title: Multidrug resistant NDM-1 metallo-beta-lactamase producing Klebsiella pneumoniae sepsis outbreak in a neonatal intensive care unit in a tertiary care center at central India.
abstract: OBJECTIVE
  The objective of the following study is to detect genes encoding carbapenem resistance in Klebsiella pneumoniae sepsis outbreak in a neonatal intensive care unit (NICU).
  
  
  METHODS
  Antibiotic sensitivity test was performed by standard Kirby Bauer disc diffusion technique and minimum inhibitory concentrations of antibiotics was determined by VITEK-2. Polymerase chain reaction (PCR) assays and sequencing was used to determine the presence of beta-lactamase encoding genes. Conjugation experiments were performed to determine the transferability of beta-lactamase. Isolate relatedness were determined by repetitive-element PCR (REP), enterobacterial repetitive intergenic consensus (ERIC) PCR and random amplified polymorphic deoxyribonucleic acid (RAPD).
  
  
  RESULTS
  All the isolates were completely resistant to the second and third generation cephalosporins tested as well as carbapenems. Susceptibility profiling of the isolates indicated that 100% retained susceptibility to tigecycline and colistin. Conjugation experiments indicated that blaNDM-1 was transferable and likely through a plasmid-mediated event. All the isolates showed the presence of blaNDM-1 with co association of blaCTX-M-15. REP-PCR, ERIC-PCR and RAPD revealed a single clonal type circulating in NICU environment.
  
  
  CONCLUSIONS
  Co-production of NDM-1 with CTX-M-15 in K. pneumoniae isolates was detected for the first time in our NICU. Transmission of plasmid carrying these resistant genes to other members of Enterobacteriaceae will increase the incidence of multidrug resistance. Early detection of these genes will help in prevention and adequate infection control by limiting the spread of these organisms.
authors.affiliation: Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: Atul
authors.initials: A
authors.lastname: Khajuria
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Praharaj
authors.forename: Mahadevan
authors.initials: M
authors.lastname: Kumar
authors.forename: Naveen
authors.initials: N
authors.lastname: Grover
authors.forename: Amit
authors.initials: A
authors.lastname: Aggarwal
mesh_terms: D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005838:Genotype; D006801:Humans; D007194:India; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D010957:Plasmids / Q000032:analysis; D016133:Polymerase Chain Reaction; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D004269:DNA, Bacterial; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1