title: NDM-producing Enterobacteriaceae in Poland, 2012-14: inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic cases.
abstract: OBJECTIVE
  The objective of this study was to characterize New Delhi metallo-β-lactamase (NDM)-producing Enterobacteriaceae isolates reported in Poland in 2012-14.
  
  
  METHODS
  Representative isolates were typed by PFGE and MLST. NDM and other β-lactamase genes were amplified and sequenced. Plasmids with blaNDM genes were analysed by nuclease S1 plus hybridization profiling, by transfer assays and by PCR-based replicon typing. The blaNDM genetic context was studied by PCR mapping assays.
  
  
  RESULTS
  Of 374 cases of infection/colonization with NDM-positive Enterobacteriaceae identified in 2012-14, 370 cases in 40 hospitals, 10 outpatient clinics and 1 nursing home were associated with a Klebsiella pneumoniae outbreak with epicentres in Poznań and Warsaw. The outbreak strain of K. pneumoniae ST11 was similar to an isolate from the Czech Republic from 2013. Like the Czech strain, many of the isolates had two blaNDM-1-carrying IncFII- and IncR-type plasmids of variable size, sharing a blaNDM-1-containing segment. The early isolates also produced CTX-M-15 co-encoded by the IncR-type plasmids, and differentiated later by extensive plasmid rearrangements. Four other NDM cases were reported in 2013, three being associated with arrivals from Montenegro, India or Afghanistan. The Indian Escherichia coli ST448 NDM-5 isolate revealed similarity to a recent isolate from Spain, including the blaNDM genetic context observed previously in E. coli strains in Poland and France (of Congolese and Indian origins, respectively). The Afghani Proteus mirabilis was the second isolate of this species with a chromosomal blaNDM-1 location.
  
  
  CONCLUSIONS
  The largest NDM outbreak in a non-endemic country has been observed, being an alarming phenomenon in resistance epidemiology in Poland.
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Baraniak
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: R
authors.initials: R
authors.lastname: Izdebski
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Fiett
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: I
authors.initials: I
authors.lastname: Gawryszewska
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Bojarska
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Herda
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Literacka
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: D
authors.initials: D
authors.lastname: Żabicka
authors.affiliation: Central Microbiology Laboratory, H. Święcicki Clinical Hospital at the Medical University in Poznań, Poznań, Poland.
authors.forename: H
authors.initials: H
authors.lastname: Tomczak
authors.affiliation: ALAB Laboratories, Poznań, Poland.
authors.forename: N
authors.initials: N
authors.lastname: Pewińska
authors.affiliation: Department of Laboratory and Microbiological Diagnostics, Voivodship Hospital, Poznań, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Szarata
authors.affiliation: Infection Control Team, University Hospital of Lord's Transfiguration, Poznań, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Ozorowski
authors.affiliation: Department of Microbiology, Public Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Milner
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Hryniewicz
authors.affiliation: Department of Molecular Microbiology & National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland gniadkow@cls.edu.pl.
authors.forename: M
authors.initials: M
authors.lastname: Gniadkowski
mesh_terms: D000293:Adolescent; D000328:Adult; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004196:Disease Outbreaks; D005260:Female; D022761:Gene Transfer, Horizontal; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009693:Nucleic Acid Hybridization; D010957:Plasmids / Q000032:analysis; D011044:Poland / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D004269:DNA, Bacterial; D001618:beta-Lactamases