Carbapenem-resistant Enterobacteriaceae are a worldwide health problem and isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe the microbiological and clinical characteristics of five cases of bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens having both blaKPC-2 and blaNDM-1. Of the five blood samples, three are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a surgical patient. All patients lived in low-income neighbourhoods and had no travel history. Despite antibiotic treatment, four out of five patients died. The phenotypic susceptibility assays showed that meropenem with the addition of either EDTA, phenylboronic acid (PBA), or both, increased the zone of inhibition in comparison to meropenem alone. Molecular tests showed the presence of blaKPC-2 and blaNDM-1 genes. K. pneumoniae isolates were assigned to ST258 or ST340 by whole genome sequencing. This case-series showed a high mortality among patients with BSI caused by Enterobacteriae harbouring both carbapenemases. The detection of carbapenemase-producing isolates carrying both blaKPC-2 and blaNDM-1 remains a challenge when using only phenotypic assays. Microbiology laboratories must be alert for K. pneumoniae isolates producing both KPC-2 and NDM-1.

中文翻译：

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由肺炎克雷伯菌和粘质沙雷氏菌引起的血流感染分离株共同携带 NDM-1 和 KPC-2

耐碳青霉烯类肠杆菌科细菌是一个全球性的健康问题，同时携带 blaKPC-2 和 blaNDM-1 的分离株并不常见。在这里，我们描述了由具有 blaKPC-2 和 blaNDM-1 的耐碳青霉烯类肺炎克雷伯菌和粘质沙雷氏菌引起的 5 例血流感染 (BSI) 的微生物学和临床特征。在五份血液样本中，三份来自造血干细胞移植患者，一份来自肾移植患者，一份来自外科手术患者。所有患者都住在低收入社区，没有旅行史。尽管接受了抗生素治疗，五分之四的患者死亡。表型敏感性分析表明，与单独的美罗培南相比，添加 EDTA、苯基硼酸 (PBA) 或两者的美罗培南增加了抑制区。分子测试显示 blaKPC-2 和 blaNDM-1 基因的存在。通过全基因组测序，肺炎克雷伯菌分离株被分配到 ST258 或 ST340。该病例系列显示，由含有两种碳青霉烯酶的肠杆菌引起的 BSI 患者死亡率很高。仅使用表型分析时，检测同时携带 blaKPC-2 和 blaNDM-1 的产生碳青霉烯酶的分离物仍然是一个挑战。微生物学实验室必须对同时产生 KPC-2 和 NDM-1 的肺炎克雷伯菌分离株保持警惕。仅使用表型分析时，检测同时携带 blaKPC-2 和 blaNDM-1 的产生碳青霉烯酶的分离物仍然是一个挑战。微生物学实验室必须对同时产生 KPC-2 和 NDM-1 的肺炎克雷伯菌分离株保持警惕。仅使用表型分析时，检测同时携带 blaKPC-2 和 blaNDM-1 的产生碳青霉烯酶的分离物仍然是一个挑战。微生物学实验室必须对同时产生 KPC-2 和 NDM-1 的肺炎克雷伯菌分离株保持警惕。