Jahan, Shah

Qamar, Muhammad Usman

Saleem, Sidrah

Toleman, Mark A.

Walsh, Timothy R.

Brazilian Journal of Microbiology

Muhammad Usman Qamar

Timothy R. Walsh

Mark A. Toleman

Sidrah Saleem

Shah Jahan

Crossref

First identification of clinical isolate of a Novel “NDM-4” producing Escherichia coli ST405 from urine sample in Pakistan

Online Research @ Cardiff

19/06/2018, 11*45First identification of clinical isolate of a Novel “NDM-4” producin…lic>Escherichia coli</ce:italic>ST405 from urine sample in PakistanPage 1 of 3https://reader.elsevier.com/reader/sd/0DB14D745FDDBCD49A96…E45F7ADF51691D431EA46D50D1269BD7003DA74D4E31F327BF24FCC907Please cite this article in press as: Qamar MU, et al. First identification of clinical isolate of a Novel “NDM-4” producing Escherichia coli ST405from urine sample in Pakistan. Braz J Microbiol. (2018), https://doi.org/10.1016/j.bjm.2018.02.009ARARTICLE IN PRESSTICLE IN PRESSBJM-390; No. of Pages 2b r azi l ia n j ou rn al of m i cr obi ol ogy xx x (2 01 8) xxx–xxxht tp : / /www.bjmicrobio l . com.br /Letter to the EditorFFirstirstidentificaidentificationtionofofclinicalclinicalisolaisolateteofofaaNoNovelvel“NDM-4”“NDM-4”prproducingoducingEscEschericherichiahiacolicoliST405ST405frfromomurineurinesamplesampleininPPakistanakistanDear Sir,New Delhi metallo- -lactamase␤ producing Enterobacteriaceaeare a serious threat to the public health sectors world-wide. NDM producing pathogens generally display resistanceagainst several different classes of antibiotics including car-bapenems; considered last resort to treat infections causedby such pathogens.1,2 Until now 19 NDM variants (NDM-1 toNDM-19) have been identified from different parts of the worldhttp://www.lahey.org/Studies/other.asp . NDM-4 differs fromNDM-1 by a single point mutation at position 154 (M–L) andis associated with high carbapenemase activity.3 We are firsttime reporting the description of NDM-4 producing Escherichiacoli isolated from urine sample in Pakistan.A 4-year-old female patient was hospitalized in a tertiarycare hospital Lahore, Pakistan in March 2014. After admis-sion, her urine culture revealed the presence of E. coli whichwas confirmed by VITEK®2 system (bioMerieux, France)and MALDI-TOF (Bruker, Germany). Isolate was also car-bapenemase and metallo- -lactamase␤ producer identifiedby modified Hodge’s test and double disk synergy methodrespectively.4 Minimum inhibitory concentration ( g/mL)␮of antibiotics using GN XN05 card in VITEK®2 compactsystem (bioMerieux, France) displayed pan-drug resistanceto commonly used antibiotics including meropenem andonly effective drug was colistin. Furthermore, colistinsusceptibility was determined by broth microdilution assayTable 1 – MIC ( g/mL)␮ of NDM-4 producing Escherichia coli.Isolates SAM PIP CXM CXA CFM CRO FEP ATM MEM LEV MXF MNO TE TMP C TGC CSNDM-4producing E. coli≥32 ≥128 ≥64 ≥64 ≥4 ≥64 ≥64 ≥64 ≥16 ≥8 ≥8 ≥16 ≥16 ≥16 ≥64 4 1SAM: ampicillin/sulbactam, PIP: piperacillin, CXM: cefuroxime, CXA: cefuroxime axetil, CFM: cefixime, CRO: ceftriaxone, FEP: cefepime, ATM:aztreonam, MEM: meropenem, LEV: levofloxacin, MXF: moxifloxacin, MNO: minocycline, TE: tetracycline, TMP: trimethoprim, C: chlorampheni-col, TGC: tigecycline, CS: colistin.in 96 microtiter Plate5 (Table 1). A previous study reportedthat NDM-4 producing bacteria has higher MIC ( g/mL)␮and hydrolytic activity as compared to NDM-1 producingbacteria.3 Genotyping of blaNDM-4 was accomplished by PCR(NDM-F-TGGCTTTTGAAACTGTCGCACC, NDM-R- CTGTCA-CATCGAAATCGCGCGA) and DNA sequence analysis. Plasmidcharacterization was performed as previously reported.4 S1nuclease pulse field gel electrophoresis and in gel DNAhybridization revealed the presence of blaNDM-4 on 120 kb ofplasmid (data not shown). As per Carratoli6 procedure of plas-mid typing, the isolate contained the Incompatible FII group ofplasmids. Multilocus sequence typing (MLST) was performedas described earlier and E. coli belonged to the sequence type(ST) 405.7 ST405 NDM producing E. coli has also been isolatedfrom two inpatients in Italy.8 It is documented that the Indiansub-continent is the main reservoir and source of NDM pro-ducing bacteria globally. Present study also supported this factin that the patient had no previous travel history. Moreover,NDM-4 producing E. coli has also been reported from differentparts of the world including India and Italy.3,8 This study indi-cates, the emergence of NDM-4 producing E. coli ST405 whichcan lead to therapeutic failure and deaths particularly in chil-dren. This isolate could be transferred through risk factorssuch as bed sharing, substandard