Extraintestinal Pathogenic <i>Escherichia coli</i> ST405 Isolate Coharboring blaNDM-5 and blaCTXM-15: A New Threat in Mozambique

Abstract

The development of carbapenem resistance in extraintestinal pathogenic <i>Escherichia coli</i> (ExPEC) has significant clinical implications, particularly in countries where second-line antimicrobials are not readily available, rendering treatments ineffective, and ExPEC infections untreatable. Thus, early detection of high-risk ExPEC lineages and raising awareness of the specific mechanisms underlying carbapenem resistance are mandatory for the selection of appropriate treatment options and the prevention of <i>E. coli</i> spread. This study aims to investigate the phenotypic and genotypic features of the first NDM-5 carbapenemase-producing ExPEC strain isolated from the blood of a patient admitted to the Maputo Central Hospital (MCH), in Mozambique. <i>E. coli</i> SSM100 isolate was identified by MALDI-TOF, it displayed high-level resistance to third generation cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides, performing antimicrobial susceptibilities testing by VITEK 2 system. <i>E. coli</i> SSM100 isolate was classified through whole-genome sequencing as ST405-D-O102: H6, a globally distributed lineage associated with antimicrobial resistance, carrying the <i>bla</i>NDM-5 gene located on an F1:A1:B49 plasmid, coharboring <i>bla</i>CTX-M-15, <i>bla</i>TEM-1, <i>aadA2</i>, <i>sul1</i>, and <i>dfrA12</i> genes. In addition, mutations in <i>gyrA</i> (S83L and D87N), <i>parC</i> (S80I and E84V), and <i>parE</i> (I529L) conferring fluoroquinolone resistance were also found. Moreover, SSM100 isolate carried 88 virulence genes, of which 28 are reported to be associated with UPEC. The emergence of NDM-5 carbapenemase in a pandemic ST405-D-O102:H6 clone in Mozambique is of great concern. Locations of extended-spectrum β-lactamase determinants and NDM-5 carbapenemase gene on Inc<i>F</i>-plasmid can increase their spread reinforcing the need for antimicrobial surveillance and the urgent introduction of carbapenemase detection tests in diagnostic laboratories of the country.