Colistin-Nonsusceptible Pseudomonas aeruginosa Sequence Type 654 with blaNDM-1 Arrives in North America

This study describes 3 different bla(NDM-1) genetic platforms in 3 different species obtained from the same patient who was directly transferred to an institution in Calgary, Alberta, Canada, following a prolonged hospital stay in India. The bla(NDM-1) in the Escherichia coli isolate was located on a 176-kb IncA/C plasmid contained within an ISCR1 region. The bla(NDM-1) in the Providencia rettgeri isolate was located on a 117-kb IncT plasmid contained within Tn3000, while the bla(NDM-1) in the Pseudomonas aeruginosa isolate was located on the chromosome within an ISCR3 region. This report highlights the plasticity of the genetic regions and environments associated with bla(NDM-1). To the best of our knowledge, this is the first report of P. aeruginosa with bla(NDM-1) identified in North America and the first report of bla(OXA-181) in P. rettgeri. The P. aeruginosa isolate belonged to the international high-risk sequence type 654 clone and was nonsusceptible to colistin. This case emphasizes the need for the use of appropriate infection prevention and control measures and vigilant screening for carbapenem-resistant Gram-negative bacteria in patients with a history of travel to areas of endemicity, such as the Indian subcontinent.