title: Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring blaIMP-4 and blaDHA-1 in a neonatal intensive care unit in China.
abstract: Outbreaks caused by Klebsiella pneumoniae producing carbapenemases and other β-lactamases have been reported. Four neonates admitted to a neonatal intensive care unit (NICU) in a Chinese hospital developed respiratory infection while receiving intensive care. In all four cases, multidrug-resistant K. pneumoniae was isolated from multiple respiratory specimens, leading to additional characterization of these organisms and investigation of the local environment in the NICU. Multiple β-lactamase genes, including bla(TEM-1), bla(IMP-4), bla(DHA-1) and bla(CTX-M-14), as well as the quinolone resistance gene qnrB4, were harboured by transferable plasmids from all four clinical isolates. Furthermore, PFGE confirmed that three of the four clinical isolates from the patients and three K. pneumoniae isolates collected from the hands of health-care workers and an incubator in the NICU belonged to the same PFGE cluster, indicating that an outbreak due to multidrug-resistant K. pneumoniae carrying bla(IMP-4) and bla(DHA-1) occurred in this NICU. As far as is known, this is the first report of the co-existence of bla(IMP-4) and bla(DHA-1) in the same K. pneumoniae isolate. These data suggest that additional precautions are needed to prevent outbreaks of infection caused by multidrug-resistant K. pneumoniae resulting from environmental exposure in NICUs.
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Fangyou
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Laboratory Medicine, Shaoxing Municipal Women and Children Hospital, Shaoxing 312000, PR China.
authors.forename: Qunhua
authors.initials: Q
authors.lastname: Ying
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Tingjian
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Baixing
authors.initials: B
authors.lastname: Ding
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Qin
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Parsons
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Salgado
authors.affiliation: Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institute of Medical Microbiology and Institutes of Biomedical Sciences, Shanghai Medical School of Fudan University, Shanghai 200032, PR China.
authors.forename: Di
authors.initials: D
authors.lastname: Qu
authors.affiliation: Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Jingye
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China.
authors.forename: Liangxing
authors.initials: L
authors.lastname: Wang
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005798:Genes, Bacterial; D005838:Genotype; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D017720:Molecular Epidemiology; D058889:Molecular Typing; D010957:Plasmids; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D001618:beta-Lactamases