
pmid: 28876169
New Delhi MBL (NDM) carbapenemase-producing Klebsiella pneumoniae has become one of the most concerning multidrug-resistant pathogens. The Balkan counties are considered a reservoir for the spread of such strains based on several reports documenting NDM infections after hospitalization in this region. Nevertheless, NDM-producing K. pneumoniae have been only occasionally documented from Balkans. The current study documents the first polyclonal outbreak caused by NDM-1-producing K. pneumoniae in Bulgaria. From July 2015 to April 2016, all 25 single-patient carbapenem-nonsusceptible K. pneumoniae isolates were collected. Phenotypic and molecular screening revealed that 17 produced NDM-1 carbapenemase. All NDM-1 producers harbored bla CTX-M-15 , bla CMY-4 , bla TEM-1 , and bla OXA-2 ; five also harbored bla OXA-1 . In all cases, bla NDM-1 was flanked upstream by IS Ab a125 element and downstream by ble MBL . Pulsed-field gel electrophoresis (PFGE) clustered NDM-1-positive isolates into four distinct clonal types, A to D. MLST assigned isolates of the dominant clonal type A ( n = 14) to sequence type (ST) 11, while isolates of clonal types B, C, and D to ST16, ST15, and ST391, respectively. Of interest, ST11 isolates belonged to the same PFGE type as those of the recently described NDM-1 ST11 clonal outbreak in Greece. Traveling abroad or overseas hospitalization was not reported in any case, suggesting most likely intra- and interhospital dissemination. The study presents the first polyclonal outbreak of NDM-producing K. pneumoniae in the Balkans and underlines the need for larger epidemiological studies in the region to illustrate commonalities in the transmission of NDM clones and possible sources in the community.
Genotype, Gene Expression, Microbial Sensitivity Tests, beta-Lactam Resistance, beta-Lactamases, Anti-Bacterial Agents, Clone Cells, Disease Outbreaks, Electrophoresis, Gel, Pulsed-Field, Klebsiella Infections, Klebsiella pneumoniae, Carbapenems, Humans, Bulgaria, Multilocus Sequence Typing, Plasmids
Genotype, Gene Expression, Microbial Sensitivity Tests, beta-Lactam Resistance, beta-Lactamases, Anti-Bacterial Agents, Clone Cells, Disease Outbreaks, Electrophoresis, Gel, Pulsed-Field, Klebsiella Infections, Klebsiella pneumoniae, Carbapenems, Humans, Bulgaria, Multilocus Sequence Typing, Plasmids
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