Towards endemicity: large-scale expansion of the NDM-1-producing Klebsiella pneumoniae ST11 lineage in Poland, 2015–16

Abstract

Objectives In 2015 and 2016 Poland recorded rapid proliferation of New Delhi MBL (NDM)-producing Enterobacterales, with at least 470 and 1780 cases, respectively. We addressed the roles of the Klebsiella pneumoniae ST11 NDM-1 outbreak genotype, already spreading in 2012–14, and of newly imported organisms in this increase. Methods The study included 2136 NDM-positive isolates identified between April 2015 and December 2016, following transfer of patients with K. pneumoniae ST147 NDM-1 from Tunisia to Warsaw in March 2015. The isolates were screened by PCR mapping for variants of blaNDM-carrying Tn125-like elements. Selected isolates were typed by PFGE and MLST. NDM-encoding plasmids were analysed by nuclease S1/hybridization, transfer assays, PCR-based replicon typing and PCR mapping. Results The organisms were mainly K. pneumoniae containing the Tn125A variant of the ST11 epidemic lineage (n = 2094; ∼98%). Their representatives were of the outbreak pulsotype and ST11, and produced NDM-1, encoded by specific IncFII (pKPX-1/pB-3002cz)-like plasmids. The isolates were recovered in 145 healthcare centres in 13/16 administrative regions, predominantly the Warsaw area. The ‘Tunisian’ genotype K. pneumoniae ST147 NDM-1 Tn125F comprised 18 isolates (0.8%) from eight institutions. The remaining 24 isolates, mostly K. pneumoniae and Escherichia coli of diverse STs, produced NDM-1 or NDM-5 specified by various Tn125 derivatives and plasmids. Conclusions The K. pneumoniae ST11 NDM-1 outbreak has dramatically expanded in Poland since 2012, which may bring about a countrywide endemic situation in the near future. In addition, the so-far limited K. pneumoniae ST147 NDM-1 outbreak plus multiple NDM imports from different countries were observed in 2015–16.

Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019

“…NDM-CRE, highlighting the risk of rapid emergence and disseminations of uncommon variants of CPE within healthcare facility networks, as recently reported in other European countries [6,7]. Tuscany has a comprehensive and effective microbiological surveillance system, yet the increase in NDM-CRE cases was detected with some delay.…”

“…NDM-CRE are able to hydrolyse almost all beta-lactams and are not inhibited by currently available beta-lactamase inhibitors, including the new ones avibactam and vaborbactam [4]. NDM-CRE were first described in 2008 in Sweden and subsequently reported across Europe [1,5], resulting in growing concern for these pathogens to become endemic in the region [6,7]. In Italy, a country where CRE are reported at endemic level [8], NDM-CRE were first detected in 2009 [9,10] and sporadic, often travel-related, cases have been recorded since [5].…”

Characteristics of Carbapenem-Resistant and Colistin-Resistant Escherichia coli Co-Producing NDM-1 and MCR-1 from Pig Farms in China

“…Plasmid prediction using whole genome sequences identified several putative types of plasmids harbored by the eight strains (Figure 4). Among these putative types of plasmids, IncHI2A, IncFIB(K), IncFII, IncFI1, IncR, IncHI2, and IncFIA plasmids carrying bla NDM-1 have been reported [33,34,35,36,37], while IncX4, IncFIB(K), IncFII, IncFI1, IncY, IncHI2, IncX1, and IncFIA plasmids carrying mcr-1 have been reported [38,39,40,41,42]. Although more accurate and reliable technologies such as the third-generation sequencing technologies are necessary for determining the accurate type and sequence of the plasmids, bioinformatical analysis using whole genome sequences revealed that an IncFII-type plasmid homologous to pHNEC55 (GenBank accession: KT879914) likely carried the bla NDM-1 gene, and an IncX4-type plasmid homologous to pIBMC_mcr1 (GenBank accession: MF449287) likely carried the mcr-1 gene, as the backbones of both plasmids were found in the genomes of the eight strains (Figure 5).…”

Characterization of bla NDM-5-harbouring Klebsiella pneumoniae sequence type 11 international high-risk clones isolated from clinical samples in Yangon General Hospital, a tertiary-care hospital in Myanmar

“…In recent years, ST 11 clones harbouring carbapenemase genes have been reported from countries around the world, especially PR China [3]. A K. pneumoniae ST11 strain harbouring bla NDM-1 had become predominant among CPE isolated in Poland [6]. Herein, we report the first identification of bla NDM-5 -harbouring K. pneumoniae ST11 isolates in clinical specimens from patients at Yangon General Hospital in Yangon, Myanmar.…”