Emergence of New Delhi Metallo-β-Lactamase (NDM-5) in Klebsiella quasipneumoniae From Neonates in a Nigerian Hospital

mSphere. 2019 Mar 13;4(2):e00685-18. doi: 10.1128/mSphere.00685-18.

Abstract

Outbreaks of infection occur more often than they are reported in most developing countries, largely due to poor diagnostic services. A Klebsiella species bacteremia outbreak in a newborn unit with high mortality was recently encountered at a location being surveilled for childhood bacteremia. These surveillance efforts offered the opportunity to determine the cause of this neonatal outbreak. In this report, we present the whole-genome sequences of New Delhi metallo-β-lactamase (NDM-5)-containing Klebsiella quasipneumoniae subsp. similipneumoniae bloodstream isolates from a neonatal bacteremia outbreak at a tertiary hospital in Nigeria and as part of the largest collection of K. pneumoniae bloodstream isolates from children in Africa. Comparative analysis of the genetic environment surrounding the NDM-5 genes revealed nearly perfect sequence identity to bla NDM-5-bearing IncX3-type plasmids from other members of the Enterobacteriaceae IMPORTANCE Carbapenem-resistant Klebsiella pneumoniae is of global health importance, yet there is a paucity of genome-based studies in Africa. Here we report fatal blood-borne NDM-5-producing K. quasipneumoniae subsp. similipneumoniae infections from Nigeria, Africa. New Delhi metallo-β-lactamase (NDM)-producing Klebsiella spp. are responsible for high mortality and morbidity, with the NDM-5 variant showing elevated carbapenem resistance. The prevalence of NDM-5 in Klebsiella has been limited primarily to K. pneumoniae, with only one isolate being collected from Africa. During an outbreak of sepsis in a teaching hospital in Nigeria, five NDM-5-producing K. quasipneumoniae subsp. similipneumoniae sequence type 476 isolates were identified. Given the increased resistance profile of these strains, this study highlights the emerging threat of bla NDM-5 dissemination in hospital environments. The observation of these NDM-5-producing isolates in Africa stresses the urgency to improve monitoring and clinical practices to reduce or prevent the further spread of resistance.

Keywords: ESBL; Enterobacteriaceae; Klebsiella; New Delhi metallo-β-lactamase (NDM-5); Nigeria; antimicrobial resistance; bacteria; carbapenemase; neonate.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bacteremia / epidemiology
  • Child, Preschool
  • Disease Outbreaks
  • Drug Resistance, Multiple, Bacterial / genetics
  • Epidemiological Monitoring
  • Genome, Bacterial*
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • Klebsiella Infections / blood
  • Klebsiella Infections / epidemiology*
  • Klebsiella pneumoniae / enzymology*
  • Klebsiella pneumoniae / genetics*
  • Klebsiella pneumoniae / isolation & purification
  • Microbial Sensitivity Tests
  • Nigeria / epidemiology
  • Plasmids
  • Whole Genome Sequencing
  • beta-Lactamases / genetics*

Substances

  • beta-Lactamases
  • beta-lactamase NDM-1