Korean J healthc assoc Infect Control Prev.  2021 Dec;26(2):129-133. 10.14192/kjicp.2021.26.2.129.

Detection of NDM-1 Metallo-β-Lactamase Genes in Pseudomonas Aeruginosa from Clinical Surveillance Sample: A Case Report and Literature Review

• Chang J
• Kim S
• Kwak YG
• Um TH
• Cho CR
• Kang HK
• Song JE

• KMID: 2523611
• DOI: http://doi.org/10.14192/kjicp.2021.26.2.129

Abstract

Pseudomonas aeruginosa is an opportunistic pathogen that can be an important nosocomial pathogen. Herein, we report a case of NDM-1-carrying P. aeruginosa isolated from a clinical specimen in Korea. An 82-year-old man was transferred to our hospital because of aspiration pneumonia. Blood tests revealed leukocytosis and elevated C-reactive protein levels. The Xpert Carba-R assay was performed before admission, and the test result was positive for bla_NDM. After admission, cultures using rectal swabs were used for carbapenem-resistant Enterobacteriaceae surveillance, and carbapenem-resistant P. aeruginosa was grown. Repeat Xpert CarbaR assay and sequencing for bla_NDM detection in P. aeruginosa detected bla_NDM-1 . Therefore, the patient was treated with meropenem and transferred to a long-term care hospital. Experts working in the clinical microbiology departments should investigate multidrug resistance for other gram-negative bacteria not only for Enterobacteriaceae. For effective infection control in hospitals, it is essential to determine the presence of resistance genes in clinical isolates.

Keyword

Pseudomonas aeruginosa; Beta-lactamase NDM-1; Metallo-β-Lactamase

Reference

1. Theuretzbacher U. 2017; Global antimicrobial resistance in Gram-negative pathogens and clinical need. Curr Opin Microbiol. 39:106–12. DOI: 10.1016/j.mib.2017.10.028. PMID: 29154024.

2. Fitzpatrick MA. 2020; Real-world antibiotic needs for resistant Gram-negative infections. Lancet Infect Dis. 20:1108–9. DOI: 10.1016/S1473-3099(20)30178-X. PMID: 32505229.

3. Tomczyk S, Zanichelli V, Grayson ML, Twyman A, Abbas M, Pires D, et al. 2019; Control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in healthcare facilities: a systematic review and reanalysis of quasi-experimental studies. Clin Infect Dis. 68:873–84. DOI: 10.1093/cid/ciy752. PMID: 30475989. PMCID: PMC6389314.

4. Kim YA, Park YS. 2018; Epidemiology and treatment of antimicrobialresistant gram-negative bacteria in Korea. Korean J Intern Med. 33:247–55. DOI: 10.3904/kjim.2018.028. PMID: 29506343. PMCID: PMC5840603.

5. Moradali MF, Ghods S, Rehm BH. 2017; Pseudomonas aeruginosa lifestyle: a paradigm for adaptation, survival, and persistence. Front Cell Infect Microbiol. 7:39.

6. Yum JH. 2019; Prevalence and diversity of MBL gene-containing integrons in metallo-β-lactamase (MBL)-producing Pseudomonas spp. isolates disseminated in a Korean hospital. Biomed Sci Lett. 25:321–30.

7. Liu Y, Deng Q, Yu Y, Cao X, Xu Q, Wan L. 2014; [Analysis of the resistance mechanism and homology of carbapenems-resistant Pseudomonas aeruginosa]. Zhonghua Shao Shang Za Zhi. 30:15–20. Chinese. PMID: 24684984.

8. Jovcic B, Lepsanovic Z, Suljagic V, Rackov G, Begovic J, Topisirovic L, et al. 2011; Emergence of NDM-1 metallo-β-lactamase in Pseudomonas aeruginosa clinical isolates from Serbia. Antimicrob Agents Chemother. 55:3929–31. DOI: 10.1128/AAC.00226-11. PMID: 21646490. PMCID: PMC3147624.

9. Hong DJ, Bae IK, Jang IH, Jeong SH, Kang HK, Lee K. 2015; Epidemiology and characteristics of metallo-β-lactamase-producing Pseudomonas aeruginosa. Infect Chemother. 47:81–97. DOI: 10.3947/ic.2015.47.2.81. PMID: 26157586. PMCID: PMC4495280.

