Dissemination of extensively drug-resistant NDM-producing Providencia stuartii in Europe linked to patients transferred from Ukraine, March 2022 to March 2023

Abstract

BackgroundThe war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients.AimTo investigate the genomic epidemiology of New Delhi metallo-β-lactamase (NDM)-producing <i>Providencia stuartii</i> from Ukrainian patients among European countries.MethodsWhole-genome sequencing of 66 isolates sampled in 2022-2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five <i>bla</i> _NDM-1-carrying-<i>P. stuartii</i> isolates underwent antimicrobial susceptibility testing (AST). Transferability to <i>Escherichia coli</i> of a <i>bla</i> _NDM-1-carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing <i>P. stuartii</i> were gathered by questionnaire.ResultswgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised <i>bla</i> _NDM-1-carrying-<i>P. stuartii</i> and the third <i>bla</i> _NDM-5-carrying-<i>P. stuartii.</i> The <i>bla</i> _NDM-1 clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The <i>bla</i> _NDM-5 cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring <i>bla</i> _NDM-1, <i>bla</i> _OXA-10, <i>bla</i> _CMY-16, <i>rmtC</i> and <i>armA</i>, which was transferrable <i>in vitro</i> and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam-avibactam. Patients with data on age (n = 41) were 19-74 years old; of 49 with information on sex, 38 were male.ConclusionXDR <i>P. stuartii</i> were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.