Multiple NDM-5-Expressing Escherichia Coli Isolates From an Immunocompromised Pediatric Host

Abstract

Background Genes conferring carbapenem resistance have disseminated worldwide among Gram-negative bacteria. Here we present longitudinal changes in clinically obtained Escherichia coli isolates from 1 immunocompromised pediatric patient. This report demonstrates potential for antibiotic resistance genes and plasmids to emerge over time in clinical isolates from patients receiving intensive anticancer chemotherapy and broad-spectrum antibiotics. Methods Thirty-three isolates obtained over 7 months from 1 patient were included. Clinical data were abstracted from the medical record. For each isolate, studies included phenotypic antibacterial resistance patterns, sequence typing, bacterial isolate sequencing, plasmid identification, and antibiotic resistance gene identification. Results Sites of isolation included blood, wound culture, and culture for surveillance purposes from the perianal area. Isolates were of 5 sequence types (STs). All were resistant to multiple classes of antibiotics; 23 (69.6%) were phenotypically resistant to all carbapenems. The blaNDM-5 gene was identified in 22 (67%) isolates, all of ST-167 and ST-940, and appeared to coincide with the presence of the IncFII and IncX3 plasmid. Conclusions We present unique microbiologic data from 33 multidrug-resistant E. coli isolates obtained over the course of 7 months from an individual patient in the United States. Two E. coli sequence types causing invasive infection in the same patient and harboring the blaNDM-5 gene, encoded on the IncX3 plasmid and the IncFII plasmid, were identified. This study highlights the emergence of multidrug-resistant bacteria on antibiotic therapy and the necessity of adequate neutrophil number and function in the clearance of bacteremia.

High Colonization Rate and Heterogeneity of ESBL- and Carbapenemase-Producing Enterobacteriaceae Isolated from Gull Feces in Lisbon, Portugal

“…Although NDM producers have been recently detected in a single patient in Lisbon [ 18 ], no bla NDM-1 was found in gulls in our study, suggesting its still low diffusion rate. While ST940 was the predominant E. coli background identified from gulls in our study, this ST had not been identified in Portugal before and, to the best of our knowledge, has been exclusively identified among NDM-5-producing E. coli isolates in the US [ 36 ]. By contrast, the K. pneumoniae ST17 background that has frequently been identified here is a clonal type frequently found among clinical isolates recovered from Portuguese patients [ 24 ].…”

Co-Occurrence of NDM-5 and RmtB in a Clinical Isolate of Escherichia coli Belonging to CC354 in Latin America

“…In contrast to NDM-1 that is widely spread among several Enterobacterales and other Gram-negative bacilli, NDM-5 seems to be more restricted to Escherichia coli isolates ( Wu et al., 2019 ), as it was the first to be reported from a patient in the United Kingdom after previous hospitalization in India ( Hornsey et al., 2011 ). In the Americas, NDM-5 has been only described in clinical isolates in the USA ( Mediavilla et al., 2016 ; Flerlage et al., 2020 ) and, to the best of our knowledge; it has not been reported in human clinical samples in Latin America, so far. We are aware that the emergence of a novel variant in our geographical region could lead to the replacement or substitution of the prevailing carbapenemases present in the area.…”

Screening and Characterization of Multidrug-Resistant Enterobacterales among Hospitalized Patients in the African Archipelago of Cape Verde

“…To date, E. coli isolates belonging to ST940 have been sporadically reported. The first E. coli ST940 isolates reported harbored the bla NDM-5 gene, encoded on IncX3 and IncFII plasmids, and caused invasive infection in an immunocompromised pediatric patient hospitalized in 2014 in Lebanon and later transferred to the USA [ 17 ]. ST940 has been also found in Ghana, in E. coli carrying the bla OXA-181 gene localized on an IncFIC plasmid [ 18 ], and it has been recently reported as the predominant clone among uropathogenic E. coli isolates in India [ 19 ].…”