Spreading patterns of NDM-producing Enterobacteriaceae in clinical and environmental settings in Yangon, Myanmar

Yo Sugawara, Yukihiro Akeda, Hideharu Hagiya, Noriko Sakamoto, Dan Takeuchi, Rathina Kumar Shanmugakani, Daisuke Motooka, Isao Nishi, Khwar Nyo Zin, Mya Mya Aye, Thuzar Myint, Kazunori Tomono, Shigeyuki Hamada

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The spread of carbapenemase-producing Enterobacteriaceae (CPE), contributing to widespread carbapenem resistance, has become a global concern. However, the specific dissemination patterns of carbapenemase genes have not been intensively investigated in developing countries, including Myanmar, where NDM-type carbapenemases are spreading in clinical settings. In the present study, we pheno-typically and genetically characterized 91 CPE isolates obtained from clinical (n 77) and environmental (n 14) samples in Yangon, Myanmar. We determined the dissemination of plasmids harboring genes encoding NDM-1 and its variants using whole-genome sequencing and plasmid analysis. IncFII plasmids harboring blaNDM-5 and IncX3 plasmids harboring blaNDM-4 or blaNDM-7 were the most prevalent plasmid types identified among the isolates. The IncFII plasmids were predominantly carried by clinical isolates of Escherichia coli, and their clonal expansion was observed within the same ward of a hospital. In contrast, the IncX3 plasmids were found in phylogenetically divergent isolates from clinical and environmental samples classified into nine species, suggesting widespread dissemination of plasmids via horizontal transfer. Half of the environmental isolates were found to possess IncX3 plasmids, and this type of plasmid was confirmed to transfer more effectively to recipient organisms at a relatively low temperature (25°C) compared to the IncFII plasmid. Moreover, various other plasmid types were identified harboring blaNDM-1, including IncFIB, IncFII, IncL/M, and IncA/C2, among clinical isolates of Klebsiella pneumoniae or Enterobacter cloacae complex. Overall, our results highlight three distinct patterns of the dissemination of blaNDM-harboring plasmids among CPE isolates in Myanmar, contributing to a better understanding of their molecular epidemiology and dissemination in a setting of endemicity.

Original languageEnglish
Article numbere01924-18
JournalAntimicrobial Agents and Chemotherapy
Volume63
Issue number3
DOIs
Publication statusPublished - Mar 2019
Externally publishedYes

Keywords

  • Bla
  • Carbapenemase
  • Carbapenems
  • Enterobacteriaceae
  • Myanmar
  • Plasmid-mediated resistance

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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  • Cite this

    Sugawara, Y., Akeda, Y., Hagiya, H., Sakamoto, N., Takeuchi, D., Shanmugakani, R. K., Motooka, D., Nishi, I., Zin, K. N., Aye, M. M., Myint, T., Tomono, K., & Hamada, S. (2019). Spreading patterns of NDM-producing Enterobacteriaceae in clinical and environmental settings in Yangon, Myanmar. Antimicrobial Agents and Chemotherapy, 63(3), [e01924-18]. https://doi.org/10.1128/AAC.01924-18