# Identification of a Potential High-Risk Clone and Novel Sequence Type of Carbapenem-Resistant Pseudomonas aeruginosa in Metro Manila, Philippines

## TL;DR

This study identifies new antibiotic-resistant strains of Pseudomonas aeruginosa in the Philippines, including a high-risk clone and a novel sequence type, raising public health concerns.

## Contribution

The first report of KPC in Pseudomonas aeruginosa in the Philippines and a novel sequence type ST4b1c.

## Key findings

- CRPA isolates included high-risk clones ST111 and ST357.
- A P. aeruginosa strain was found to harbor KPC-2, VIM-2, and OXA-74, the first KPC detection in the Philippines.
- NDM-7 was identified in a novel ST4b1c, highlighting potential resistance dissemination.

## Abstract

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a significant opportunistic human pathogen, posing a considerable threat to public health due to its antimicrobial resistance and limited treatment options. The incidence of CRPA is high in the Philippines; however, genomic analysis of CRPA in this setting is limited. Here, we provide the phenotypic and molecular characterization of 35 non-duplicate CRPA obtained from three tertiary hospitals in Metro Manila, Philippines, from August 2022 to January 2023. Six sequence types (STs), including international high-risk clones ST111 and ST357, were identified. This article highlights the first report in the Philippines on the identification of P. aeruginosa harboring Klebsiella pneumoniae Carbapenemase-2 (KPC-2), coproduced with Verona Integron-encoded Metallo-beta-lactamase-2 (VIM-2) and Oxacillinase-74 (OXA-74). Notably, this is also the first report of KPC in the Philippines identified in P. aeruginosa. New Delhi Metallo-beta-lactamase-7 (NDM-7), coproduced with Cefotaxime-Munich-15 (CTX-M-15) and Temoneira-2 (TEM-2), was also identified from a novel ST4b1c. The relentless identification of NDM in the Philippines’ healthcare setting poses a significant global public health risk. The initial detection of the P. aeruginosa strain harboring KPC exacerbated the situation, indicating the inception of potential dissemination of these resistance determinants within P. aeruginosa in the Philippines.