Emergence of Klebsiella pneumoniae producing dual carbapenemases (NDM-1 and OXA-232) and 16S rRNA methylase (armA) isolated from a Malaysian patient returning from India.

Carbapenems are often used for the treatment of complicated nfections caused by extended-spectrum -lactamase-producing lebsiella pneumoniae [1]. However, the emergence and spread f carbapenemases endanger the activity of these antibiotics as herapeutic options. To date, one case of carbapenemase (NDM)-producing K. pneumoniae has been reported in Malaysia [2]. igh-level aminoglycoside resistance due to 16S rRNA methylases as been increasingly documented, particularly in NDM-producing . pneumoniae [1]. In this report, we describe the first imported ase of multidrug-resistant (MDR) K. pneumoniae carrying dual arbapenemases (NDM-1 and OXA-232) and 16S rRNA methyase (armA) in Malaysia. The isolate was recovered from a urine pecimen of an 80-year-old Malaysian male patient with benign rostatic hyperplasia. In May 2012 the patient developed uriary retention during a trip to India, where he was hospitalised or continuous urine drainage using an indwelling catheter. Upon eturning to Malaysia he was admitted to a local hospital in Kuala umpur for catheter removal. Two urine samples were taken for acterial culture, one from the urinary catheter on admission to he hospital and another after the catheter was removed. Both rine samples yielded a pure growth of K. pneumoniae at a count of 105 bacilli/mL. These isolates formed mucoid, lactose-fermenting olonies on MacConkey agar and showed in vitro resistance to muliple antibiotics including imipenem. The patient was diagnosed as case of urinary tract infection. He was treated with intravenous olistin and was discharged several days later. Minimum inhibitory concentrations (MICs) of the isolate (desgnated as strain NDM-2012) were determined using Etest strips bioMérieux, Marcy-l’Étoile, France). The isolate demonstrated esistance to all antibiotics tested including carbapenems, but was usceptible to colistin and tigecycline. Isolate MICs are shown n Table 1. High levels of resistance to amikacin and gentamicin MICs ≥ 256 g/mL) were noted. The modified Hodge test showed positive result for carbapenemase production. PCR and sequence analyses were used to identify various esistance genes against -lactam antibiotics, carbapenems, fluorouinolones, aminoglycosides and trimethoprim/sulfamethoxazole SXT). All of the primers used in the detection of antibiotic resisance genes are listed in Supplementary Table S1. Table 1 gives the ICs for various antibiotics and the resistance genes detected in train NDM-2012.