Emergence of NDM-1-producing Klebsiella pneumoniae in Guatemala

FERNANDO PASTERAN; EZEQUIEL ALBORNOZ; DIEGO FACCONE; GÓMEZ, SONIA ALEJANDRA; CLAUDIA VALENZUELA; MELISSA MORALES; PAVELA ESTRADA; LAURA VALENZUELA; JORGE MATHEU; LEONOR GUERRIERO; ENRIQUE ARBIZU; YERALDINE CALDERON; PILAR RAMON-PARDO; ALEJANDRA CORSO

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY

OXFORD UNIV PRESS

Lugar: Oxford; Año: 2012 vol. 67 p. 1291 - 1293

0305-7453

In June 2010, a regional protocol for the detection of carbapenemases was harmonized and implemented through ReLAVRA. From January 2011 to February 2011, the Health National Laboratory from Guatemala confirmed an MBL phenotype in two K. pneumoniae isolates. The strains were submitted to the regional reference laboratory (Servicio Antimicrobianos, INEI-ANLIS ?Dr. Carlos G. Malbra´ n?) for further characterization. Antimicrobial drug susceptibility testing was performed using Sensititre panels (Trek Diagnostic Systems, Cleveland, OH, USA).PCR, sequencing, PFGE was performed with XbaI digested DNA, multilocus sequence typing, sequencing and biparental conjugation were done under standard procedures. Both strains showed identical resistance profiles, and remained susceptible to amikacin, nalidixic acid, levofloxacin and, according to EUCAST standards, to tigecycline, colistin and fosfomycin. PCR screening followed by DNA sequencing detected the presence of blaNDM-1, blaCTX-M-15, blaSHV-11, blaSHV-12, blaTEM-1 and blaOXA-1, as well as qnrB1 and aac(6′)-Ib-cr. PFGE analysis showed a similar profile for both isolates (two bands of difference). The clonal relationship was further assessed by multilocus sequence typing, which showed that both K. pneumoniae isolates belonged to sequence type (ST) 17). Transconjugants from both clinical isolates were obtained with E. coli J53 as the recipient strain under cefoxitin (10 mg/L) and azide (200 mg/L). The transfer of NDM-1 was associated with plasmids that gave negative results for all the Inc groups when assessed by PCR replicon typing. Given this situation, in November 2011, PAHO issued a regional alert, to strengthen the Latin American surveillance of carbapenemase producers and to highlight the importance of microbiological detection of NDM carbapenemase.