Abstract
We sought to determine the epidemiology of carbapenem-resistant Enterobacteriaceae and to investigate the emergence of carbapenem-resistant Klebsiella pneumoniae in two teaching hospitals in Manila, Philippines. We screened 364 Enterobacteriaceae for carbapenem resistance between 2012 and 2013 and detected four carbapenem-resistant K. pneumoniae isolates from three different patients. We used whole genome sequencing to determine the antibiotic resistance profiles and confirmed the presence of carbapenemase genes by multiplex PCR. We used multilocus sequence typing and PCR-based replicon typing to genetically characterize the carbapenem-resistant isolates. The carbapenemase gene blaNDM was detected in K. pneumoniae isolates from two patients. The first patient had ventilator-associated pneumonia and lumbar shunt infection from K. pneumoniae ST273 carrying blaNDM-7. The second patient had asymptomatic genitourinary colonization with K. pneumoniae ST656 carrying blaNDM-1. The third patient had a gluteal abscess with K. pneumoniae ST1 that did not carry a carbapenemase gene, but did carry blaDHA-1, blaOXA-1, and blaSHV-1. In this study, we report the first cases of blaNDM-carrying pathogens in the Philippines and add to the growing evidence of the worldwide spread of ST273 and NDM-7, a more efficient carbapenem hydrolyzer than NDM-1.
Highlights
New-Delhi metallo-beta-lactamase-1 (NDM-1) is the most recently described metallo-beta-lactamase and has emerged as a global health threat.[1]
During passive surveillance of antimicrobial resistance in two academic teaching hospitals, we identified the emergence of carbapenem-resistant K. pneumoniae and sought to determine which beta-lactamase and carbapenemase genes were present in these isolates
We report the detection of blaNDM-1 and blaNDM-7, which produces a more efficient carbapenem hydrolyzer than NDM-1, and the spread of K. pneumoniae ST273, a clone with outbreak and epidemic potential
Summary
New-Delhi metallo-beta-lactamase-1 (NDM-1) is the most recently described metallo-beta-lactamase and has emerged as a global health threat.[1]. NDM-1 is a global health threat because the gene encoding NDM-1, blaNDM-1, is found on more diverse mobile genetic elements than other metallobeta-lactamase genes.[2] Since first detected in 2008, NDM-1 has been reported on every continent except the Antarctica, the main reservoirs appear to be the Indian subcontinent, the Balkan region, and the Middle East.[3,4] NDM-1 has been sporadically detected in Southeast Asia, but never in the Philippines, where previous regional surveillance of carbapenemases detected IMP-26 only.[5,6] Of 24,684 isolates analyzed by the Philippines Department of Health, only 0.7% of Klebsiella were carbapenem resistant, carbapenemase gene testing was not reported.[7]. During passive surveillance of antimicrobial resistance in two academic teaching hospitals, we identified the emergence of carbapenem-resistant K. pneumoniae and sought to determine which beta-lactamase and carbapenemase genes were present in these isolates.
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