Isolation of the first New Delhi metallo-ß-lactamase-1 (NDM-1) producing, colistin resistant, Klebsiella pneumoniae sequence type ST15, from a digestive carrier in Albania, May 2018

Objectives: Carbapenemases represent a public health threat as they are able to spread through horizontal gene transfer and cause outbreaks. NDM-1 is a metallo-ß-lactamase that has spread rapidly in the last decade causing worldwide alarm. We aimed to describe the first isolation of NDM-1 producing and XDR Klebsiella pneumoniae in Albania, clinical context and genetic characterization of the strain.Methods: Strain was isolated from both oral and rectal ICU admission screening swabs of a 70 years old male patient with no history of international travel in the previous six months. Sequencing was performed by Illumina NextSeq500 platform, with a paired-end run of 2 by 150 bp, after Nextera XT paired-end library preparation. Sequencing reads were assembled using SPAdes Genome (version 3.6.1) with accurate de novo settings. The assembled contigs were uploaded into the online tools: BIGSdb-Kp, ResFinder and PlasmidFinder .Results: Isolate was resistant to all tested antibiotics but tigecycline and trimethoprim-sulfamethoxazole. Sequencing of the isolate revealed the presence of acquired resistance genes conferring resistance to β-lactams (blaNDM-1, blaCMY-6, blaCTX-M-15 and blaSHV-28), aminoglycosides (rmtC, aac(6')-Ib3), fluoroquinolones (oqxB, aac(6')-Ib-cr), fosfomycin (fosA) and sulfonamides (sul1). Although strain was resistant to colistin, mcr-1 to mcr-8 genes were absent in both isolates. Identification of plasmid replicons revealed the carriage of IncA/C2 (NDM-1-encoding) and IncFIB(pKPHS1) plasmids .Conclusions: NDM-1-producing Enterobacteriaceae are spreading in the Balkans. Identification of NDM-1 producing and XDR Klebsiella pneumoniae ST15 in Albania is a cause for serious concern. There should be a continuous national and Balkan multinational surveillance of blaNDM-1-carrying isolates.