Co- #Infections of Two #Strains of #NDM-1 and #OXA-232 Co-producing #Klebsiella pneumoniae in a #Kidney #Transplant Patient (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Co-Infections of Two Strains of NDM-1 and OXA-232 Co-producing Klebsiella pneumoniae in a Kidney Transplant Patient

Deisy A. Contreras, Sean P. Fitzwater, Deepa D. Nanayakkara, Joanna Schaenman, Grace M. Aldrovandi, Omai B. Garner, Shangxin Yang

DOI: 10.1128/AAC.00948-19



We report here a fatal case of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in a renal transplant patient without travel history in the past year, from whom 2 genetically different CRKP (ST14 and ST2497) strains carrying the same plasmids and anti-microbial resistance genes including blaNDM-1, blaOXA-232, blaCTX-M-15, armA and tet(D) were isolated from blood and abdominal cavity. The isolates were susceptible to colistin, tigecycline, eravacycline and cefiderocol, which was used to treat the CRKP in combination with ceftazidime/avibactam and polymyxin B and resulted in bacterial clearance. Despite the aggressive treatment, the patient died of ischemic colitis and multi-organ failure.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; NDM1; Carbapenem; Klebsiella pneumoniae.



#Evolution of #Outbreak-Causing #Carbapenem-Resistant #Klebsiella pneumoniae ST258 at a Tertiary Care #Hospital over 8 Years (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

Evolution of Outbreak-Causing Carbapenem-Resistant Klebsiella pneumoniae ST258 at a Tertiary Care Hospital over 8 Years

Jane W. Marsh, Mustapha M. Mustapha, Marissa P. Griffith, Daniel R. Evans, Chinelo Ezeonwuka, A. William Pasculle, Kathleen A. Shutt, Alexander Sundermann, Ashley M. Ayres,Ryan K. Shields, Ahmed Babiker, Vaughn S. Cooper, Daria Van Tyne, Lee H. Harrison

Robert A. Bonomo, Editor

DOI: 10.1128/mBio.01945-19



Carbapenem-resistant Klebsiella pneumoniae (CRKP) strains belonging to sequence type 258 (ST258) are frequent causes of hospital-associated outbreaks and are a major contributor to the spread of carbapenemases. This genetic lineage emerged several decades ago and remains a major global health care challenge. In this study, genomic epidemiology was used to investigate the emergence, evolution, and persistence of ST258 carbapenem-resistant K. pneumoniae outbreak-causing lineages at a large tertiary care hospital over 8 years. A time-based phylogenetic analysis of 136 ST258 isolates demonstrated the succession of multiple genetically distinct ST258 sublineages over the 8-year period. Ongoing genomic surveillance identified the emergence and persistence of several distinct clonal ST258 populations. Patterns of multidrug resistance determinants and plasmid replicons were consistent with continued evolution and persistence of these populations. Five ST258 outbreaks were documented, including three that were caused by the same clonal lineage. Mutations in genes encoding effectors of biofilm production and iron acquisition were identified among persistent clones. Two emergent lineages bearing K. pneumoniae integrative conjugative element 10 (ICEKp10) and harboring yersiniabactin and colibactin virulence factors were identified. The results show how distinct ST258 subpopulations have evolved and persisted within the same hospital over nearly a decade.



The carbapenem class of antibiotics is invaluable for the treatment of selected multidrug-resistant Gram-negative pathogens. The continued transmission of carbapenem-resistant bacteria such as ST258 K. pneumoniae is of serious global public health concern, as treatment options for these infections are limited. This genomic epidemiologic investigation traced the natural history of ST258 K. pneumoniae in a single health care setting over nearly a decade. We found that distinct ST258 subpopulations have caused both device-associated and ward-associated outbreaks, and some of these populations remain endemic within our hospital to the present day. The finding of virulence determinants among emergent ST258 clones supports the idea of convergent evolution of drug-resistant and virulent CRKP strains and highlights the need for continued surveillance, prevention, and control efforts to address emergent and evolving ST258 populations in the health care setting.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Nosocomial outbreaks.


