Nosocomial Clustering of NDM-1-Producing Klebsiella pneumoniae Sequence Type 340 Strains in Four Patients at a South Korean Tertiary Care Hospital

Kim, Seung Up; Yong, Dongeun; An, Dongheui; Chung, Hae Sun; Woo, Jun Hee; Lee, Kyungwon; Chong, Yunsop

doi:10.1128/jcm.06855-11

Cited by 57 publications

(43 citation statements)

References 24 publications

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“…Recently, two studies have demonstrated limited nosocomial transmission of bla NDM-1 -producing isolates in non-endemic areas. 21,37 We previously showed that the two bla NDM-1 -carrying E. coli strains (CRE396 and CRE397) in the infant and her mother were clonally related. 11 Here, we confirmed that there was in vivo transfer of the bla NDM-1 -carrying IncX3 plasmid among E. coli , K. peumoniae and E. aerogenes strains carried by the infant.…”

Section: Discussionmentioning

confidence: 99%

“…In Enterobacteriaceae , bla NDM-1 has been identified on plasmids with a narrow (IncF1B, IncFII) or broad (IncA/C, IncH, IncL/M and IncN) host range and rarely in the chromosome. 18,19,20,21 The first plasmid to be completely sequenced was pNDM-HK (IncL/M, INSDC-GenBank accession HQ451074). The other plasmids that have been completely sequenced and deposited in the INSDC-GenBank were pNDM-1_Dok01 (IncA/C2, AP012208), pNDM-KN (IncA/C2, JN157804), pNDM10505 (IncA/C2, JF503991), pNDM10469 (IncA/C2, JN861072), pNDM102337 (IncA/C2, JF714412), pMR0211 (IncA/C2, JN687470), p271A (IncN2, JF785549), pNDM-MAR (IncH1B-F1B, JN420336) and pGUE-NDM (IncFII, JQ364967).…”

Section: Introductionmentioning

confidence: 99%

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Identification and characterization of a novel incompatibility group X3 plasmid carrying bla _NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

et al. 2012

Emerging Microbes & Infections

112

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The New Delhi metallo-β-lactamase (NDM-1) is one of the most important resistance traits in Enterobacteriaceae. We characterized nine blaNDM-1 producing Enterobacteriaceae recovered from seven patients who have recently travelled or been treated in India (n=1) or mainland China (n=6) during December 2010–May 2012. All the China-linked patients had no links to the Indian subcontinent. The blaNDM-1 carrying plasmids belonged to the novel IncX3 (∼50 kb, in seven isolates including two Escherichia coli, two Klebsiella pneumoniae, one Citrobacter freundii, one Enterobacter aerogenes and one E. cloacae), IncA/C2 (∼140 kb, in one E. coli) or FII-F1B groups (∼110 kb, in one E. coli). Restriction fragment length polymorphism analysis of the seven IncX3 plasmids revealed identical pattern in six and two bands difference in the remaining one. The IncX3 plasmids carrying blaNDM-1 were epidemiologically linked to Guangzhou (n=1), Hunan (n=4), Haifeng (n=1) and Dongguan (n=1) in mainland China. Complete sequencing of the IncX3 plasmid pNDM-HN380 revealed that it was 54 035 bp long and encoded 52 open reading frames. The blaNDM-1 gene was found in a transposon-like structure flanked by ISAba125 and IS26, inserted into the plasmid genetic load region. The sequences of the blaNDM-1 containing module within the two IS elements were identical to those previously described for blaNDM-1-positive Tn125 in the plasmids or chromosome of Acinetobacter isolates. In summary, this is the first description of IncX3 plasmids carrying blaNDM-1. The findings indicate the worrisome involvement of an epidemic plasmid in the dissemination of NDM-1 in China.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identification and characterization of a novel incompatibility group X3 plasmid carrying bla _NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

et al. 2012

Emerging Microbes & Infections

112

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“…In contrast, the recent spread of NDM producers in Western Europe, North America, Australia, and the Far East has clearly been attributed to patients who originated mainly from India, Pakistan, and Bangladesh (192). A characteristic of NDM-producing K. pneumoniae isolates has so far been their rapid dissemination; indeed, infected or colonized humans without obvious connection to the Indian epidemic are increasingly being reported in several countries (125,190,214).…”

Section: Producers Of M␤lsmentioning

confidence: 99%

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

et al. 2012

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SUMMARY The spread of Enterobacteriaceae , primarily Klebsiella pneumoniae , producing KPC, VIM, IMP, and NDM carbapenemases, is causing an unprecedented public health crisis. Carbapenemase-producing enterobacteria (CPE) infect mainly hospitalized patients but also have been spreading in long-term care facilities. Given their multidrug resistance, therapeutic options are limited and, as discussed here, should be reevaluated and optimized. Based on susceptibility data, colistin and tigecycline are commonly used to treat CPE infections. Nevertheless, a review of the literature revealed high failure rates in cases of monotherapy with these drugs, whilst monotherapy with either a carbapenem or an aminoglycoside appeared to be more effective. Combination therapies not including carbapenems were comparable to aminoglycoside and carbapenem monotherapies. Higher success rates have been achieved with carbapenem-containing combinations. Pharmacodynamic simulations and experimental infections indicate that modification of the current patterns of carbapenem use against CPE warrants further attention. Epidemiological data, though fragmentary in many countries, indicate CPE foci and transmission routes, to some extent, whilst also underlining the lack of international collaborative systems that could react promptly and effectively. Fortunately, there are sound studies showing successful containment of CPE by bundles of measures, among which the most important are active surveillance cultures, separation of carriers, and assignment of dedicated nursing staff.

