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This variant, designatedNDM-4, differs from NDM-1 by a single amino substitution and anincreased carbapenemase activity. NDM-4 was rst detected inan Escherichia coli isolated from a urinary sample from a patientpreviously hospitalized in India. A second nding of the NDM-4variantwasreportedinanE.colirectalisolatefromapatienttrans-ferredfromCameroontoFrance.

An ST405 NDM-4-producing Escherichia coli isolated from a Danish patient previously hospitalized in Vietnam