#Risk #Factors for #Carbapenem-Resistant #Pseudomonas aeruginosa, #Zhejiang Province, #China (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 10—October 2019 / Research

Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China

Yan-Yan Hu, Jun-Min Cao, Qing Yang, Shi Chen, Huo-Yang Lv, Hong-Wei Zhou, Zuowei Wu, and Rong Zhang

Author affiliations: Zhejiang University, Hangzhou, China (Y.-Y. Hu, Q. Yang, H.-W. Zhou, R. Zhang); Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou (J.-M. Cao, H.-Y. Lv); Hangzhou Third People’s Hospital, Hangzhou (S. Chen); Iowa State University, Ames, Iowa, USA (Z. Wu)



Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a public health concern worldwide, but comprehensive analysis of risk factors for CRPA remains limited in China. We conducted a retrospective observational study of carbapenem resistance in 71,880 P. aeruginosa isolates collected in Zhejiang Province during 2015–2017. We analyzed risk factors for CRPA, including the type of clinical specimen; the year, season, and region, in which it was collected; patient information, including age, whether they were an outpatient or inpatient, and whether inpatients were in the intensive care unit or general ward; and the level of hospital submitting isolates. We found CRPA was more prevalent among isolates from patients >60 years of age and in inpatients, especially in intensive care units. In addition, specimen types and seasons in which they were collected were associated with higher rates of CRPA. Our findings can help hospitals reduce the spread of P. aeruginosa and optimize antimicrobial drug use.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Pseudomonas aeruginosa; Zhejiang; China.


Activity of #imipenem / #relebactam against #carbapenemase-producing #Enterobacteriaceae with high #colistin resistance (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Activity of imipenem/relebactam against carbapenemase-producing Enterobacteriaceae with high colistin resistance

Jessica Carpenter, Nick Neidig, Alex Campbell, Tanner Thornsberry, Taylor Truex,Tiffany Fortney, Yunliang Zhang, Karen Bush

Journal of Antimicrobial Chemotherapy, dkz354,

Published: 20 August 2019




Imipenem/relebactam, an investigational β-lactam/β-lactamase inhibitor combination for treatment of Gram-negative infections, and comparators including ceftazidime/avibactam, piperacillin/tazobactam and colistin were tested for activity against representative carbapenemase-producing Enterobacteriaceae (CPE) isolates.


MICs of the antimicrobial agents were determined using standard broth microdilution methodology for CPE isolates collected from Indiana patients, primarily during the time frame of 2013–17 (n = 199 of a total of 200 isolates). Inhibitors were tested at 4 mg/L in all combinations.


Of the CPE in the study, 199 produced plasmid-encoded KPC class A carbapenemases; 1 Serratia marcescens isolate produced the SME-1 chromosomal class A carbapenemase. MIC50/MIC90 values of imipenem/relebactam were ≤0.25/0.5 mg/L, whereas MIC50/MIC90 values of ceftazidime/avibactam were 1/2 mg/L. Resistance to colistin was observed in 54% (n = 97) of 180 non-Serratia isolates tested (MIC50 of 4 mg/L). Colistin resistance mechanisms included production of a plasmid-encoded mcr-1-like gene (n = 2) or an inactivated mgrB gene.


Imipenem/relebactam was the most potent agent tested against CPE in this study and may be a useful addition to the antimicrobial armamentarium to treat infections caused by these pathogens.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email:

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Colistin; MCR1; Enterobacteriaceae; Imipenem; Relebactam.


Spread of #NDM-5 and #OXA-181 #carbapenemase-producing #Escherichia coli in #Chad (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Spread of NDM-5 and OXA-181 carbapenemase-producing Escherichia coli in Chad

Oumar Ouchar Mahamat, Manon Lounnas, Mallorie Hide, Abelsalam Tidjani, Julio Benavides, Abibatou Diack, Calèbe Somasse, Kadidja Gamougam, Christian Carrière, Dominique Decré,Anne-Laure Bañuls, Hélène Jean-Pierre, Yann Dumont, Fabrice Compain, Sylvain Godreuil

DOI: 10.1128/AAC.00646-19



We detected for the first time blaNDM-5 and blaOXA-181 in E. coli isolates from hospitalized patients and healthy volunteers in Chad. These resistance genes were located on IncX3 and IncF plasmids. Despite E. coli clone large diversity, the identified resistant intestinal isolates belonged mainly to the same sequence type.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; E. Coli; NDM5; Chad.


#Protein #determinants of #dissemination and host specificity of metallo- #betalactamases (Nat Commun., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Nat Commun. 2019 Aug 9;10(1):3617. doi: 10.1038/s41467-019-11615-w.

Protein determinants of dissemination and host specificity of metallo-β-lactamases.

López C1, Ayala JA2, Bonomo RA3,4,5, González LJ6,7, Vila AJ8,9,10.

Author information: 1 Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), S2000EZP, Rosario, Argentina. 2 Centro de Biología Molecular Severo Ochoa, Agencia Estatal Consejo Superior de Investigaciones Científicas (CSIC-UAM), Campus de Cantoblanco, 28049, Madrid, Spain. 3 Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, 44106, USA. 4 Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA. 5 CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, 44106, USA. 6 Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), S2000EZP, Rosario, Argentina. 7 Área Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, S2002LRK, Rosario, Argentina. 8 Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), S2000EZP, Rosario, Argentina. 9 CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, 44106, USA. 10 Área Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, S2002LRK, Rosario, Argentina.



