Pseudomonas aeruginosa (PA) is one of the most common and serious causes of healthcare-associated bacteremia. The emergence and dissemination of multidrug-resistant (MDR) and extensively drug-resistant (XDR) PA strains pose a major clinical concern. ST235-PA is a high-risk clone which shows a high capacity to acquire antibiotic resistance. Here we describe the first autochthonous New Delhi metallo-β-lactamase (NDM)-producing Pseudomonas aeruginosa ST235 identified in Italy. In October 2019, a patient residing in an elderly health care and rehabilitation facility, was hospitalized and died from sepsis caused by an XDR-PA. The strain belonged to the high-risk clone sequence type ST235. Whole genome sequencing (WGS) revealed the presence of genes encoding NDM-1 and multiple β-lactamases, many clinically significant multidrug efflux pump complexes and also the virulence gene ExoU, which is associated with a high cytotoxic phenotype. Few strains of NDM-1-PA have been identified worldwide, all belonging to ST235. The combination of ST235 and ExoU is a predictor of highly unfavorable prognosis. The potential spread of these high-risk clones in healthcare settings is worrisome because treatment options are limited. Early identification of high-risk clones could help in outbreaks investigation and infections control.

中文翻译：

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2019年10月，在意大利首次从一名患有血液感染的患者中检测到了本地化的广泛耐药的NDM-1铜绿假单胞菌ST235。

铜绿假单胞菌（PA）是医疗相关菌血症的最常见和最严重的原因之一。多药耐药（MDR）和广泛耐药（XDR）PA菌株的出现和传播引起了临床上的重大关注。ST235-PA是高风险克隆，显示出高水平的获得抗生素耐药性的能力。在这里，我们描述了在意大利发现的第一个自生的新德里金属β-内酰胺酶（NDM）生产铜绿假单胞菌ST235。2019年10月，一名住在老年保健和康复机构的患者住院治疗，死于XDR-PA引起的败血症。该菌株属于高危克隆序列类型ST235。全基因组测序（WGS）显示存在编码NDM-1和多种β-内酰胺酶的基因，许多具有临床意义的多药外排泵复合物，以及具有高细胞毒性表型的毒力基因ExoU。在全球范围内，几乎没有鉴定出所有属于ST235的NDM-1-PA菌株。ST235和ExoU的组合可预后极差。这些高风险克隆在医疗机构中的潜在传播令人担忧，因为治疗选择有限。尽早发现高风险克隆可帮助进行暴发调查和控制感染。这些高风险克隆在医疗机构中的潜在传播令人担忧，因为治疗选择有限。尽早发现高风险克隆可以帮助进行暴发调查和控制感染。这些高风险克隆在医疗机构中的潜在传播令人担忧，因为治疗选择有限。尽早发现高风险克隆可以帮助进行暴发调查和控制感染。