title: Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China.
abstract: BACKGROUND
  In the past decade, the carbapenemase-producing Enterobacteriaceae (CPE) have been reported worldwide. Emergence of carbapenemase-producing strains among Enterobacteriaceae has been a challenge for treatment of clinical infection. The present study was undertaken to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae recovered from an outbreak that affected 17 neonatal patients in neonatal intensive care unit (NICU) of Kunming City Maternal and Child health Hospital, which is located in the Kunming city in far southwest of China.
  
  
  METHODS
  Minimum inhibitory concentrations (MICs) for antimicrobial agents were determined according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI); Modified Hodge test and Carba-NP test were preformed to identified the phenotypes of carbapenemases producing; To determine whether carbapenem resistance was transferable, a conjugation experiment was carried out in mixed broth cultures; Resistant genes were detected by using PCR and sequencing; Plasmids were typed by PCR-based replicon typing method; Clone relationships were analyzed by using multilocus-sequence typing (MLST) and pulsed field gel electrophoresis (PFGE).
  
  
  RESULTS
  Eighteen highly carbapenem-resistant Klebsiella pneumoniae were isolated from patients in NICU and one carbapenem-resistant K. pneumoniae isolate was detected in incubator water. All these isolates harbored bla NDM-1. Moreover, other resistance genes, viz., bla IMP-4 , bla SHV-1 , bla TEM-1 , bla CTX-M-15 , qnrS1, qnrB4, and aacA4 were detected. The bla NDM-1 gene was located on a ca. 50 kb IncFI type plasmid. PFGE analysis showed that NDM-1-producing K. pneumoniae were clonally related and MLST assigned them to sequence type 105.
  
  
  CONCLUSIONS
  NDM-1 producing strains present in the hospital environment pose a potential risk and the incubator water may act as a diffusion reservoir of NDM-1- producing bacteria. Nosocomial surveillance system should play a more important role in the infection control to limit the spread of these pathogens.
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. god_ruirui@aliyun.com.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. god_ruirui@aliyun.com.|Department of Clinical Laboratory, First People's Hospital of Yunnan province, Kunming, Yunnan, China. god_ruirui@aliyun.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Zheng
authors.affiliation: Department of Clinical Laboratory, Kunming City Maternal and Child health Hospital, Kunming, Yunnan, China. zhangqian@163.com.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China. Guoyd1979@163.com.
authors.forename: Yidan
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. fengyue1981@163.com.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. fengyue1981@163.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. Lli1969@hotmail.com.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. Lli1969@hotmail.com.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. zam1980@yeah.net.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. zam1980@yeah.net.
authors.forename: Amei
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. zy19860908@yeah.net.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. zy19860908@yeah.net.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. Yangxiaoyu@163.com.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. Yangxiaoyu@163.com.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Yang
authors.affiliation: Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. oliverxia2000@aliyun.com.|Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. oliverxia2000@aliyun.com.
authors.forename: Xueshan
authors.initials: X
authors.lastname: Xia
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D002681:China / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000382:microbiology*; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D008297:Male; D010957:Plasmids / Q000235:genetics / Q000378:metabolism; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1