Emergence of NDM-1-producing Klebsiella pneumoniae in Greece: evidence of a widespread clonal outbreak

Abstract

Objectives NDM-producing Enterobacteriaceae clinical isolates remain uncommon in the European region. We describe the emergence and broad dissemination of one successful NDM-1-producing Klebsiella pneumoniae clone in Greek hospitals. Methods During a 4 year survey (January 2013–December 2016), 480 single-patient carbapenem non-susceptible K. pneumoniae isolates, phenotypically MBL positive, were consecutively recovered in eight Greek hospitals from different locations and subjected to further investigation. Antimicrobial susceptibility testing, combined-disc test, identification of resistance genes by PCR and sequencing, molecular fingerprinting by PFGE, plasmid profiling, replicon typing, conjugation experiments and MLST were performed. Results Molecular analysis confirmed the presence of the blaNDM-1 gene in 341 (71%) K. pneumoniae isolates. A substantially increasing trend of NDM-1-producing K. pneumoniae was noticed during the survey (R2 = 0.9724). Most blaNDM-1-carrying isolates contained blaCTX-M-15, blaOXA-1, blaOXA-2 and blaTEM-1 genes. PFGE analysis clustered NDM-1 producers into five distinct clonal types, with five distinct STs related to each PFGE clone. The predominant ST11 PFGE clonal type was detected in all eight participating hospitals, despite adherence to the national infection control programme; it was identical to that observed in the original NDM-1 outbreak in Greece in 2011, as well as in a less-extensive NDM-1 outbreak in Bulgaria in 2015. The remaining four ST clonal types (ST15, ST70, ST258 and ST1883) were sporadically detected. blaNDM-1 was located in IncFII-type plasmids in all five clonal types. Conclusions This study gives evidence of possibly the largest NDM-1-producing K. pneumoniae outbreak in Europe; it may also reinforce the hypothesis of an NDM-1 clone circulating in the Balkans.

Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019

“…NDM-CRE, highlighting the risk of rapid emergence and disseminations of uncommon variants of CPE within healthcare facility networks, as recently reported in other European countries [6,7]. Tuscany has a comprehensive and effective microbiological surveillance system, yet the increase in NDM-CRE cases was detected with some delay.…”

“…NDM-CRE are able to hydrolyse almost all beta-lactams and are not inhibited by currently available beta-lactamase inhibitors, including the new ones avibactam and vaborbactam [4]. NDM-CRE were first described in 2008 in Sweden and subsequently reported across Europe [1,5], resulting in growing concern for these pathogens to become endemic in the region [6,7]. In Italy, a country where CRE are reported at endemic level [8], NDM-CRE were first detected in 2009 [9,10] and sporadic, often travel-related, cases have been recorded since [5].…”

IS26-Mediated Transfer of blaNDM–1 as the Main Route of Resistance Transmission During a Polyclonal, Multispecies Outbreak in a German Hospital

“…The reliable reconstruction of transmission chains is therefore essential to the analysis of multispecies outbreaks, although often difficult and laborious (Pirs et al, 2019). Outbreaks of NDM-1-producing Enterobacterales have been reported, as described for the United Kingdom (Fairley et al, 2019), Greece (Politi et al, 2019), Poland (Baraniak et al, 2016), Slovenia (Pirs et al, 2019), Belgium (Heinrichs et al, 2019), Netherlands (Bosch et al, 2017), and most recently Italy (ECDC, 2019). In Europe and more particular in Germany, the prevalence of invasive Enterobacterales with resistance to carbapenems is still low, and NDM-1-producing isolates have only been observed occasionally (Becker et al, 2018b).…”

Inhibitory Potential of Polyclonal Camel Antibodies against New Delhi Metallo-β-lactamase-1 (NDM-1)

“…The bla IMP-like and bla VIM-like genes have been identified in most clinically relevant bacteria belonging to the Enterobacteriaceae family, in Pseudomonas spp., and in Acinetobacter spp., while bla NDM-1 has mainly been found in Enterobacteriaceae. Among them, NDM-1 represents a worldwide threat to healthcare [ 16 , 17 ].…”