Association of the Emerging Carbapenemase NDM-1 with a Bleomycin Resistance Protein in Enterobacteriaceae and Acinetobacter baumannii

Self Cite

Twenty-two consecutive carbapenem-resistant enterobacterial isolates were recovered from patients hospitalized between January and April 2013 in different units at a university hospital in Istanbul, Turkey. These were Klebsiella pneumoniae isolates producing the carbapenemases OXA-48, NDM-1, and KPC-2, Enterobacter cloacae isolates producing NDM-1, and Escherichia coli isolates producing OXA-48. Most of the OXA-48-producing K. pneumoniae and all the NDM-1-producing E. cloacae were clonally related. The NDM-1-producing E. cloacae isolates recovered from a single neonatal intensive care unit corresponded to a single cluster, highlighting the spread of that clone in that setting.

supporting

confidence: 63%

Spread of NDM-1-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Istanbul, Turkey

Poirel

Yılmaz

Istanbullu

et al. 2014

Self Cite

“…3). It was reported that bla NDM-1 and ble MBL are under the control of the same promoter in front of bla NDM-1 , and this structure may facilitate the spread of NDM-1 when under the selective pressure of bleomycin-like mol- ecules in the environment (38). The entire ISAba125 element was detected immediately upstream of the bla NDM-1 gene in each of the 16 isolates.…”

Section: Resultsmentioning

confidence: 88%

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

Qin

Zhang

et al. 2014

The emergence and spread of New Delhi metallo-␤-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla NDM-1 , and the gene was found to be carried on plasmids of various sizes (ϳ55 to ϳ360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla NDM-1 -positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla NDM-1 -positive CRE isolate, the bla NDM-1 gene was downstream of an intact ISAba125 element and upstream of the ble MBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla NDM-1 -containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.

“…CP000649.1). Notably, the bla NDM-1 gene environment is adjacent to a bleomycin resistance protein-encoding gene, a finding that is common in bla NDM-1 -producing strains and is thought to impact the overall survival value of this strain (15).…”

Section: Patientsmentioning

confidence: 99%

Surveillance of Carbapenem-Resistant Klebsiella pneumoniae: Tracking Molecular Epidemiology and Outcomes through a Regional Network

Duin

Pérez

Rudin

et al. 2014

143

144

m Carbapenem resistance in Gram-negative bacteria is on the rise in the United States. A regional network was established to study microbiological and genetic determinants of clinical outcomes in hospitalized patients with carbapenem-resistant (CR) Klebsiella pneumoniae in a prospective, multicenter, observational study. To this end, predefined clinical characteristics and outcomes were recorded and K. pneumoniae isolates were analyzed for strain typing and resistance mechanism determination. In a 14-month period, 251 patients were included. While most of the patients were admitted from long-term care settings, 28% of them were admitted from home. Hospitalizations were prolonged and complicated. Nonsusceptibility to colistin and tigecycline occurred in isolates from 7 and 45% of the patients, respectively. Most of the CR K. pneumoniae isolates belonged to repetitive extragenic palindromic PCR (rep-PCR) types A and B (both sequence type 258) and carried either bla KPC-2 (48%) or bla KPC-3 (51%). One isolate tested positive for bla NDM-1 , a sentinel discovery in this region. Important differences between strain types were noted; rep-PCR type B strains were associated with bla KPC-3 (odds ratio [OR], 294; 95% confidence interval [CI], 58 to 2,552; P < 0.001), gentamicin nonsusceptibility (OR, 24; 95% CI, 8.39 to 79.38; P < 0.001), amikacin susceptibility (OR, 11.0; 95% CI, 3.21 to 42.42; P < 0.001), tigecycline nonsusceptibility (OR, 5.34; 95% CI, 1.30 to 36.41; P ‫؍‬ 0.018), a shorter length of stay (OR, 0.98; 95% CI, 0.95 to 1.00; P ‫؍‬ 0.043), and admission from a skilled-nursing facility (OR, 3.09; 95% CI, 1.26 to 8.08; P ‫؍‬ 0.013). Our analysis shows that (i) CR K. pneumoniae is seen primarily in the elderly long-term care population and that (ii) regional monitoring of CR K. pneumoniae reveals insights into molecular characteristics. This work highlights the crucial role of ongoing surveillance of carbapenem resistance determinants.