First case of NDM-1 producing Klebsiella pneumoniae in Caribbean islands

Sylvaine Bastian, Patrice Nordmann, Elodie Creton, Edith Malpote, Guillaume Thiery, Frederic Martino, Sebastien Breurec, Laurent Dortet
2015 International Journal of Infectious Diseases  
The metallo-b-lactamase (MBL) group of enzymes are carbapenemases that inactivate most of the b-lactam molecules except aztreonam, and are frequently associated with genes conferring resistance to several other classes of antibiotics. Among the MBLs, the New Delhi metallo-b-lactamase-1 (NDM-1) was first described in a Klebsiella pneumoniae isolate. 1 Initially, the spread of NDM-1 was mostly identified from the Indian sub-continent. 2 Since then, NDM-1 producers have been described worldwide. 2
more » ... Here, we report the emergence of a NDM-1 producing K. pneumoniae recovered from a patient hospitalized in Guadeloupe, French West Indies after its transfer from Cuba. In June 2014, a 67-year-old German traveler was hospitalized in La Havana, Cuba, for an ischemic cerebrovascular failure. On day 8, the patient developed a pneumonia that was empirically treated with ceftazidime, ciprofloxacin, and metronidazole. The clinical status of the patient worsened necessitating intubation and mechanical ventilation on day 11, and his transfer on day 15 to the intensive care unit of the University hospital of Pointe-à -Pitre, Guadeloupe, France. As recommended for the detection of carbapenemase producers, 3 a rectal swab was collected at admission, leading to the isolation of the multidrug resistant K. pneumoniae KHU strain. Antimicrobial drug susceptibilities were determined by the disk diffusion method and interpreted according to the Clinical Laboratory Standards Institute (CLSI) guidelines as updated in 2014. 4 The minimal inhibitory concentrations (MICs) were determined by using E-test (bioMé rieux, La Balme-les-Grottes, France) on Mueller-Hinton agar at 37 Objectives: Characterize a NDM-1 producing K. pneumoniae isolate recovered from a patient hospitalized in Guadeloupe, French West Indies, after its transfer from Cuba Methods: Antibiotic susceptibilities were determined by the disk diffusion method, and E-test. Carbapenemase production was assessed using the Carba NP test. Antibiotic resistance determinants and their surrounding structures were characterized by PCR mapping and DNA sequencing. Transfer of the blactam resistance marker was attempted by liquid mating-out assays Results: Here we reported the first NDM-1 producing enterobacterial isolate recovered from Caribbean islands. This K. pneumoniae isolate belongs to a new sequence type (ST1649). The bla NDM-1 gene together with the aacA4 gene were carried on a self conjugative IncR plasmid of c.a. 80 kb. Conclusion: This study describes the first identification of a NDM-1 producer in Caribbean islands. The uncommon incompatibility group of the bla NDM-1 carrying plasmid and the uncommon ST type of the K. pneumoniae strain suggest a possible local emergence of NDM producers.
doi:10.1016/j.ijid.2015.03.002 pmid:25747780 fatcat:crumttk24ne3pmlwpy43tvkypq