Surveillance of Carbapenem Resistance and the First Case of NDM-7-producing Klebsiella pneumoniae in the Philippines
KPC, NDM, and OXA-48 have spread to virtually every continent, although not every country has been affected. The SMART worldwide surveillance program from 2008-2009 characterized the molecular epidemiology of carbapenem resistant Klebsiella pneumoniae, and identified three K. pneumoniae ST903 with IMP-26 in the Philippines; no other carbapenemases have been reported in the Philippines.
We sought to characterize recent changes in antibiotic resistance and molecular epidemiology in the Philippines.
Clinical isolates were collected from the microbiology laboratories of two hospitals in metropolitan Manila, Philippines over 14-months. Bacteria identification and antibiotic susceptibility testing were performed with the VITEK 2. DNA-typing was performed with multilocus sequence typing. Multiplex polymerase chain reaction was used to test for up to seven carbapenemase genes, as previously described.
A total of 364 Enterobacteriaceae were collected, including 19 Enterobacter spp., 181 Escherichia coli, 135 Klebsiella spp., 9 Proteus mirabilis, 19 Salmonella spp., and 10 other Enterobacteriaceae.
Carbapenem resistance was detected in 2 (1.2%) E. coli, and 4 (3.0%) Klebsiella spp., but was not found in Enterobacter spp. or P. mirabilis. A cluster of four patients with carbapenem-resistant K. pneumoniae was identified in a single month, and investigated. Two contained the bla NDM-7 beta-lactamase gene, and were typed as K. pneumoniae ST273. The third had the bla VIM gene. None of the seven tested carbapenemase genes were identified in the fourth case.
We report the first two patients with pathogens carrying the bla NDM-7 gene, and the first patient with a pathogen carrying the bla VIM gene in the Philippines. While K. pneumoniae ST273 carrying the bla NDM-1 gene has been described in Italy and the United Kingdom, this is the first report of this sequence type spreading outside Europe.
We also report that carbapenem resistance in the Philippines is rare, but the emergence of NDM-7 should prompt further antibiotic resistance surveillance and implementation of policies to control the spread of antibiotic resistance in this bacterium with outbreak potential.
A. K. Sulit, None
B. Torres, None
M. Roa, None
D. C. Klinzing, None
L. Zechiedrich, None
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