The worldwide dissemination of metallo-β-lactamases (MBLs), mediating resistance to carbapenem antibiotics, is a major public health problem. The extent of dissemination of MBLs such as VIM-2, SPM-1 and NDM among Gram-negative pathogens cannot be explained solely based on the associated mobile genetic elements or the resistance phenotype. Here, we report that MBL host range is determined by the impact of MBL expression on bacterial fitness. The signal peptide sequence of MBLs dictates their adaptability to each host. In uncommon hosts, inefficient processing of MBLs leads to accumulation of toxic intermediates that compromises bacterial growth. This fitness cost explains the exclusion of VIM-2 and SPM-1 from Escherichia coli and Acinetobacter baumannii, and their confinement to Pseudomonas aeruginosa. By contrast, NDMs are expressed without any apparent fitness cost in different bacteria, and are secreted into outer membrane vesicles. We propose that the successful dissemination and adaptation of MBLs to different bacterial hosts depend on protein determinants that enable host adaptability and carbapenem resistance.

PMID: 31399590 DOI: 10.1038/s41467-019-11615-w

Keywords: Antibiotics; Drugs Resistance; Carbapenem; NDM.


#Urban brown #rats (Rattus norvegicus) as possible #source of #MDR #Enterobacteriaceae and #MRSA, Vienna, #Austria, 2016 and 2017 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Urban brown rats (Rattus norvegicus) as possible source of multidrug-resistant Enterobacteriaceae and meticillin-resistant Staphylococcus spp., Vienna, Austria, 2016 and 2017

Amélie Desvars-Larrive1, Werner Ruppitsch2, Sarah Lepuschitz2, Michael P Szostak1, Joachim Spergser1, Andrea T Feßler3, Stefan Schwarz3, Stefan Monecke4,5,6, Ralf Ehricht4,6, Chris Walzer1,7, Igor Loncaric1

Affiliations: 1 University of Veterinary Medicine, Vienna, Austria; 2 Austrian Agency for Health and Food Safety, Vienna, Austria; 3 Freie Universität, Berlin, Germany; 4 Leibniz Institute of Photonic Technology (IPHT), Jena, Germany; 5 Technische Universität, Dresden, Germany; 6 InfectoGnostics Research Campus, Jena, Germany; 7 Wildlife Conservation Society, Bronx, New York, United States

Correspondence: Amélie Desvars-Larrive

Citation style for this article: Desvars-Larrive Amélie, Ruppitsch Werner, Lepuschitz Sarah, Szostak Michael P, Spergser Joachim, Feßler Andrea T, Schwarz Stefan, Monecke Stefan, Ehricht Ralf, Walzer Chris, Loncaric Igor. Urban brown rats (Rattus norvegicus) as possible source of multidrug-resistant Enterobacteriaceae and meticillin-resistant Staphylococcus spp., Vienna, Austria, 2016 and 2017. Euro Surveill. 2019;24(32):pii=1900149.

Received: 25 Feb 2019;   Accepted: 03 Jun 2019




Brown rats (Rattus norvegicus) are an important wildlife species in cities, where they live in close proximity to humans. However, few studies have investigated their role as reservoir of antimicrobial-resistant bacteria.


We intended to determine whether urban rats at two highly frequented sites in Vienna, Austria, carry extended-spectrum β-lactamase-producing Enterobacteriaceae, fluoroquinolone-resistant Enterobacteriaceae and meticillin-resistant (MR) Staphylococcus spp. (MRS).


We surveyed the presence of antimicrobial resistance in 62 urban brown rats captured in 2016 and 2017 in Vienna, Austria. Intestinal and nasopharyngeal samples were cultured on selective media. We characterised the isolates and their antimicrobial properties using microbiological and genetic methods including disk diffusion, microarray analysis, sequencing, and detection and characterisation of plasmids.


Eight multidrug-resistant Escherichia coli and two extensively drug-resistant New Delhi metallo-β-lactamases-1 (NDM-1)-producing Enterobacter xiangfangensis ST114 (En. cloacae complex) were isolated from nine of 62 rats. Nine Enterobacteriaceae isolates harboured the blaCTX-M gene and one carried a plasmid-encoded ampC gene (blaCMY-2). Forty-four MRS were isolated from 37 rats; they belonged to seven different staphylococcal species: S. fleurettii, S. sciuri, S. aureus, S. pseudintermedius, S. epidermidis, S. haemolyticus (all mecA-positive) and mecC-positive S. xylosus.


Our findings suggest that brown rats in cities are a potential source of multidrug-resistant bacteria, including carbapenem-resistant En. xiangfangensis ST114. Considering the increasing worldwide urbanisation, rodent control remains an important priority for health in modern cities.

© This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; MRSA; Enterobacteriaceae; Wildlife; Austria.