Emergence of NDM-1-producing Acinetobacter pittiiinBrazil
Sir,
TheNewDelhimetallo--lactamase(NDM),initiallyreported inKlebsiellapneumoniaeandEscherichiacoli,isnowdisseminated worldwidemostlyamong Enterobacteriaceae[1].TheNDM car-bapenemasehasalsobeendescribedinAcinetobacterbaumannii, butonlyinsporadiccasesincountriessuchasChina,India,Egypt, Germany,Israeland,morerecently,Brazil[1,2].Noteworthy,recent studiesreportedNDM-producersamongnon-baumannii Acineto-bacterspp.,whichmayalsobehumanpathogens.Herewereport thefirstcaseofNDM-1-producingAcinetobacterpittiiinBrazil.
A66-year-oldmalepatientwithbladdercarcinomawas admit-tedforradicalcystectomytoa900-bedtertiarycarehospitalin PortoAlegre,SouthernBrazil,on25February2013.Fifteendays laterhepresentedanintestinalsubocclusionandfever. Compu-terisedtomography(CT)oftheabdomenshowedthepresenceof a collectionin pelvis, which wasdrained surgically.This puru-lent secretionwascultured anda K.pneumoniaewasidentified (VITEK® 2 system; bioMérieux, La Balme-les-Grottes, France). Urine was also cultured and revealed the presence of Candida sp.(50000CFU/mL)andAcinetobactersp.(>100000CFU/mL).The patientwastreatedwithintravenousmeropenem500mgevery 12h for 7 days, followed by cefepime 1g every 24h (doses adjustedtoimpairedrenalfunction).Threesubsequenturine cul-tures obtained 11, 28 and 44 days after the first culturewere negativeforAcinetobactersp.Thepatientwasthereforeconsidered colonisedbyAcinetobactersp.After90daysthepatientimproved andwasdischargedfromthehospital.
TheAcinetobactersp.isolateMPwasidentifiedasA. pittiiby matrix-assistedlaserdesorption/ionisationtime-of-flight (MALDI-TOF)(BrukerDaltonik,Bremen,Germany),gyrBmultiplexPCRand 16SrRNA genesequencing.Minimum inhibitoryconcentrations (MICs)of-lactams,aminoglycosides,ciprofloxacin, fosfomycin, chloramphenicol, tigecycline, colistin and polymyxin B were determined (Etest® and microdilution method) and showed thattheisolatewasresistant toall-lactams(with the excep-tionof aztreonam),including carbapenems(MICs of imipenem, ertapenem,doripenemandmeropenem>32g/mL).The isolate
remainedsusceptibletoamikacin,gentamicin,tigecycline,colistin, polymyxinB,ciprofloxacinandchloramphenicol.Carbapenemase genesweresearched byreal-timePCR (blaOXA-48, blaKPC,blaIMP, blaVIMandblaGES)andmultiplexPCR(blaOXA-23-like,blaOXA-40-like, blaOXA-58-likeandblaOXA-143).Apositivesignalwasobtainedonly fortheblaNDMgene,andsequencingidentifiedtheblaNDM-1gene. Toidentifythelocationofthisgene,electrotransformationassays wereattemptedusingplasmidDNAextractsfromA.pittiiisolate MPusingA. baumanniiCIP7010 andE.coliTOP10 asrecipients. TransferoftheblaNDM-1genebyelectrotransformationintothese tworecipientstrainsremainedunsuccessful,suggestingthatthe genemightbechromosomallylocatedinA.pittiiMP,asreported inA.baumannii[3].
ThegeneticenvironmentoftheblaNDM-1genewasdetermined byPCRmappingasdescribed[3]andinsertionsequenceISAba125 wasidentifiedupstreamoftheblaNDM-1gene.However,attempts to identify another copy of ISAba125 downstream of blaNDM-1 remainedunsuccessful,suggestingthattheblaNDM-1genemightbe partofatruncatedTn125transposon,aspreviouslyreportedinA. baumannii[3].Multilocussequencetyping(MLST)wasperformed accordingtotheInstitutePasteurscheme(http://www.pasteur.fr) and A. pittii isolate MP was identified as ST119. Interestingly, two blaNDM-positiveA. pittii isolateswererecently identifiedin Paraguay[4],aneighbouringcountryofBrazil,butthoseisolates belongedtoST320andST321.TheonlyreportsofA.pittiiST119 isolatesarefromJapan,withisolatesproducingthecarbapenemase IMP-19[1].
IdentificationofblaNDM-positivenon-baumanniiAcinetobacter spp.isnowincreasinglyreportedworldwide,concomitantlywith those of blaNDM-positive A. baumannii isolates. There are few reportsofNDM-producingA.pittii,beingfromChina,Turkeyand recentlyParaguay.Thisisofparticularconcernconsideringthat Acinetobacter sp. may (i) act as reservoirs for blaNDM genes in non-humansettings,asrecentlyshowninseveralChinesestudies withidentificationofNDM-1-producersamongAcinetobacter cal-coaceticusandAcinetobacterjuniifromenvironmentalsamplesfrom livestockfarms[1],Acinetobacterjohnsoniifromhospitalsewage
[1]andAcinetobacterlwoffiifromchickens[1],butalso(ii)actasa sourceofblaNDMgenesthenhorizontallytransferredto enterobac-terialspeciesasevidenced[5].
