Naslov
NDM-1-producing Klebsiella pneumoniae, Croatia

Autori
Mazzariol, Annarita ; Bošnjak, Zrinka ; Ballarini, Piero ; Budimir, Ana ; Bedenić, Branka ; Kalenić, Smilja ; Cornaglia, Giuseppe

Izvornik
Emerging infectious diseases (1080-6040) 18 (2012), 3; 532-534

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, pismo uredniku, znanstveni

Ključne riječi
Klebsiella pneumoniae ; NDM-1

Sažetak
Objectives: A K. pneumoniae strain, resistant to carbapenems, was isolated in May 2009, from a blood culture of a 40-years-old man, recovered in a surgical intensive care unit of the Clinical Hospital Center in Zagreb, Croatia.The patient had been transferred from another hospital of a neighbouring country after 5 days of hospitalization due to a car accident. The clinical history mentioned antibiotic treatment not including carbapenems (gentamicine, metronidazole and ceftriaxone), and no link to India or Pakistan.We investigated the carbapenem resistance mechanism. Materials and Methods: Antimicrobial susceptibility testing was performed by both Vitek2 and microdiluition, and interpreted according to the latest EUCAST documents. The presence of a carbapenemase was investigated by means of an MBL-etest, hydrolysis of carbapenems and EDTA inhibition of hydrolysis. PCR and sequencing were carried out by standard procedures. Resistance was transferred by conjugation to E. coli J53. Results: The strain was resistant to imipenem and meropenem (MICs 16 g/ml and 64 g/ml, respectively), and to all 3G-cephalosporins (MICs>128 g/ml), and susceptible to ciprofloxacin (MIC 0.25 g/ml) It also harboured a qnrA and a CTX-M-15 genes. The presence of an MBL was suggested by the MBL Etest and confirmed spectrophotometric by EDTA-inhibited imipenem hydrolysis. PCR performed by using primers specific for blaIMP, , blaVIM, blaSPM, blaGIM, and blaSIM, did not yield any product. A product obtained with NDM primers was confirmed, after sequencing, to code for an NDM-1 enzyme. The resistance to carbapenems and 3G-cephalosporins was transferred to E. coli J53 by conjugation. Conclusions: To our knowledge this is the first report of an NDM-1-producing K. pneumoniae in Croatia and in the Balkans. The patient had no apparent link to the Indian subcontinent and the strain was isolated before the recent outbreak of NDM-1 producing Enterobacteriaceae. Although several cases reported by a recent pan-European survey showed a clear link to the Balkan region, this is the first documented report of NDM-1 from that area, thus confirming a possible multifocal spread of this enzyme and prompting for a widespread epidemiological surveillance.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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