Characterization of NDM-1- and CMH-3-producing Enterobacter cloacae complex ST932 in a patient transferred from Ukraine to Spain

Abstract

Introduction: To characterize a carbapenem-resistant Enterobacter cloacae complex isolate recovered from a patient from Ukraine.

Methods: The isolate was sent to a regional reference laboratory for molecular characterization by whole genome sequencing. Susceptibility assays, carbapenemase identification, imipenem hydrolysis and clonality were performed.

Results: The isolate showed resistance or reduced susceptibility to all β-lactam agents tested. Genome analysis led to the identification of an NDM-1-producing E. cloacae complex strain that was assigned to a new multilocus sequence type, ST932. The bla_NDM-1 enzyme was located in a conjugative IncX3 plasmid of ca. 50kb. In addition, bla_CMH-3, a recently described AmpC β-lactamase sequence, which has not previously been reported in Europe, was also detected and its genetic environment was studied.

Conclusion: To our knowledge, this is the first reported case in Europe of an E. cloacae complex strain that produces both bla_NDM-1 and bla_CMH-3.

Keywords: CMH-3; E. cloacae complex; España; NDM-1; Spain.