Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron causing a hospital outbreak in a Mexican attention center

Abstract

Introduction: Infections acquired in hospitals are the cause of high morbidity and mortality and with the emergence of resistant bacteria, the problem is greater. The aim of this work was to determine the genetic characteristics and timeline of Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron involved in an intrahospital outbreak.
 Methodology: Investigation was made from the first detection of K. pneumoniae blaNDM-1, strain “466”, and the last clone “423”. 16S rRNA gene analysis showed that 466 strain and clones were related to K. pneumoniae. Extended-spectrum β-lactamases (ESBL) was detected according to the Clinical and Laboratory Standards Institute (CLSI) and real time-PCR. Typing of K. pneumoniae blaNDM-1 strains was carried by ERIC-PCR and sequencing the variable region of the integrons were performed.
 Results: A cluster of six resistant isolates of K. pneumoniae blaNDM-1 was detected in intensive care unit (ICU), internal medicine (IM) and orthopedics (OT). Timeline revealed that the first bacterial identification was in ICU and the last clone in OT service. The array genetic of variable region was “IntI/aadA5-drfA17/qacEΔ1-Sul1”.
 Conclusions: The evidences highlight the importance of the epidemiological surveillance of Extended-spectrum β-lactamases (ESBL) strains, as well as the need for molecular epidemiological studies to identify the routes of transmission and the contamination sources within health personnel.

ESKAPE bacteria characterization reveals the presence of Acinetobacter baumannii and Pseudomonas aeruginosa outbreaks in COVID-19/VAP patients

“…MH plates were incubated at 37°C for 18-24 h and the zones of inhibition were measured as for the routine disk diffusion method. Klebsiella pneumoniae bla NDM-1 was used as positive control 30 .…”

Gram-Negative ESKAPE Bacteria Surveillance in COVID-19 Pandemic Exposes High-Risk Sequence Types of Acinetobacter baumannii MDR in a Tertiary Care Hospital

“…The identification to genus and species level was performed using the automated system Vitek 2-XL (bioMériux, Durham, NC, USA) according to the manufacturer's protocol. Klebsiella pneumoniae 466 (bla NDM-1 ), P. aeruginosa PA-11 (bla VIM ), K. pneumoniae ATTC BAA-1705 (bla KPC ), and K. pneumoniae BAA-2524 (bla OXA-48 ) strains were used as positive controls, and E. coli J53-1 as negative control [7,25]. Only for the detection of the bla OXA-40 and bla OXA-23 genes, the identity of the amplicons was sequenced by the Biology Institute of Universidad Nacional Autónoma de México (UNAM) using a DNA Analyzer 3730xL (Applied Biosystems, Forrest City, CA, USA).…”

“…Another example of a bacterial pathogen that has recently been recognized as a potential ESKAPE member is Stenotrophomonas maltophilia, which has been the causative agent of in-hospital outbreaks among critically ill patients [22][23][24]. In Mexico, we have locally reported the members of the ESKAPE group resistant to antibiotics (mainly Gram-negative bacteria) circulating in pre-pandemic and pandemic times in patients of Hospital Juárez de México (HJM) [7,14], as well as the consequences of their dispersion on inert surfaces and critical devices, such as A. baumannii [5,[25][26][27][28]. Therefore, microbiological evidence from our hospital has shown that only some Gram-negative bacteria (A. baumannii, P. aeruginosa, and Enterobacterales) have played an important role as causal agents of HAIs and nosocomial contamination.…”

Molecular Profiling of a Multi-Strain Hypervirulent Klebsiella pneumoniae Infection Within a Single Patient

“…3,10 While an accurate prevalence of CR-hvKP as an infectious agent is hard to measure, due to the lack of standardised diagnostic markers, devastating regional outbreaks of CR-hvKP in healthcare facilities have been reported around the world. [15][16][17][18][19][20] In particular, CR-hvKP is a major cause for ventilator-associated pneumonia, with a very high mortality rate. ICU, where tracheostomy and other indwelling medical devices are regularly applied, represents a unique niche in favour of biomaterial-associated infections.…”