The following is a summary of “Tracing the origin of NDM-1-producing and extensively drug-resistant Pseudomonas aeruginosa ST357 in the Netherlands,” published in the August 2024 issue of Infectious Disease by Rossel et al.
Carbapenemase-producing Pseudomonas aeruginosa (CPPA) is a deadly hospital pathogen with often unclear transmission pathways.
Researchers conducted a retrospective study in 2023 to investigate the origin of CPPA ST357, which caused hospital-acquired pneumonia in a repatriated Guillain-Barré patient.
They determined the antimicrobial susceptibility of the CPPA isolate for 30 single and combination therapies using disk-diffusion, Etest, or broth microdilution. Whole-genome sequencing was conducted on 3 CPPA isolates (1 patient and 2 sinks), and 4 distinct CPPA ST357 patient isolates from the Dutch CPPA surveillance program. Additionally, 193 international *Pseudomonas aeruginosa* ST357 assemblies were collected from 3 genome repositories and analyzed using whole-genome multi-locus sequence typing and antimicrobial resistance gene (ARG) characterization.
The results showed that a Dutch patient with NDM-1-producing CPPA was transferred from Kenya to the Netherlands, spreading CPPA isolates to local sinks within a month. The CPPA isolates exhibited extensive drug resistance, being susceptible only to colistin and cefiderocol-fosfomycin. Phylogenetic analysis revealed significant variation in allelic distances (mean = 150, max = 527 alleles) among ST357 isolates from Asia (n = 92), Europe (n = 58), Africa (n = 21), America (n = 16), Oceania (n = 2), and unregistered regions (n = 4). The case isolates (n = 3) and additional Dutch patient surveillance isolates (n = 2) clustered with isolates from Kenya (n = 17; 15–49 alleles), the United States (n = 7; 21–115 alleles), and other countries (n = 6; 14–121 alleles). This clustering correlated with prior hospitalization in Kenya for 2 out of 3 Dutch patients. Over half of the isolates in this sub-clade (20/35) shared an identical resistome with isolates from Kenya (9/17), the Netherlands (5/5), the United States (4/7), and other countries (2/6), characterized by the presence of blaNDM-1, aph(3’)-VI, ARR-3, and cmlA1 ARGs.
Investigators concluded that a novel, extensively-drug-resistant P. aeruginosa ST357 subclone was imported to the Netherlands from Kenya via patient repatriation, highlighting the need for vigilant monitoring and infection control measures to prevent further spread.
Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09722-1
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