title: Emergence of NDM-1-producing Klebsiella pneumoniae in Morocco.
abstract: OBJECTIVE
  To analyse the mechanisms responsible for multidrug resistance in three carbapenem-resistant Klebsiella pneumoniae isolates recovered from two hospitalized patients and an outpatient from the same hospital in Rabat, Morocco.
  
  
  METHODS
  PCR and sequencing were used to search for β-lactamase genes. Clonal relationships between the isolates were analysed by multilocus sequence typing and PFGE.
  
  
  RESULTS
  A history of prior hospitalization in the same ward was determined for two of the three patients. The three isolates of K. pneumoniae belonged to the same sequence type (ST), ST15, and were clonally related. All three isolates carried the bla(NDM-1) gene and co-expressed the extended-spectrum β-lactamases CTX-M-15 and SHV-5, as well as the narrow-spectrum β-lactamases SHV-1, OXA-1, OXA-9 and TEM-1. The bla(NDM-1) gene was located on an ~250 kb non-typeable plasmid co-harbouring the bla(OXA-1) and bla(CTX-M-15) genes. No link with the Indian subcontinent could be established for the three patients.
  
  
  CONCLUSIONS
  This work further emphasizes the spread of NDM-1 producers worldwide.
authors.affiliation: Service de Bactériologie-Virologie, INSERM U914 Emerging Resistance to Antibiotics, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine Paris Sud, K-Bicêtre, France. laurent.poirel@bct.aphp.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Poirel
authors.forename: Amina
authors.initials: A
authors.lastname: Benouda
authors.forename: Constantin
authors.initials: C
authors.lastname: Hays
authors.forename: Patrice
authors.initials: P
authors.lastname: Nordmann
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009018:Morocco; D058885:Multilocus Sequence Typing; D010957:Plasmids; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004269:DNA, Bacterial; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1