Abstract
Providencia rettgeri is a nosocomial pathogen associated with urinary tract infections related to hospital-acquired Infections. In recent years, P. rettgeri clinical strains producing New Delhi Metallo-β-lactamase (NDM) and other β-lactamase which reduce the efficiency of antimicrobial therapy have been reported. However, there are few reports of P. rettgeri co-producing two metallo-β-lactamases in one isolate. Here, we first reported a P. rettgeri strain (P138) co-harboring bla NDM-1, bla VIM-1, and bla OXA-10. The specie were identified using MALDI-TOF MS. The results of antimicrobial susceptibility testing by broth microdilution method indicated that P. rettgeri P138 was resistant to meropenem (MIC = 64μg/ml), imipenem (MIC = 64μg/ml), and aztreonam (MIC = 32μg/ml). Conjugation experiments revealed that the bla NDM-1-carrying plasmid was transferrable. The carbapenemase genes were detected using PCR and confirmed by PCR-based sequencing. The complete genomic sequence of the P. rettgeri was identified using Illumina (Illumina, San Diego, CA, USA) short-read sequencing (150bp paired-end reads), and many common resistance genes had been identified, including bla NDM-1, bla VIM-1, bla OXA-10, aac(6’)-Il, aadA5, ant(2’’)-Ia, aadA1, aac(6’)-Ib3, aadA1, aph(3’)-Ia, aac(6’)-Ib-cr, qnrD1, qnrA1, and catA2. The bla NDM-1 gene was characterized by the following structure: IS110–TnpA–IntI1–aadB–IS91–GroEL–GroES–DsbD–PAI–ble–bla NDM-1–IS91–QnrS1–IS110. Blast comparison revealed that the bla NDM-1 gene structure shared >99% similarity with plasmid p5_SCLZS62 (99% nucleotide identity and query coverage). In summary, we isolated a P. rettgeri strain coproducing bla NDM-1, bla VIM-1, and blaOXA-10. To the best of our acknowledge, this was first reported in the world. The occurrence of the strain needs to be closely monitored.
Highlights
Providencia rettgeri is an opportunistic human pathogen, unlike other Enterobacterales, it is a little-known pathogen, which is mainly associated with hospital-acquired infections including catheter-related urinary tract infections, bacteremia, meningitis, diarrhea, and eye infections (Yoh et al, 2005; Tada et al, 2014)
The P. rettgeri strain P138 was isolated from a 51-year-old female patient that was admitted to a public hospital for the treatment of cervical cancer in 2019 in Sichuan Province in the southwest of China
On the ninth day after the operation, the patient developed a fever, an E. coli and the P. rettgeri strain P138 were isolated from urine culture, therapeutic regimen switched to levofloxacin (0.5g QD) and ceftizoxime (2g Q12h) for 2 days
Summary
Providencia rettgeri is an opportunistic human pathogen, unlike other Enterobacterales, it is a little-known pathogen, which is mainly associated with hospital-acquired infections including catheter-related urinary tract infections, bacteremia, meningitis, diarrhea, and eye infections (Yoh et al, 2005; Tada et al, 2014). Treatment of these infections is challenging, as they are intrinsically resistant to multiple antibiotics including first-generation cephalosporins, amoxicillin-clavulanic acid, nitrofurantoin, tigecycline, and polymyxins. We report the co-existence of the carbapenemase genes blaNDM-1, blaVIM-1, and blaOXA-10 in a P. rettgeri clinical isolate in China
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