Funding:Thisworkwasfunded bytheCAPESFoundation, Min-istryofEducationofBrazil(Brasília,Brazil),bytheUniversityof Fribourg (Fribourg, Switzerland) and by grants from the Euro-peanCommunity[R-GNOSIS,FP7/HEALTH-F3-2011-282512,and MAGIC-BULLET,FP7/HEALTH-F3-2001-278232].
Competinginterests:Nonedeclared. Ethicalapproval:Notrequired.
Reference
[1]BonninRA,PoirelL,NordmannP.NewDelhimetallo--lactamase-producing
Acinetobacterbaumannii:anovelparadigmforspreadingantibioticresistance
genes.FutureMicrobiol2014;9:33–41.
[2]PillonettoM,ArendL,VesperoEC,PelissonM,ChagasTP,Carvalho-AssefAP,
etal.FirstreportofNDM-1-producingAcinetobacterbaumanniisequencetype
25inBrazil.AntimicrobAgentsChemother2014;58:7592–4.
[3]PoirelL,BonninRA,BoulangerA,SchrenzelJ,KaaseM,NordmannP.
Tn125-relatedacquisitionofblaNDM-likegenesinAcinetobacterbaumannii.Antimicrob
AgentsChemother2012;56:1087–9.
[4]PasteranF,MoraMM,AlbornozE,FacconeD,FrancoR,OrtelladoJ,etal.
Emer-genceofgeneticallyunrelatedNDM-1-producingAcinetobacterpittiistrainsin
Paraguay.JAntimicrobChemother2014;69:2575–8.
[5]PoirelL,BonninRA,NordmannP.Analysisoftheresistomeofa
multidrug-resistantNDM-1-producingEscherichiacolistrainbyhigh-throughputgenome
sequencing.AntimicrobAgentsChemother2011;55:4224–9.
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which should be cited to refer to this work.
MarianaPaganoa,b,c
aMedicalandMolecularMicrobiologyUnit‘EmergingAntibiotic Resistance’,DepartmentofMedicine,FacultyofScience,Universityof Fribourg,3rueAlbert-Gockel,CH-1700Fribourg,Switzerland bProgramadePósGraduac¸ãoemCiênciasFarmacêutica,Faculdade deFarmácia,UniversidadeFederaldoRioGrandedoSul(UFRGS), PortoAlegre,Brazil cLaboratóriodePesquisaemResistênciaBacteriana(LABRESIS), CentrodePesquisaExperimental,HospitaldeClínicasdePortoAlegre (HCPA),PortoAlegre,Brazil LaurentPoirel∗ MedicalandMolecularMicrobiologyUnit‘EmergingAntibiotic Resistance’,DepartmentofMedicine,FacultyofScience,Universityof Fribourg,3rueAlbert-Gockel,CH-1700Fribourg,Switzerland AndrezaFranciscoMartinsa,b
FrancieliP.Rozalesa,b
aProgramadePósGraduac¸ãoemCiênciasFarmacêutica,Faculdade deFarmácia,UniversidadeFederaldoRioGrandedoSul(UFRGS), PortoAlegre,Brazil bLaboratóriodePesquisaemResistênciaBacteriana(LABRESIS), CentrodePesquisaExperimental,HospitaldeClínicasdePortoAlegre (HCPA),PortoAlegre,Brazil AlexandrePrehnZavasckia,b
aProgramadePósGraduac¸ãoemCiênciasFarmacêutica,Faculdade deFarmácia,UniversidadeFederaldoRioGrandedoSul(UFRGS), PortoAlegre,Brazil bInfectiousDiseasesService,HospitaldeClínicasdePorto,Porto Alegre,Brazil AfonsoLuisBartha,b
aProgramadePósGraduac¸ãoemCiênciasFarmacêutica,Faculdade deFarmácia,UniversidadeFederaldoRioGrandedoSul(UFRGS), PortoAlegre,Brazil bLaboratóriodePesquisaemResistênciaBacteriana(LABRESIS), CentrodePesquisaExperimental,HospitaldeClínicasdePortoAlegre (HCPA),PortoAlegre,Brazil PatriceNordmanna,b
aMedicalandMolecularMicrobiologyUnit‘EmergingAntibiotic Resistance’,DepartmentofMedicine,FacultyofScience, UniversityofFribourg,3rueAlbert-Gockel,CH-1700Fribourg, Switzerland bHFR-HôpitalCantonaldeFribourg,Fribourg,Switzerland ∗Correspondingauthor.Tel.:+41263009582. E-mailaddress:laurent.poirel@unifr.ch(L.Poirel) 23December2014
http://dx.doi.org/10.1016/j.ijantimicag.2014.12.011
