<p>First Reported Nosocomial Outbreak Of NDM-5-Producing <em>Klebsiella pneumoniae</em> In A Neonatal Unit In China</p>

Abstract

PurposeCarbapenem-resistant Klebsiella pneumoniae (CRKP) have emerged worldwide and also being a major threat to children and neonate. In this study, we describe a nosocomial outbreak of NDM-5-producing Klebsiella pneumoniae in neonatal unit of a teaching hospital in China from September 2015 to September 2016.Patients and methodsWe collected 12 carbapenem-resistant K. pneumoniae outbreak strains from 12 newborns and characterized these isolates for their antimicrobial susceptibility, clone relationships, and multi-locus sequence types using vitek-2 compact system, pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Resistant genes were detected by using PCR and sequencing. Plasmid conjugation experiment was carried out to determine the transferability of carbapenem resistance. PCR-based replicon typing (PBRT), S1 nuclease-PFGE, and southern blotting were conducted for plasmid profiling.ResultsAll 12 K. pneumoniae isolates were resistant to carbapenems and carried blaNDM-5, blaTEM-1 and blaSHV-11. Furthermore, PFGE analysis showed that NDM-5-producing K. pneumoniae were clonally related and MLST assigned them to sequence type 337. Conjugative assays showed that plasmids harboring blaNDM-5 gene were self-transmissible. Plasmid analysis suggested that all blaNDM-5 gene located on a ~45 kb IncX3 type plasmid.ConclusionTo the best of our knowledge, this is the first report of a clone outbreak of blaNDM-5-carrying K. pneumoniae isolates from neonates. There is an urgent need for effective infection control measures to prevent blaNDM-5 variants from becoming epidemic in the neonates in the future.

<p>NDM-1 Carbapenemase-Producing Enterobacteriaceae are Highly Susceptible to Ceragenins CSA-13, CSA-44, and CSA-131</p>

“…It should be emphasized that, since then, strains producing NDM-1 carbapenemases have been revealed in almost all countries and in most species among Enterobacterales bacteria threatening epidemic outbreaks. 3,[11][12][13] In effect, NDM-1 mediated resistance has become one of the most meaningful current problems in the field of drug resistance. 13 It should be noted that bacteria harboring NDM-1 are not only resistant to β-lactams, but also to another groups of antibiotics, hence frequently are classified as pandrug-resistant (PDR) pathogens.…”

“…13 To date, the treatment options for NDM-1 infections have remained very limited, with colistin, tigecycline, fosfomycin, aminoglycosides, as well as ciprofloxacin as the basic therapy. 11 Unfortunately, the effective use of these agents is undermined by their significant toxicity and the increasing number of resistant strains. 1 Consequently, there is an imperative and urgent need to introduce new antimicrobial therapeutic strategies.…”

<p>Emergence of NDM-5-Producing Carbapenem-Resistant <em>Klebsiella pneumoniae</em> and SIM-Producing Hypervirulent <em>Klebsiella pneumoniae</em> Isolated from Aseptic Body Fluid in a Large Tertiary Hospital, 2017–2018: Genetic Traits of <em>bla</em>NDM-Like and <em>bla</em>SIM-Like Genes as Determined by NGS</p>

“…9 Among class B, New Delhi metallo-β-lactamase (NDM) is the main resistance gene that can hydrolyze all β-lactams antibiotics except monobactams. 10 Hitherto, more than 20 different KPC variants and 21 different NDM variants have been observed worldwide. [10][11][12] NDM-1 enzyme hydrolyzes carbapenems and is not targeted by betalactamase inhibitors.…”

“…10 Hitherto, more than 20 different KPC variants and 21 different NDM variants have been observed worldwide. [10][11][12] NDM-1 enzyme hydrolyzes carbapenems and is not targeted by betalactamase inhibitors. 5 In 2011, NDM-5 was first identified in Escherichia coli isolates in the UK.…”

“…13 This enzyme has a higher resistance to carbapenems and extended-spectrum cephalosporins in KP. 10 Recent researches have reported the outbreaks of NDM-5-producing CRKP in China. 10,13 Thus, NDM-producing CRKP poses a great challenge for clinical treatment.…”