title: Outbreak of carbapenem-resistant enterobacteriaceae containing blaNDM-1, Ontario, Canada.
abstract: BACKGROUND
  New Delhi metallo-ß-lactamase (NDM) has emerged worldwide in clinically relevant gram-negative bacteria. We report an outbreak of NDM-producing Klebsiella pneumoniae in patients with no prior travel history to endemic regions.
  
  
  METHODS
  Five NDM-1-producing K. pneumoniae colonizing and/or clinically infecting patients in a community tertiary hospital were detected between October and November 2011. NDM-1-producing Enterobacteriaceae (K. pneumoniae and Escherichia coli) were clinically and epidemiologically characterized, including susceptibility profiles, molecular typing, and molecular characterization of plasmids and resistant determinants.
  
  
  RESULTS
  Five patients were identified carrying NDM-1-producing K. pneumoniae, all of them epidemiologically linked with each other. K. pneumoniae were confirmed to belong to the same clone, exhibiting multidrug-resistant phenotypes. One patient was positive for NDM-1-producing E. coli in blood and E. coli and K. pneumoniae in rectal specimens, both containing the same bla(NDM) plasmid, suggesting horizontal transfer between species in the patient. No environmental sources of these strains were found. Detection of positive isolates directly from rectal specimens allowed the rapid identification and isolation of colonized patients.
  
  
  CONCLUSIONS
  We report a NDM-1-producing K. pneumoniae outbreak in Ontario, Canada. Implementation of standard infection control practices, including active screening was able to contain the spread of this organism in the hospital setting. Of concern is the potential loss of a travel history to identify patients that are at high risk of being colonized or infected with this organism and the lack of an accurate, cost-effective test that can be implemented in the hospital setting to identify these multidrug-resistant organisms.
authors.affiliation: Division of Infectious Diseases, William Osler Health System, Brampton, Canada.
authors.forename: Sergio
authors.initials: S
authors.lastname: Borgia
authors.forename: Olga
authors.initials: O
authors.lastname: Lastovetska
authors.forename: David
authors.initials: D
authors.lastname: Richardson
authors.forename: Alireza
authors.initials: A
authors.lastname: Eshaghi
authors.forename: Jianhui
authors.initials: J
authors.lastname: Xiong
authors.forename: Catherine
authors.initials: C
authors.lastname: Chung
authors.forename: Mahin
authors.initials: M
authors.lastname: Baqi
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.forename: Gloria
authors.initials: G
authors.lastname: Ricci
authors.forename: Rachael
authors.initials: R
authors.lastname: Sawicki
authors.forename: Rajni
authors.initials: R
authors.lastname: Pantelidis
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
authors.forename: Samir N
authors.initials: SN
authors.lastname: Patel
authors.forename: Roberto G
authors.initials: RG
authors.lastname: Melano
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012007:Rectum / Q000382:microbiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1