https://orcid.org/0009-0001-3935-5787
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Guilhem Conquet, Lokman Galal, Nicolas Martel, Chrislène Laurens, Christian Carrière, Sylvain Godreuil, Chloé Dupont, Potential community acquisition of NMC-A-producing Enterobacter ludwigii, an underestimated environmental threat?, Journal of Antimicrobial Chemotherapy, Volume 79, Issue 11, November 2024, Pages 3041–3043, https://doi.org/10.1093/jac/dkae284
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Carbapenemase-producing Enterobacteriaceae (CPE) have emerged in the two last decades and are a global threat to public health. These bacteria were then classified as critical priority pathogens by the WHO for research and antibiotic development.1 In France, monitoring the digestive carriage of CPE is recommended for patients hospitalized in ICUs or returning from endemic areas. This screening allows the hospital staff to take hygiene measures to avoid serious nosocomial outbreaks. Here, we report two concomitant cases of IMI-producing Enterobacter ludwigii colonization at Montpellier University Hospital, France. IMIs are Ambler class A carbapenemases first described in 1993 and relatively uncommon in mainland France.2,3
E. ludwigii isolates were identified in rectal samples from two patients hospitalized in September 2020. The first patient was admitted to the orthopaedic ward for hip replacement surgery. Because he was sharing his room with a patient carrying an OXA-48-producing Escherichia coli, CPE screening was requested. In the same week, the laboratory received a sample from another patient hospitalized in the cardiology department for coronary angiography. CPE screening was requested because this patient had been in contact with another patient carrying a carbapenem-resistant Acinetobacter baumannii complex organism. Two isolates from these patients grew on chromID CARBA SMART selective medium (bioMérieux, Marcy-l’Étoile, France), and were identified as Enterobacter cloacae complex using MALDI-TOF MS (Bruker Daltonics, Germany). Antibiotic susceptibility testing using the disc diffusion method, interpreted according to the CASFM-EUCAST 2019 clinical breakpoints, showed resistance to carbapenems (https://www.sfm-microbiologie.org/2020/04/07/casfm-eucast-v1-0-avril-2020); see Table S1 (available as Supplementary data at JAC Online). As the NG-Test® CARBA 5 immunochromatographic assay (NG Biotech, France) was negative, the KPC/MBL and OXA-48 Confirm Kit (Rosco Diagnostica, Denmark) was used and a class A carbapenemase was detected for both strains. When confronted with this antimicrobial susceptibility profile, a rapid change towards yellow in the CARBA NP test is a good indicator of the production of these carbapenemase types.4 Unfortunately, a colorimetric hydrolysis assay such as the CARBA NP test was not carried out in 2020.
