New Delhi Metallo-β-Lactamase-5 (NDM-5)-Producing Klebsiella pneumoniae Urinary Tract Infection in a Young Patient Without a History of Overseas Travel: A Case Suggesting Local Spread in Japan.

We isolated New Delhi metallo-β-lactamase-5 (NDM-5)-producing Klebsiella pneumoniae KU-00156 from a young individual with no history of overseas travel or exposure to foreign healthcare facilities. During hematologic recovery after chemotherapy for osteosarcoma, the patient developed a urinary tract infection. Urine cultures yielded Klebsiella pneumoniae and Enterococcus faecalis. The K. pneumoniae isolate demonstrated resistance to multiple β-lactam antibiotics, including carbapenems, and PCR-based carbapenemase gene testing confirmed the presence of NDM. Whole-genome analysis revealed that the strain KU-00156 was an NDM-5-producing K. pneumoniae ST290, harboring multiple resistance genes, including bla NDM-5, on an IncHI2-replicon type plasmid. This case represents the detection of NDM-5-producing K. pneumoniae from a young individual without a history of overseas exposure and is considered an important case suggesting the possible prevalence of NDM-5 in the Japanese community.