NDM-1 and VIM-1 dual metallo-beta-lactamase producing Klebsiella pneumoniae ST15 high-risk clone from a blood culture of a patient at Intensive Care Unit in a Greek Tertiary Care Hospital

Abstract

The emergence of carbapenemase-producing Klebsiella pneumoniae poses a significant global health threat, particularly in hospital settings. This study reports on the first detection of a pandrug-resistant (PDR) high-risk ST15 K. pneumoniae strain co-producing NDM-1 and VIM-1 in Greece. The isolate was recovered from a blood culture of a male patient admitted to the Intensive Care Unit (ICU) of Volos Hospital in July 2024. Next generation Sequencing (NGS) confirmed the presence of blaNDM-1 and blaVIM-1 genes. Other beta-lactamase type (CTX-M-15) was detected in association with NDM and VIM enzymes. Furthermore, this isolate was resistant to other antimicrobial agents, including aminoglycosides [aac(3)-II, aac(3)-IIe, aac(6')-Ib, aadA1, aph(3″)-Ib, aph(6)-Id, aph(3')-Ia), chloramphenicol (catB3), fluoroquinolones (qnrS1) and sulfonamides (sul1 and sul2). The Multilocus Sequence Typing revealed that the strain belonged to ST15. According to Kaptive the strain belonged to KL48. Our study provides new data about MBL producing K. pneumoniae in Greece. Thus, we report for the first time the co-expression of blaNDM-1 and blaVIM-1 in our country in ST15 K. pneumoniae. This study provides crucial epidemiological data on MBL-producing K. pneumoniae in Greece and highlights the urgent need for enhanced surveillance, infection control strategies, and access to last-resort antibiotics such as aztreonam-avibactam.

Keywords: ICU infections; Klebsiella pneumoniae ST15; NDM-1; VIM-1; antimicrobial resistance; carbapenem resistance; metallo-beta-lactamase.