Simultaneous clonal spread of NDM-1–producing Pseudomonas aeruginosa ST773 from Ukrainian patients in the Netherlands and Spain

Abstract

We describe the clonal spread of NDM-1-producing Pseudomonas aeruginosa isolates belonging to the ST773 clone in Spain and The Netherlands, associated with the transfer of Ukrainian patients during the war. Between March-December 2022, nine NDM-1-producing P. aeruginosa ST773 isolates were recovered from nine Ukrainian patients evacuated to two Spanish (n=3) and five Dutch (n=6) hospitals. Antimicrobial susceptibility testing was studied (Sensititre, Microscan, EUCAST-2023). WGS (Illumina, Oxford-Nanopore) was used to analyze the genetic relatedness, the resistome and the prophage content. All NDM-1-producing P. aeruginosa ST773 isolates exhibited resistance to all tested antimicrobials except colistin, aztreonam and cefiderocol. Genomic analysis revealed that all isolates had an identical resistome and a chromosomally encoded integrative conjugative element carrying the blaNDM-1 gene. cgMLST analysis showed highly related isolates, irrespective of country of isolation, distant from other NDM-1-ST773-P. aeruginosa not collected in Ukraine. cgMLST and cgSNPs analysis revealed two closely related clusters, spanning both Spanish and Dutch isolates. Additionally, a high content of prophages was identified in all strains, most of them in more than one isolate simultaneously, regardless of their origin country. Moreover, an identical phage tail-like bacteriocin (PTLB) cluster was identified in all NDM-1-ST773-P. aeruginosa. We report clonal dissemination of NDM-producing P. aeruginosa ST773 to The Netherlands and Spain associated with patients from Ukraine. Our work highlights the importance of genomic surveillance and to understand the dynamics of resistance in multidrug-resistant bacteria following the transfer of patients from conflict zones. International collaboration is crucial to address global antimicrobial resistance.

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