistin, is expected to pose a severe threat to human health.
| S-EPMC7034111 | biostudies-literature
Project description:Currently, Gram-negative bacteria have developed multidrug and broad-spectrum drug resistance, and the numbers of species and strains carrying mcr or bla NDM genes are increasing. In this study, mcr-1 and bla NDM distribution of 12,858 Gram-negative bacteria isolated from wildlife, patients, livestock, poultry and environment in 14 provinces of China from 2010 to 2019 and the antibiotics resistance in regard to polymyxins (polymyxin B and colistin) and carbapenems of positive strains were investigated. A total of 70 strains of 10 species carried the mcr-1 gene, positive rates of patients, livestock and poultry, and environmental strains were 0.62% (36/5,828), 4.07% (29/712), 5.43% (5/92), respectively. Six strains of 3 species carrying the bla NDM gene all came from patients 0.10% (6/5,828). Two new mcr-1 gene variants (GenBank: MK965883, MK965884) were identified, one of which contains premature stop codon. The drug susceptibility results showed that all mcr-1 carriers were sensitive to carbapenems, among which, 66 strains were resistant and 4 were sensitive to polymyxins. The strains with the bla NDM gene had different degrees of resistance to carbapenems and were sensitive to polymyxins. The findings that species carrying mcr-1 or bla NDM genes were limited and mostly normal flora of opportunistic or low pathogenic organisms indicated that transfer of mcr-1 and bla NDM genes between bacteria was relatively limited in China. The none detection among wildlife compared with other sources supports the speculation that the emergence of and increase in polymyxins and carbapenem-resistant strains was mainly related to the selective pressure of antibiotics.
| S-EPMC7026248 | biostudies-literature
Project description:BackgroundThe stroke burden in China has increased during the past 40 years. The present study aimed to determine the recent trends in the prevalence of stroke from 2013 to 2019 stratified by sociodemographic characteristics, including sex, age, residence, ethnicity, and province within a population-based screening project in China.MethodsWe made use of data generated from 2013 to 2019 in the China Stroke High-risk Population Screening Program. All living subjects with confirmed stroke at interview were considered to have prevalent stroke. All analyses of prevalence of stroke were weighted and results were presented as percentage and 95% confidence interval (CI).FindingsA total of 4229,616 Chinese adults aged ≥40 years from 227 cities in the 31 provinces were finally included. The enrollment rate ranged from 58.8% (2017) to 67.8% (2013). The weighted prevalence of stroke increased annually from 2013 to 2019, being 2.28% (95% CI: 2.28-2.28%) in 2013, 2.34% (2.34-2.35%) in 2014, 2.43% (2.43-2.43%) in 2015, 2.48% (2.48-2.48%) in 2016, 2.52% (2.52-2.52%) in 2017, 2.55% (2.55-2.55%) in 2018, and 2.58% (2.58-2.58%) in 2019 (p for trend <0.001). The weighted prevalence of stroke was higher for male sex, older age, and residence in rural and northeast areas.InterpretationThe prevalence of stroke in China and most provinces has continued to increase in the past 7 years (2013-2019). These findings, especially in provinces with high stroke prevalence, can help public health officials to increase province capacity for stroke and related risk factors prevention.FundingsThis study was supported by grants from the National Major Public Health Service Projects.
| S-EPMC9727498 | biostudies-literature
Project description:We identified discrete importation events of the mcr-1 gene on incompatibility group IncI2 plasmids in Escherichia coli isolated from patients in New South Wales, Australia, in 2011 and 2013. mcr-1 is present in a small minority of colistin-resistant Enterobacteriaceae and appears not to be established locally.
| S-EPMC5512495 | biostudies-literature