Highly carbapenem-resistant <i>Achromobacter xylosoxidans</i> harboring <i>bla</i> _NDM-1 in Myanmar

<i>Achromobacter xylosoxidans</i> is a multidrug-resistant, non-glucose-fermenting, gram-negative bacterium with intrinsic resistance to many antimicrobial agents. Between 2016 and 2017, five <i>A. xylosoxidans</i> isolates were obtained from five patients at three hospitals in Myanmar. Minimum inhibitory concentrations (MICs) against various antimicrobial agents were determined using the microdilution method. Whole genome sequencing was performed with the MiSeq and MinION platforms. Resistance genes and their surrounding structures were identified and compared. All five isolates were resistant to amikacin and aztreonam. Among them, one isolate, MyNCGM749, was resistant to imipenem and meropenem with MICs of 256 µg/mL and amikacin with MIC of >512 µg/mL but intermediate to ciprofloxacin with MIC of 2 µg/mL. The isolate carried <i>bla</i>_NDM-1 encoding metallo-β-lactamase, <i>bla</i>_PSE-1 encoding extended-spectrum-β-lactamase, and <i>bla</i>_OXA-114 (encoding intrinsic -β-lactamase present in <i>A. xylosoxidans</i>), along with five aminoglycoside modification encoding genes including <i>aac(6')-Ib</i>, <i>aph (6)-Id</i>, <i>aph(3'')-Ib</i>, <i>ant(4')-Iib</i>, and <i>aph(3')-VI</i> on its chromosome. The genetic structure surrounding <i>bla</i>_NDM-1 contained four IS<i>91</i> elements identical to those found in carbapenem-resistant <i>Pseudomonas asiatica</i> isolates in Myanmar. This is the first report of <i>A. xylosoxidans</i> in Myanmar. Although <i>A. xylosoxidans</i> harboring <i>bla</i>_NDM-1 has been reported in a single strain from India, its genomic details have not been previously described. This study indicates that the <i>bla</i>_NDM-1-containing structure flanked by IS<i>91</i> is spreading among gram-negative, non-glucose-fermenting bacteria in Myanmar and neighboring countries.IMPORTANCE<i>Achromobacter</i> species were originally environmental organisms that became opportunistic pathogens with multidrug resistance. <i>Achromobacter xylosoxidans</i> is associated with nosocomially acquired infections affecting multiple organ systems, including the respiratory and urinary tracts, and, less commonly, the cardiovascular and central nervous systems. To date, carbapenem-resistant <i>A. xylosoxidans</i> carrying carbapenemase-encoding genes has been reported in several countries, including Greece, India, Italy, Japan, Korea, Libya, and the Netherlands. In this molecular epidemiological study on <i>A. xylosoxidans</i> in Myanmar, we identified the genomic structure surrounding <i>bla</i>_NDM-1, flanked by IS<i>91</i>. This structure may facilitate the spread of non-glucose-fermenting gram-negative bacteria, such as <i>Achromobacter</i>, <i>Pseudomonas,</i> and <i>Stenotrophomonas</i> species, in Asian countries.