title: Emergence of NDM-1-producing Enterobacteriaceae in Porto Alegre, Brazil.
abstract: OBJECTIVE
  To evaluate the emergence of New Delhi metallo-β-lactamase 1 (NDM-1)-producing Enterobacteriaceae isolates in Brazil.
  
  
  METHODS
  From April to October 2013, following the detection of the first NDM-1-producing isolate, a surveillance study was performed for the detection of blaNDM-1 among Enterobacteriaceae isolates with reduced susceptibility to carbapenems in 17 hospitals of Porto Alegre, Brazil. Real-time PCR was used to determine the presence of carbapenemase genes, which were further sequenced. Clonal relatedness was assessed by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  A total of 1134 isolates were evaluated. blaNDM-1 was detected in 11 (0.97%) isolates: nine Enterobacter cloacae complex (eight belonging to a single clone recovered from two distinct hospitals and the other strain from a third hospital) and two Morganella morganii (belonging to a single clone recovered from one hospital). Most isolates presented high-level resistance to carbapenems.
  
  
  CONCLUSIONS
  NDM-1-producing Enterobacteriaceae have emerged rapidly in the hospitals of the Brazilian city where they were first detected. The emergence of NDM-1 in Brazil is of great concern, since it is a severe threat to antimicrobial therapy against Enterobacteriaceae in this country.
authors.affiliation: Programa de Pós Graduação em Ciências Farmacêutica, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
authors.forename: Franciéli P
authors.initials: FP
authors.lastname: Rozales
authors.affiliation: Programa de Pós Graduação em Ciências Farmacêutica, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Ribeiro
authors.affiliation: Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Programa de Pós Graduação em Ciências Médicas, Faculdade de Medicina, UFRGS, Porto Alegre, Brazil.
authors.forename: Cibele M
authors.initials: CM
authors.lastname: Magagnin
authors.affiliation: Programa de Pós Graduação em Ciências Farmacêutica, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Pagano
authors.affiliation: Unidade de Microbiologia, Serviço de Patologia Clínica, HCPA, Porto Alegre, Brazil.
authors.forename: Larissa
authors.initials: L
authors.lastname: Lutz
authors.affiliation: Infection Control Service Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
authors.forename: Diego R
authors.initials: DR
authors.lastname: Falci
authors.affiliation: Infection Control Service Hospital Beneficiência Portuguesa, Porto Alegre, Brazil.
authors.forename: Adão
authors.initials: A
authors.lastname: Machado
authors.affiliation: Programa de Pós Graduação em Ciências Farmacêutica, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
authors.forename: Afonso L
authors.initials: AL
authors.lastname: Barth
authors.affiliation: Infectious Diseases Service, Hospital de Clínicas de Porto, 2350 Ramiro Barcelos St, 90035-903, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: azavascki@hcpa.ufrgs.br.
authors.forename: Alexandre P
authors.initials: AP
authors.lastname: Zavascki
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001938:Brazil / Q000453:epidemiology; D021821:Communicable Diseases, Emerging; D003428:Cross Infection; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1
keywords: Carbapenemase; Epidemiology; NDM-1; Resistance