First detection of autochthonous extensively drug-resistant NDM-1 Pseudomonas aeruginosa ST235 from a patient with bloodstream infection in Italy, October 2019

• Published in: Antimicrobial resistance & infection control 2020-05, Vol.9 (1), p.73-73, Article 73
• Main Authors: Loconsole, Daniela, Accogli, Marisa, Monaco, Monica, Del Grosso, Maria, De Robertis, Anna Lisa, Morea, Anna, Capozzi, Loredana, Del Sambro, Laura, Simone, Annarosa, De Letteriis, Vincenzo, Quarto, Michele, Parisi, Antonio, Chironna, Maria
• Format: Article
• Language: English
• Subjects: Aged; Antibiotic resistance; Antibiotics; Antimicrobial agents; Avibactam; Bacteria; Beta lactamases; beta-Lactamases - metabolism; Case Report; Case reports; Cell division; Cloning; Disease control; DNA sequencing; Drug resistance; Drug Resistance, Multiple, Bacterial; Epidemiology; Extensively-drug resistant; Fatal Outcome; Female; Genes; Genomes; Genomics; Health aspects; Health care; Health Services for the Aged; Humans; Infections; Italy; lactamase; Microbial drug resistance; Mortality; New Delhi metallo beta; Pathogens; Patients; Pseudomonas aeruginosa; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - isolation & purification; Pseudomonas aeruginosa - metabolism; Pseudomonas Infections - diagnosis; Sepsis; Sepsis - microbiology; Surveillance; Tazobactam; Urine; Virulence; Virulence (Microbiology); Whole-genome sequencing, ST235, sepsis
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-020-00734-5

Pseudomonas aeruginosa (PA) is one of the most common and serious causes of healthcare-associated bacteremia. The emergence and dissemination of multidrug-resistant (MDR) and extensively drug-resistant (XDR) PA strains pose a major clinical concern. ST235-PA is a high-risk clone which shows a high capacity to acquire antibiotic resistance. Here we describe the first autochthonous New Delhi metallo-β-lactamase (NDM)-producing Pseudomonas aeruginosa ST235 identified in Italy. In October 2019, a patient residing in an elderly health care and rehabilitation facility, was hospitalized and died from sepsis caused by an XDR-PA. The strain belonged to the high-risk clone sequence type ST235. Whole genome sequencing (WGS) revealed the presence of genes encoding NDM-1 and multiple β-lactamases, many clinically significant multidrug efflux pump complexes and also the virulence gene ExoU, which is associated with a high cytotoxic phenotype. Few strains of NDM-1-PA have been identified worldwide, all belonging to ST235. The combination of ST235 and ExoU is a predictor of highly unfavorable prognosis. The potential spread of these high-risk clones in healthcare settings is worrisome because treatment options are limited. Early identification of high-risk clones could help in outbreaks investigation and infections control.