NDM-1-producing Enterobacter aerogenes isolated from a patient with a JJ ureteric stent in situ
Urinary tract infections after JJ stent insertion are among the most common complications, and the associated microorganisms carry more antibiotic resistance determinants than those found in urine prior to stent insertion. In line with the trends in healthcare epidemiology which implicate multi-resistant microorganisms in a plethora of healthcare-associated infections, prosthetic stent material also represents an ideal milieu for biofilm formation and subsequent infection development with resistant bacterial agents. Here we describe a case of a 73-year-old Caucasian woman presenting with urinary tract infection after JJ ureteric stent insertion due to ureteric obstruction and hydronephrosis of her left kidney. Extensive microbiological work-up and comprehensive molecular analysis identified the putative microorganism as carbapenem-resistant Enterobacter aerogenes carrying New Delhi metallo-beta-lactamase 1 (NDM-1). This is a first literature report implicating such extensively resistant strain of this species in early indwelling ureteric stent complications, and also the first report of NDM-1 in Enterobacter aerogenes in Croatia and Europe.
KeywordsEnterobacter aerogenes NDM-1 Antimicrobial resistance JJ stent Ureteric obstruction
IF, BB, NB, ALG and GZ conceived and planned the experiments pertinent for this case description. IF, BB, NB and GZ carried out the experiments. IF, BB, ALG, LB and GZ contributed to sample preparation. BB, NB, SM, LB and TM contributed to the interpretation of the results. IF, BB and TM took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis and final version of the manuscript.
No funding or financial support was received.
Compliance with ethical standards
Conflict of interest
All authors have declared that no conflict of interest exists. No funding or financial support was received.
The study describes clinical and diagnostic procedures of a specific case. All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
Informed consent has been obtained from the patient presented in this paper.
- 1.Liaw A, Knudsen B. Urinary tract infections associated with ureteral stents: a review. Arch Esp Urol. 2016;69:479–84.Google Scholar
- 5.Zumstein V, Betschart P, Albrich WC, Buhmann MT, Ren Q, Schmid HP, et al. Biofilm formation on ureteral stents—incidence, clinical impact, and prevention. Swiss Med Wkly. 2017;147:w14408.Google Scholar
- 6.Elwell LP, Falkow S. The characterization of R plasmids and the detection of plasmid-specified genes. In: Lorian V, editor. Antibiotics in laboratory medicine. 2nd ed. Baltimore: Williams and Wilkins; 1986. p. 683–721.Google Scholar
- 9.Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.CrossRefGoogle Scholar
- 13.Seija V, Medina Presentado JC, Bado I, Papa Ezdra R, Batista N, Gutierrez C, et al. Sepsis caused by New Delhi metallo-β-lactamase (bla NDM–1) and qnrD-producing Morganella morganii, treated successfully with fosfomycin and meropenem: case report and literature review. Int J Infect Dis. 2015;30:20–6.CrossRefGoogle Scholar
- 18.Bedenić B, Sardelić S, Luxner J, Bošnjak Z, Varda-Brkić D, Lukić-Grlić A, et al. Molecular characterization of class b carbapenemases in advanced stage of dissemination and emergence of class d carbapenemases in Enterobacteriaceae from Croatia. Infect Genet Evol. 2016;43:74–82.CrossRefGoogle Scholar