10. Ismail SJ, Mahmoud SS. 2018; First detection of New Delhi metallo-β-lactamases variants (NDM-1, NDM-2) among Pseudomonas aeruginosa isolated from Iraqi hospitals. Iran J Microbiol. 10:98–103. PMID: 29997749. PMCID: PMC6039455.

11. Alshara JM, Alsehlawi ZS, Aljameel DS, Al-Zubbedy ZS, Almohana AM. 2014; First report of New Delhi metallo-beta-lactamase (NDM-1) producing Pseudomonas aeruginosa in Iraq. J Biol Agric Healthc. 4:40–8.

12. Farajzadeh Sheikh A, Shahin M, Shokoohizadeh L, Ghanbari F, Solgi H, Shahcheraghi F. 2020; Emerge of NDM-1-producing multidrug-resistant Pseudomonas aeruginosa and co-harboring of carbapenemase genes in south of Iran. Iran J Public Health. 49:959–67. PMID: 32953684. PMCID: PMC7475625.

13. Vatansever C, Menekse S, Dogan O, Gucer LS, Ozer B, Ergonul O, et al. 2020; Co-existence of OXA-48 and NDM-1 in colistin resistant Pseudomonas aeruginosa ST235. Emerg Microbes Infect. 9:152–4. DOI: 10.1080/22221751.2020.1713025. PMID: 31964275. PMCID: PMC7006663.

14. Zafer MM, Amin M, El Mahallawy H, Ashour MS, Al Agamy M. 2014; First report of NDM-1-producing Pseudomonas aeruginosa in Egypt. Int J Infect Dis. 29:80–1. DOI: 10.1016/j.ijid.2014.07.008. PMID: 25449240.

15. Tafaj S, Gona F, Rodrigues CF, Kapisyzi P, Caushi F, Rossen JW, et al. 2020; Whole-genome sequences of two NDM-1-producing Pseudomonas aeruginosa strains isolated in a clinical setting in Albania in 2018. Microbiol Resour Announc. 9:e01291–19. DOI: 10.1128/MRA.01291-19. PMCID: PMC6940294.

16. Zhang F, Xie L, Wang X, Han L, Guo X, Ni Y, et al. 2016; Further spread of bla NDM-5 in Enterobacteriaceae via IncX3 plasmids in Shanghai, China. Front Microbiol. 7:424. DOI: 10.3389/fmicb.2016.00424. PMID: 27065982. PMCID: PMC4811927.

17. Paul D, Maurya AP, Chanda DD, Sharma GD, Chakravarty A, Bhattacharjee A. 2016; Carriage of blaNDM-1 in Pseudomonas aeruginosa through multiple Inc type plasmids in a tertiary referral hospital of northeast India. Indian J Med Res. 143:826–9. DOI: 10.4103/0971-5916.192079. PMID: 27748310. PMCID: PMC5094125.

18. Janvier F, Jeannot K, Tessé S, Robert-Nicoud M, Delacour H, Rapp C, et al. 2013; Molecular characterization of blaNDM-1 in a sequence type 235 Pseudomonas aeruginosa isolate from France. Antimicrob Agents Chemother. 57:3408–11. DOI: 10.1128/AAC.02334-12. PMID: 23612200. PMCID: PMC3697391.

19. Carattoli A, Fortini D, Galetti R, Garcia-Fernandez A, Nardi G, Orazi D, et al. 2013; Isolation of NDM-1-producing Pseudomonas aeruginosa sequence type ST235 from a stem cell transplant patient in Italy, May 2013. Euro Surveill. 18:20633. DOI: 10.2807/1560-7917.es2013.18.46.20633. PMID: 24256888.

20. Kulkova N, Babalova M, Sokolova J, Krcmery V. 2015; First report of New Delhi metallo-β-lactamase-1-producing strains in Slovakia. Microb Drug Resist. 21:117–20. DOI: 10.1089/mdr.2013.0162. PMID: 25343711.

