Molecular Characterization of Multidrug-Resistant and Hypervirulent New Delhi Metallo-Beta-Lactamase <i>Klebsiella pneumoniae</i> in Lazio, Italy: A Five-Year Retrospective Study
Claudia Rotondo,
Carolina Venditti,
Ornella Butera,
Valentina Dimartino,
Francesco Messina,
Michele Properzi,
Claudia Caparrelli,
Valentina Antonelli,
Silvia D’Arezzo,
Marina Selleri,
Carla Nisii,
Carla Fontana,
on behalf of the Lazio Region Laboratory Study Group
Affiliations
Claudia Rotondo
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Carolina Venditti
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Ornella Butera
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Valentina Dimartino
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Francesco Messina
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Michele Properzi
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Claudia Caparrelli
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Valentina Antonelli
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Silvia D’Arezzo
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Marina Selleri
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Carla Nisii
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Carla Fontana
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
on behalf of the Lazio Region Laboratory Study Group
National Institute for Infectious Diseases “L. Spallanzani” Istituto di Ricovero e Cura a Carattere Scientifico, via Portuense 292, 00149 Rome, Italy
Background/Objectives: Antimicrobial resistance represents a challenge to public health systems because of the array of resistance and virulence mechanisms that lead to treatment failure and increased mortality rates. Although for years the main driver of carbapenem resistance in Italy has been the Klebsiella pneumoniae KPC carbapenemase, recent years have seen an increase in VIM and NDM metallo-beta-lactamases (MBLs). We conducted a five-year survey of New Delhi Metallo-beta-Lactamase (NDM)-producing Klebsiella pneumoniae (NDM-Kpn) clinical isolates from the Lazio region, Italy; the study aimed to elucidate the molecular mechanisms underpinning their resistant and virulent phenotype. Methods: Antimicrobial susceptibility was evaluated by automated systems and broth microdilution. In silico analysis of acquired resistance and virulence genes was performed using whole-genome sequencing (WGS), molecular typing through MLST, and core genome multi-locus sequence typing (cgMLST). Conclusions: A total of 126 clinical NDM-Kpn isolates were collected from 19 distinct hospitals in the Lazio region. Molecular analysis highlighted the existence of NDM-1 (108/126) and NDM-5 (18/126) variants, 18 Sequence Types (STs), and 15 Cluster Types (CTs). Notably, 31/126 isolates displayed a virulence score of 4, carrying ybt, ICEKp, iuc, and rmp genes. This study identified a variety of NDM-Kpn STs, mainly carrying the blaNDM-1 gene, with a significant number linked to high-risk clones. Of these isolates, 24.6% showed high-level resistance and virulence, emphasizing the risk of the spread of strains that combine multi-drug-resistance (MDR) and virulence. Proactive surveillance and international collaborations are needed to prevent the spread of high-risk clones, as well as further research into new antimicrobial agents to fight antibiotic resistance.
