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CORRESPONDENCE
Year : 2013  |  Volume : 31  |  Issue : 2  |  Page : 206-207
 

First report of the emergence of New Delhi metallo-β-lactamase-1 producing Acinetobacter junii in Nanjing, China


Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China

Date of Submission22-Mar-2013
Date of Acceptance11-Apr-2013
Date of Web Publication19-Jul-2013

Correspondence Address:
K Zhang
Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.115243

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How to cite this article:
Zhou W Q, Zhang Z F, Shen H, Ning M Z, Xu X J, Cao X L, Zhang K. First report of the emergence of New Delhi metallo-β-lactamase-1 producing Acinetobacter junii in Nanjing, China. Indian J Med Microbiol 2013;31:206-7

How to cite this URL:
Zhou W Q, Zhang Z F, Shen H, Ning M Z, Xu X J, Cao X L, Zhang K. First report of the emergence of New Delhi metallo-β-lactamase-1 producing Acinetobacter junii in Nanjing, China. Indian J Med Microbiol [serial online] 2013 [cited 2019 Oct 17];31:206-7. Available from: http://www.ijmm.org/text.asp?2013/31/2/206/115243


Dear Editor,

New Delhi metallo-β-lactamase-1 (NDM-1) as a novel metallo-β-lactamase has been identified from many bacterial species, i.e.,  Escherichia More Details coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Proteus spp., Citrobacter freundii, Pseudomonas aeruginosa, Acinetobacter spp., Providencia rettgeri and Morganella morganii and rapidly spreading world-wide in America, Canada, Britain, Australia, Netherlands, Germany, Japan and China. [1],[2],[3],[4] A recent national-wide surveillance in China showed that NDM-1 has been spread among Acinetobacter lwoffii, Acinetobacter haemolyticus, Acinetobacter junii, Acinetobacter pittii, Acinetobacter johnsonii and other genospecies in Hainan, Zhejiang, Shandong, Liaoning, Guangdong and Anhui provinces as well as Beijing. [4] However, there is no information available on NDM-1 positive strains in Jiangsu province, which locate in the eastern China. We recently, identified an isolate of NDM-1 producing A. junii from a 77-year-old male patient in Nanjing City Jiangsu province, which is near to Zhejiang province.

This patient was admitted to Nanjing Drum Town Hospital with bladder cancer and his medical history included hypertension, chronic obstructive pulmonary disease and cardiac dysfunction. He received an ureterostomy on March 4 th , 2011. After that he suffered a spontaneous pneumothorax. Laboratory test revealed an elevated leukocyte count (15.7 × 10 9 /L with 82.3% neutrophils) and serum C-reactive protein (204 mg/L). There were infection signs in the middle field of the right lung with plaque image. Empirical initial therapy included cefepime and cefoperazone/sulbactam were administered for the infection symptoms. At the same time, he had received a closed drainage of the thoracic cavity. Blood cultures were shown negative results. From his sputum sample, we isolated a multi-drug resistant strain, named A. junii 1226 on March 12, 2011. This strain was identified by using the Vitek-2 system and Analytic Products Inc 32GN strips (bioMérieux). 16S ribosomal ribonucleic acid gene and rpoB gene were additionally amplified and sequenced as previous described to confirm the strain. [4] Antimicrobial susceptible testing (AST) was performed by disk diffusion method and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines (CLSI, 2010), the antimicrobial agents tested were as follows: Amikacin, gentamicin, ceftriaxone, ceftazidime, cefepime, ticarcillin, cefoperazone/sulbactam, ampicillin/sulbactam, piperacillin/tazobactam, ciprofloxacin, levofloxacin, meropenem, imipenem, aztreonam, trimethoprim/sulfamethoxazole, minocycline and tigecycline. The minimum inhibitory concentration of polymyxin B and imipenem were determined by using the agar dilution method. The AST results showed that this isolate was susceptible to aminoglycosides (amikacin and gentamicin), tetracycline (minocycline and tigecycline) and Polymyxin B, while extensively resistant to all β-lactams, including carbapenems. Therefore, this patient was given minocycline for the A. junii infection. Patient responded to minocycline and was discharged on the post-admission day 10.

The Modified Hodge test (MHT) and double-disk synergy test were performed to screen the possible carbapenemase or metallo-β-lactamase. [1] MHT was negative; however, synergy test showed an obvious inhibition of imipenem activity with the addition of ethylenediaminetetraacetic acid, which suggested the existence of metallo-β-lactamase. Polymerase chain reactions were therefore performed by screening bla NDM-1, bla IMP, bla VIM, bla SPM, bla GIM and bla SIM genes, the integrons were further detected. [3],[5] Amplified products were purified by using the Qiagen deoxyribonucleic acid purification kit and sent for sequencing. The resulting sequence was further analyzed by using the basic local alignment search tool (BLAST) program from the National Centre for Biotechnology Information (http://www.ncbi.nlm.nih.gov/BLAST). BLAST analysis confirmed a NDM-1 metallo-β-lactamase and this gene in A. junii shared a 100% identity with the NDM-1 in K. pneumoniae (Gene Bank accession no. JN677524.1), E. cloacae (JF798502.1) and Acinetobacter baumannii (JF798501.1). The following integron analysis showed that there was a class 1 integron in this NDM-1 producing strain, which might agree with the previous report that bla NDM-1 might disseminate by mobile elements such as integrons or plasmids. [1],[2] Conjugation assay was performed with E. coli 600 R (Rifampicin resistance) as recipient cell. Unfortunately, we failed, which might suggest that the NDM-1 gene probably locate on non-conjugative plasmid.

In China, NDM-1 producing A. junii has never been reported in Jiangsu province although it has been detected in Zhejiang and Guangdong province. And it seems that there is no obvious evidence this strain was originated from the provinces where NDM-1 producing strains have been isolated.


 ~ Conclusion Top


It is the first time that we identified a NDM-1-producing A. junii strain in Jiangsu Province. Our study highlights the rapid emergence and spread of NDM-1 in China.

 
 ~ References Top

1.Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, et al. Characterization of a new metallo-beta-lactamase gene, bla (NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046-54.  Back to cited text no. 1
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2.Rolain JM, Parola P, Cornaglia G. New Delhi metallo-beta-lactamase (NDM-1): Towards a new pandemia? Clin Microbiol Infect 2010;16:1699-701.  Back to cited text no. 2
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3.Chen Y, Zhou Z, Jiang Y, Yu Y. Emergence of NDM-1-producing Acinetobacter baumannii in China. J Antimicrob Chemother 2011;66:1255-9.  Back to cited text no. 3
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4.Fu Y, Du X, Ji J, Chen Y, Jiang Y, Yu Y. Epidemiological characteristics and genetic structure of blaNDM-1 in non-baumannii Acinetobacter spp. in China. J Antimicrob Chemother 2012;67:2114-22.  Back to cited text no. 4
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5.Ellington MJ, Kistler J, Livermore DM, Woodford N. Multiplex PCR for rapid detection of genes encoding acquired metallo-beta-lactamases. J Antimicrob Chemother 2007;59:321-2.  Back to cited text no. 5
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