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“…The index case was not identified, and the source of that strain in the hospital setting could not be determined. Of note, whereas there have been several reported outbreaks involving NDM-1-producing K. pneumoniae in different countries, such as Turkey (16,17), Colombia (18), Canada (19), Kenya (20), Italy (21), and South Korea (22), reports of NDM-1-producing E. coli have been scattered (13,(23)(24)(25)(26), including isolates recovered from companion animals in the United States (27). However, nosocomial transmissions of NDM-1-pro-ducing E. coli are extremely rare, with one recent report from South Korea (28).…”

Section: W Orldwide Occurrence Of Carbapenemase Producers Amongmentioning

confidence: 99%

Outbreak Caused by NDM-1- and RmtB-Producing Escherichia coli in Bulgaria

Poirel

Savov

Nazli

et al. 2014

Antimicrob Agents Chemother

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Twelve consecutive carbapenem-resistant Escherichia coli isolates were recovered from patients (infection or colonization) hospitalized between March and September 2012 in different units at a hospital in Bulgaria. They all produced the carbapenemase NDM-1 and the extended-spectrum-␤-lactamase CTX-M-15, together with the 16S rRNA methylase RmtB, conferring high-level resistance to all aminoglycosides. All those isolates were clonally related and belonged to the same sequence type, ST101. In addition to being the first to identify NDM-producing isolates in Bulgaria, this is the very first study reporting an outbreak of NDM-1-producing E. coli in the world. W orldwide occurrence of carbapenemase producers amongEnterobacteriaceae is now well recognized (1, 2). In Europe, there are distinct epidemiological situations corresponding mainly to the diffusion of OXA-48 producers in France, Belgium, The Netherlands, and Turkey (3, 4) and KPC-producing isolates in Italy and Greece (5), while some countries show more diverse distributions, such as in the United Kingdom, where KPC, OXA-48, VIM, and NDM-1 producers are being found (6). The recent emergence of NDM-1 producers (mostly Klebsiella pneumoniae isolates) is often related to imported cases, with a link to the Indian subcontinent (7). In addition, there are sporadic reports of NDM-1 producers (Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa) originating from countries of the Middle East or the Balkan region, including Croatia, Kosovo, and Serbia (7,8). Very little information is available regarding the diffusion of carbapenemase producers in Eastern Europe. Therefore, our study aimed to characterize the mechanisms responsible for carbapenem resistance by investigating a collection of enterobacterial isolates recovered in Bulgaria. From March to September 2012, 12 Escherichia coli isolates being resistant to carbapenems were recovered at the Military Medical Academy hospital of Sofia, Bulgaria. Susceptibility testing was performed by disk diffusion on solid agar plates following the CLSI recommendations (9). Those isolates had been recovered from urine (n ϭ 4), blood (n ϭ 1), respiratory specimens (n ϭ 2), wound (n ϭ 1), catheter (n ϭ 1), abdominal exudate (n ϭ 1), and rectal swabs (n ϭ 2). The MICs of carbapenems were determined by Etest (AB bioMérieux, La Balme-les-Grottes, France) on Mueller-Hinton agar plates at 37°C, and results of susceptibility testing were interpreted according to the CLSI guidelines (10). The MICs of imipenem, meropenem, and ertapenem were 32, Ͼ32, and Ͼ32 g/ml for all the E. coli isolates, respectively. They were resistant to all ␤-lactams, including broad-spectrum cephalosporins (MICs of ceftazidime and cefotaxime being Ͼ32 g/ml) ( Table 1). In addition, they were resistant to all tested aminoglycosides (amikacin, gentamicin, netilmicin, kanamycin) and to fluoroquinolones and sulfonamides. Using the Etest, the MIC of rifampin was elevated (128 g/ml), and that of colistin was found to be 0.5 g/ml.Carbapenemase detecti...

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Nosocomial Clustering of NDM-1-Producing Klebsiella pneumoniae Sequence Type 340 Strains in Four Patients at a South Korean Tertiary Care Hospital

Cited by 57 publications

References 24 publications

Identification and characterization of a novel incompatibility group X3 plasmid carrying bla _NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

Identification and characterization of a novel incompatibility group X3 plasmid carrying bla _NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

Outbreak Caused by NDM-1- and RmtB-Producing Escherichia coli in Bulgaria

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Nosocomial Clustering of NDM-1-Producing Klebsiella pneumoniae Sequence Type 340 Strains in Four Patients at a South Korean Tertiary Care Hospital

Cited by 57 publications

References 24 publications

Identification and characterization of a novel incompatibility group X3 plasmid carrying bla NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

Identification and characterization of a novel incompatibility group X3 plasmid carrying bla NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

Outbreak Caused by NDM-1- and RmtB-Producing Escherichia coli in Bulgaria

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Identification and characterization of a novel incompatibility group X3 plasmid carrying bla _NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China

Identification and characterization of a novel incompatibility group X3 plasmid carrying bla _NDM-1 in Enterobacteriaceae isolates with epidemiological links to multiple geographical areas in China