infection control practicesand most importantly urinary catheters.The blaNDM containing IncFII plasmids might have becomethe common vehicle for the spread of various NDM alleles19/06/2018, 11*45First identification of clinical isolate of a Novel “NDM-4” producin…lic>Escherichia coli</ce:italic>ST405 from urine sample in PakistanPage 2 of 3https://reader.elsevier.com/reader/sd/0DB14D745FDDBCD49A96…E45F7ADF51691D431EA46D50D1269BD7003DA74D4E31F327BF24FCC907from urine sample in Pakistan. Braz J Microbiol. (2018), https://doi.org/10.1016/j.bjm.2018.02.009ARARTICLE IN PRESSTICLE IN PRESSBJM-390; No. of Pages 22 b ra zil ian jo u rna l o f m i crob i ol og y xxx (20 18) xxx–xxxamong Enterobacteriaceae. Furthermore, they could also play arelevant rolein the spread of such strains and other resistancegenes, especially if the isolate is present as part of the dom-inant microbiota and the hygienic conditions are suboptimalparticularly in low-resource settings.Nucleotide sequence accession number: The nucleotidesequence of blaNDM-4 producing E. coli strain has beendeposited in the BankIt/GenBank/NCBI data base under acces-sion number KY912035.FundingWe are thankful to Higher Education Commission (HEC),Pakistan for approving research grant (Number: 20-3742/NRPU/R&D/HEC/14/430) and International ResearchSupport Initiative Program (IRSIP) fellowship for School ofMedicine, Cardiff University, Cardiff, United Kingdom.Conflicts of interestAll authors declared that there is no conflict of interest.ref er e nc e s1. Yong D, Toleman M, Giske C, et al. Characterization of a newmetallo-beta-lactamase gene, bla(NDM-1), and a novelerythromycin esterase gene carried on a unique geneticstructure in Klebsiella pneumoniae sequence type 14 from India.Antimicr Agents Chemother. 2009;53:5046–5054.2. Qamar M, Nahid F, Walsh T, Kamran R, Zahra R. Prevalenceand clinical burden of NDM-1 positive infections in pediatricand neonatal patients in Pakistan. Pediatr Infect Dis J.2015;34:452–454.3. Nordmann P, Boulanger A, Poirel L. NDM-4metallo-beta-lactamase with increased carbapenemaseactivity from Escherichia coli. Antimicrob Agents Chemother.2012;56:2184–2186.4. Qamar M, Saleem S, Toleman M, et al. In vitro and in vivoactivity of Manuka honey against NDM-1-producing Klebsiellapneumoniae ST11. Future Microbiol. 2018;13:13–26.5. Chew K, La M, Lina R, Teo J. Colistin and polymyxin Bsusceptibility testing for carbapenem-resistant andmcr-positive Enterobacteriaceae: comparison of Sensititre,Microscan, Vitek 2, and Etest with broth microdilution. J ClinMicrobiol. 2017;55:2609–2616.6. Carattoli A. Resistance plasmid families in enterobacteriaceae.Antimicrob Agents Chemother. 2009;53:2227–2238.7. Liu X, Thungrat K, Boothe D. Multilocus sequence typing andvirulence profiles in uropathogenic Escherichia coli isolatedfrom cats in the united states. PLOS ONE. 2015;10:e0143335.8. Coppo E, Del Bono V, Ventura F, et al. Identification of a NewDelhi metallo- -lactamase-4␤ (NDM-4)-producingEscherichia coli in Italy. BMC Microbiol. 2014;14:148.Associate Editor: Afonso BarthMuhammad Usman Qamar a b c, , ,∗, Timothy R. Walshc,Mark A. Toleman c, Sidrah Saleema , Shah Jahanda University of Health Sciences, Department of Microbiology,Lahore, Pakistanb Government College University, Faculty of Life Sciences,Department of Microbiology, Faisalabad, Pakistanc Cardiff University, Department of Infection and Immunity, Schoolof Medicine, Cardiff, United Kingdomd University of Health Sciences, Department of Immunology, Lahore,Pakistan∗Corresponding author.E-mails: usman9785@gmail.com, musmanqamar@gcuf.edu.pk(M.U. Qamar).1517-8382/© 2018 Sociedade Brasileira de Microbiologia. Published byElsevier Editora Ltda. This is an open access article under theCC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).https://doi.org/10.1016/j.bjm.2018.02.009Available online xxx19/06/2018, 11*45First identification of clinical isolate of a Novel “NDM-4” producin…lic>Escherichia coli</ce:italic>ST405 from urine sample in PakistanPage 3 of 3https://reader.elsevier.com/reader/sd/0DB14D745FDDBCD49A96…E45F7ADF51691D431EA46D50D1269BD7003DA74D4E31F327BF24FCC907Please cite this article in press as: Qamar MU, et al. First identification of clinical isolate of a Novel “NDM-4” producing Escherichia coli ST405from urine sample in Pakistan. BrazJ Microbiol. (2018), https://doi.org/10.1016/j.bjm.2018.02.009

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First identification of clinical isolate of a Novel “NDM-4” producing Escherichia coli ST405 from urine sample in Pakistan

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