Probable Three-Species In Vivo Transfer of <i>bla</i><sub>NDM-1</sub> in a Single Patient in Greece: Occurrence of NDM-1-Producing <i>Klebsiella pneumoniae</i>, <i>Proteus mirabilis</i>, and <i>Morganella morganii</i>
Georgios Meletis,
Andigoni Malousi,
Areti Tychala,
Angeliki Kassomenaki,
Nikoletta Vlachodimou,
Paraskevi Mantzana,
Simeon Metallidis,
Lemonia Skoura,
Efthymia Protonotariou
Affiliations
Georgios Meletis
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Andigoni Malousi
Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Areti Tychala
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Angeliki Kassomenaki
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Nikoletta Vlachodimou
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Paraskevi Mantzana
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Simeon Metallidis
First Department of Internal Medicine, Infectious Diseases Division, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Lemonia Skoura
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Efthymia Protonotariou
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
NDM carbapenemase-encoding genes disseminate commonly among Enterobacterales through transferable plasmids carrying additional resistance determinants. Apart from the intra-species dissemination, the inter-species exchange of plasmids seems to play an additional important role in the spread of blaNDM. We here present the genetics related to the isolation of three species (Klebsiella pneumoniae, Proteus mirabilis, and Morganella morganii) harboring the blaNDM-1 gene from a single patient in Greece. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2. Whole genome sequencing and bioinformatic tools were used to identify resistance genes and plasmids. BlaNDM-1 harboring plasmids were found in all three isolates. Moreover, the plasmid constructs of the respective incomplete or circular contigs showed that the blaNDM-1 and its neighboring genes form a cluster that was found in all isolates. Our microbiological findings, together with the patient’s history, suggest the in vivo transfer of the blaNDM-1-containing cluster through three different species in a single patient.
