First report of a blaNDM-producing extensively drug resistant Klebsiella pneumoniae ST437 in Italy

• Published in: Frontiers in cellular and infection microbiology Vol. 14
• Main Authors: Ranieri, Sofia Chiatamone, Fabbrizi, Vittoria, D’ Amario, Ada Maria, Frascella, Maria Giuseppina, Di Biase, Valeria, Di Francesco, Cinzia, Di Sante, Stefania, De Berardis, Luigino, De Martinis, Massimo, Partenza, Massimo, Chiaverini, Alexandra, Centorotola, Gabriella, Cammà, Cesare, Pomilio, Francesco, Cornacchia, Alessandra
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 11-09-2024
• Subjects: carbapenemase-producing pathogen; ceftazidime/avibactam; Klebsiella pneumoniae; New Delhi metallo-β-lactamase; whole genome sequencing (WGS)
• ISSN: 2235-2988; 2235-2988
• DOI: 10.3389/fcimb.2024.1426817

Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) have recently been observed to spread rapidly worldwide. New Delhi metallo-β-lactamase (NDM) producing clones of Klebsiella pneumoniae (K. pneumoniae) cause a significant healthcare burden, particularly in Indian sub-continent, where this clone is circulating widely. However, in Italy, data on the incidence of these new clones is limited, and an ST437 NDM-producing K. pneumoniae strain has not been reported to date. A sacral ulcer infection caused by a K. pneumoniae strain was identified in an 85-year-old Italian male patient with several comorbidities. Antimicrobial susceptibility testing revealed an extensive resistance to a wide range of antimicrobials, including novel agents such as cefiderocol and ceftazidime/avibactam. Genomic analysis identified the pathogen as an ST437 K. pneumoniae strain harboring bla NDM-5 , bla OXA-232 and bla CTX-M-15 genes. Following the identification of this first case, several infection control measures were implemented in healthcare settings, including direct precautions and reinforcement of standard cross-transmission control measures. The emergence of pathogenic microbial clones carrying new genetic determinants, particularly in a little city, requires prompt diagnosis and therapeutic protocols. An effective infection control system for the early detection and/or control of the transmission of NDM-producing Enterobacteriaceae is also needed. Further investigations are required to better understand the potential transmission routes and evolution of these clones.