title: Sepsis caused by New Delhi metallo-β-lactamase (blaNDM-1) and qnrD-producing Morganella morganii, treated successfully with fosfomycin and meropenem: case report and literature review.
abstract: OBJECTIVE
  The objective of this study was to describe the microbiological characteristics of an extensively drug-resistant (XDR) isolate of Morganella morganii obtained from a patient with sepsis of urinary origin and to describe the patient's clinical characteristics. We further aimed to perform a literature review of the situation in Latin America regarding Gram-negative bacillus (GNB) carriers of New Delhi metallo-β-lactamase (NDM-1) and qnr genes and current reports on the treatment of infections caused by XDR enterobacteria, with particular attention to colistin-resistant isolates.
  
  
  METHODS
  The patient's clinical data were obtained from his medical history. Microbiological identification and susceptibility testing were done using the VITEK 2 Compact System. Resistance genes were detected by PCR and sequencing.
  
  
  RESULTS
  Blood and urine cultures grew an M. morganii isolate (Mm4232) harboring NDM-1 and qnrD1. The patient was treated successfully with fosfomycin and double doses of meropenem. There are no previous reports of the use of fosfomycin and meropenem to treat infections by XDR enterobacteria harboring NDM-1 carbapenemase.
  
  
  CONCLUSIONS
  This is the first report of qnrD1 in South America. We consider that this report could be helpful to physicians implementing treatments for infections caused by XDR GNB, including colistin-carbapenem-resistant GNB.
authors.affiliation: Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Verónica
authors.initials: V
authors.lastname: Seija
authors.affiliation: Cátedra de Enfermedades Infecciosas, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Julio César
authors.initials: JC
authors.lastname: Medina Presentado
authors.affiliation: Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay.
authors.forename: Inés
authors.initials: I
authors.lastname: Bado
authors.affiliation: Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay.
authors.forename: Romina
authors.initials: R
authors.lastname: Papa Ezdra
authors.affiliation: Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Noelia
authors.initials: N
authors.lastname: Batista
authors.affiliation: Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Cátedra de Enfermedades Infecciosas, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Mariana
authors.initials: M
authors.lastname: Guirado
authors.affiliation: Cátedra de Enfermedades Infecciosas, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Macarena
authors.initials: M
authors.lastname: Vidal
authors.affiliation: Centro de Nefrología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Nin
authors.affiliation: Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay. Electronic address: rvignoli@higiene.edu.uy.
authors.forename: Rafael
authors.initials: R
authors.lastname: Vignoli
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D003091:Colistin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D005578:Fosfomycin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D000077731:Meropenem; D020613:Morganella morganii / Q000187:drug effects / Q000235:genetics; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013020:South America; D013845:Thienamycins / Q000627:therapeutic use*; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D013845:Thienamycins; D005578:Fosfomycin; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1; D000077731:Meropenem; D003091:Colistin
keywords: Fosfomycin; Meropenem; Morganella morganii; NDM-1; Sepsis