21. Khajuria A, Praharaj AK, Kumar M, Grover N. 2013; Emergence of NDM - 1 in the clinical isolates of Pseudomonas aeruginosa in India. J Clin Diagn Res. 7:1328–31. DOI: 10.7860/JCDR/2013/5509.3137. PMID: 23998058. PMCID: PMC3749628.

22. Tada T, Hishinuma T, Watanabe S, Uchida H, Tohya M, Kuwahara-Arai K, et al. 2019; Molecular characterization of multidrug-resistant Pseudomonas aeruginosa isolates in hospitals in Myanmar. Antimicrob Agents Chemother. 63:e02397–18. DOI: 10.1128/AAC.02397-18. PMID: 30803967. PMCID: PMC6496111.

23. Tada T, Shimada K, Satou K, Hirano T, Pokhrel BM, Sherchand JB, et al. 2017; Pseudomonas aeruginosa clinical isolates in Nepal coproducing metallo-β-lactamases and 16S rRNA methyltransferases. Antimicrob Agents Chemother. 61:e00694–17. DOI: 10.1128/AAC.00694-17. PMID: 28696242. PMCID: PMC5571325.

24. Honda NH, Aoki K, Kamisasanuki T, Matsuda N, To M, Matsushima H, et al. 2019; Isolation of three distinct carbapenemase-producing Gram-negative bacteria from a Vietnamese medical tourist. J Infect Chemother. 25:811–5. DOI: 10.1016/j.jiac.2019.03.020. PMID: 30987949.

25. Tohya M, Tada T, Watanabe S, Kuwahara-Arai K, Zin KN, Zaw NN, et al. 2019; Emergence of carbapenem-resistant Pseudomonas asiatica producing NDM-1 and VIM-2 metallo-β-lactamases in Myanmar. Antimicrob Agents Chemother. 63:e00475–19. DOI: 10.1128/AAC.00475-19. PMID: 31138570. PMCID: PMC6658799.

26. Kateete DP, Nakanjako R, Namugenyi J, Erume J, Joloba ML, Najjuka CF. 2016; Carbapenem resistant Pseudomonas aeruginosa and Acinetobacter baumannii at Mulago Hospital in Kampala, Uganda (2007-2009). Springerplus. 5:1308. DOI: 10.1186/s40064-016-2986-7. PMID: 27547682. PMCID: PMC4978656.

27. Flateau C, Janvier F, Delacour H, Males S, Ficko C, Andriamanantena D, et al. 2012; Recurrent pyelonephritis due to NDM-1 metallo-beta-lactamase producing Pseudomonas aeruginosa in a patient returning from Serbia, France, 2012. Euro Surveill. 17:20311. PMID: 23153474.

28. Poirel L, Fortineau N, Nordmann P. 2011; International transfer of NDM-1-producing Klebsiella pneumoniae from Iraq to France. Antimicrob Agents Chemother. 55:1821–2. DOI: 10.1128/AAC.01761-10. PMID: 21245442. PMCID: PMC3067196.

29. Yoon EJ, Jeong SH. 2021; Mobile carbapenemase genes in Pseudomonas aeruginosa . Front Microbiol. 12:614058.

30. Hong JS, Song W, Park MJ, Jeong S, Lee N, Jeong SH. 2021; Molecular characterization of the first emerged NDM-1-producing Pseudomonas aeruginosa isolates in South Korea. Microb Drug Resist. 27:1063–70. DOI: 10.1089/mdr.2020.0374. PMID: 33332204.

31. Korea Disease Control. Infectious diesease portal. http://www.kdca.go.kr/npt/biz/npp/portal/nppLwcrIcdMain.do . Updated on 18 November 2021.

32. Wailan AM, Paterson DL. 2014; The spread and acquisition of NDM-1: a multifactorial problem. Expert Rev Anti Infect Ther. 12:91–115. DOI: 10.1586/14787210.2014.856756. PMID: 24308710.

33. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. 2018; Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 18:318–27. DOI: 10.1016/S1473-3099(17)30753-3. PMID: 29276051.

34. Wang W, Wang X. 2020; Prevalence of metallo-β-lactamase genes among Pseudomonas aeruginosa isolated from various clinical samples in China. J Lab Med. 44:197–203.