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Outbreak of NDM-1+CTX-M-15+DHA-1-producing Klebsiella pneumoniae high-risk clone in Spain owing to an undetectable colonised patient from Pakistan

Hernández-García, Marta, Pérez-Viso, Blanca, León-Sampedro, Ricardo, Navarro-San Francisco, Carolina, López-Fresneña, Nieves, Díaz-Agero, Cristina, Morosini, María Isabel, Ruiz-Garbajosa, Patricia, Cantón, Rafael
International journal of antimicrobial agents 2019 v.54 no.2 pp. 233-239
Klebsiella pneumoniae, antibiotics, beta-lactamase, clones, control methods, disease control, health services, hospitals, monitoring, patients, plasmids, resistance genes, sequence analysis, virulence, Pakistan, Spain
Here we describe an outbreak due to NDM-1+CTX-M-15+DHA-1-producing Klebsiella pneumoniae (NDM-1-Kp) in Spain related to a patient previously admitted to a healthcare centre in an endemic area (Pakistan). Nine colonised patients were detected in the Neurosurgery ward between September 2015 and February 2016 during the R-GNOSIS European Project. NDM-1-Kp isolates from clinical samples were also recovered in three of these patients. Surveillance culture at admission was negative in the index case, but NDM-1-Kp colonisation was detected 27 days later after receiving antibiotic treatment. Co-colonisation with a second NDM-1-Kp isolate was identified in this patient 61 days post-admission. Overall length of stay (LOS = 75 days) (P < 0.01) and LOS until carbapenemase detection (LOS-1 = 36 days) was longer in NDM-1-Kp carriers than in patients with other carbapenemase-producing Enterobacterales. Intervention strategies were implemented after the outbreak declaration and NDM-1-Kp transmission was contained. Among the NDM-1-Kp isolates, two clones [ST437 (index case and Patient 2) and ST101 (index case and Patients 3–9)] with different IncFIB NDM-1-containing plasmids were identified. Whole-genome sequencing revealed a high content of antimicrobial resistance genes in both isolates in addition to a large number of virulence factors. Colonisation with other epidemic (OXA-48-ST11-K. pneumoniae and VIM-1-ST54-K. pneumoniae) and non-epidemic (VIM-1-ST908-K. pneumoniae and VIM-ST431-Escherichia coli) clones was also detected in two NDM-1 carriers. Implementation of adequate infection control measures and uninterrupted active surveillance programmes for detecting patients with a low colonisation status are crucial to prevent the introduction and dissemination of NDM-type enzymes in our region.