title: First clinical cases of NDM-1-producing Klebsiella pneumoniae from two hospitals in Bulgaria.
abstract: We report the first confirmed cases of NDM-1-producing Klebsiella pneumoniae infections in two hospitals in Bulgaria. The isolates were diverse in terms of plasmid and co-resistance gene content. K. pneumoniae PR2682, causing sepsis in patient with polytrauma due to traffic accident, harbored blaNDM-1,blaCMY-4, blaCTX-M-15, blaSHV-1, blaTEM-1b, qnrB, and aac(6')-Ib. blaNDM-1was transferable by conjugation and located on an IncA/C plasmid of 176-kb, which also carried blaCMY-4, blaCTX-M-15, blaTEM-1b, and qnrB. K. pneumoniae PR2830, causing urinary tract infection in prostate cancer patient, harbored blaNDM-1,blaSHV-1, blaTEM-1, and aac(6')-Ib. blaNDM-1was carried on an 86-kb IncA/C plasmid transferable by conjugation together with blaTEM-1, and aac(6')-Ib. Multilocus sequence typing indicated that the two isolates belonged to sequence type ST11. The emergence of NDM-1-producing K. pneumoniae indicates that blaNDM-1-mediated resistance is already disseminated among Enterobacteriaceae in Bulgaria. Our results further confirm the role of the Balkans as a secondary reservoir where NDM-encoding genes originate.
authors.affiliation: National Reference Laboratory for Control and Monitoring of Antibiotic Resistance, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria; Laboratory for Clinical Microbiology, National Oncology Center - SHATO, Sofia, Bulgaria. Electronic address: bojana_e@abv.bg.
authors.forename: Bozhana
authors.initials: B
authors.lastname: Todorova
authors.affiliation: Laboratory for Clinical Microbiology, National Oncology Center - SHATO, Sofia, Bulgaria.
authors.forename: Stefana
authors.initials: S
authors.lastname: Sabtcheva
authors.affiliation: National Reference Laboratory for Control and Monitoring of Antibiotic Resistance, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
authors.forename: Ivan N
authors.initials: IN
authors.lastname: Ivanov
authors.affiliation: Laboratory for Clinical Microbiology, Emergency Medical Institute "Pirogov", Sofia, Bulgaria.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lesseva
authors.affiliation: Laboratory for Clinical Microbiology, Emergency Medical Institute "Pirogov", Sofia, Bulgaria.
authors.forename: Tzano
authors.initials: T
authors.lastname: Chalashkanov
authors.affiliation: Laboratory for Clinical Microbiology, "Tokuda Hospital Sofia", Bulgaria.
authors.forename: Magda
authors.initials: M
authors.lastname: Ioneva
authors.affiliation: Laboratory for Clinical Microbiology, "Tokuda Hospital Sofia", Bulgaria.
authors.forename: Assya
authors.initials: A
authors.lastname: Bachvarova
authors.affiliation: National Reference Laboratory for Control and Monitoring of Antibiotic Resistance, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
authors.forename: Elina
authors.initials: E
authors.lastname: Dobreva
authors.affiliation: National Reference Laboratory for Control and Monitoring of Antibiotic Resistance, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
authors.forename: Todor
authors.initials: T
authors.lastname: Kantardjiev
mesh_terms: D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000378:metabolism; D002031:Bulgaria; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1
keywords: Carbapenem resistance; Klebsiella pneumoniae; NDM