title: Interhospital spread of NDM-7-producing Klebsiella pneumoniae belonging to ST437 in Spain.
abstract: This study describes an interhospital spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) producing NDM-7 carbapenemase that started in December 2013 in Madrid, Spain. NDM-7-producing CRKP were isolated from urine, rectal swabs or blood samples from seven patients admitted to three different hospitals (Hospital Universitario La Paz, Hospital de Cantoblanco and Hospital Central de la Cruz Roja). The isolates were resistant to all antimicrobials tested except colistin and fosfomycin. One blood isolate was susceptible to minocycline and tigecycline but was resistant to fosfomycin. All isolates were closely related by pulsed-field gel electrophoresis (PFGE) and DiversiLab(®) analysis and belonged to multilocus sequence typing (MLST) sequence type 437. In addition, blaNDM-7, blaTEM-1, blaCTX-M-15 and aac(3)-IIa were identified. Family contacts of the index case were negative for NDM-producing bacteria. The outbreak occurred in two separate waves and the cases associated with Hospital de Cantoblanco had been admitted to the same room. Environmental samples from the trap of a sink and a shower in this room were positive for NDM-7-producing CRKP. To our knowledge, this is the first reported worldwide outbreak of NDM-7-producing CRKP. No relationship with the Indian continent, the Balkans or the Middle East could be established. Frequent transfer of aged or chronically ill patients between the facilities involved may have favoured the spread of NDM-7-producing CRKP. The spread of the second wave in Hospital de Cantoblanco probably occurred as a result of transmission from an environmental reservoir.
authors.affiliation: Servicio de Microbiología, Hospital Universitario La Paz-idiPAZ, Pso. de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Seara
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Oteo
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario La Paz-idiPAZ-Cantoblanco, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Carrillo
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario La Paz-idiPAZ, Madrid, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Pérez-Blanco
authors.affiliation: Servicio de Microbiología, Hospital Universitario La Paz-idiPAZ, Pso. de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Mingorance
authors.affiliation: Servicio de Microbiología, Hospital Universitario La Paz-idiPAZ, Pso. de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gómez-Gil
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario La Paz-idiPAZ, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Herruzo
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Pérez-Vázquez
authors.affiliation: Área de Epidemiología, Servicio Madrileño de Salud, Madrid, Spain.
authors.forename: Jenaro
authors.initials: J
authors.lastname: Astray
authors.affiliation: Servicio de Microbiología, Hospital Universitario La Paz-idiPAZ, Pso. de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: García-Rodríguez
authors.affiliation: Servicio de Microbiología, Hospital Central de la Cruz Roja, Madrid, Spain.
authors.forename: Luis Moisés
authors.initials: LM
authors.lastname: Ruiz-Velasco
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Campos
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario La Paz-idiPAZ, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: de Burgos
authors.affiliation: Servicio de Microbiología, Hospital Universitario La Paz-idiPAZ, Pso. de la Castellana 261, 28046 Madrid, Spain. Electronic address: guillermo.ruiz@salud.madrid.org.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Carrascoso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001769:Blood / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D012007:Rectum / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1
keywords: Carbapenemase; Klebsiella pneumoniae; NDM-7; Outbreak