The Balkan region: NDM-1-producing Klebsiella pneumoniae ST11 clonal strain causing outbreaks in Greece

Abstract

This survey highlights the successful undetected dissemination of yet another carbapenemase in Greece and strengthens the hypothesis of a latent NDM-1 cluster in the Balkan region.

The Role of Epidemic Resistance Plasmids and International High-Risk Clones in the Spread of Multidrug-Resistant Enterobacteriaceae

“…The type IV pilus may therefore facilitate the movement of resistance genes (137). A type III restriction-modification system could also be responsible for "host specificity," i.e., preventing the exchange of certain mobile elements, including (139)(140)(141). Therefore, the restriction of plasmids and specific mobile elements by a type III restriction-modification system on ICEKp258.2 may explain some of the differences observed between these SLVs (i.e., ST258 and ST11).…”

Molecular Characterization of bla NDM-5 Carried on an IncFII Plasmid in an Escherichia coli Isolate from a Nontraveler Patient in Spain

“…Both pMC-NDM and pGUE-NDM are IncFII plasmids of approximately 90 kb that were identified in Poland and France from E. coli isolates of African and Indian origin and belong to ST complexes ST23 and ST131, respectively. NDM enzymes encoded in IncFII plasmids, with a narrow host range, are being increasingly reported (12)(13)(14)(15)(16)(17), an observation that deserves further attention since IncFII plasmid scaffolds have been linked to the worldwide spread of CTX-M-15 (18). Of note, the genetic array bla TEM-1 -rmtB-IS26 upstream from bla NDM in both pHC105-NDM and pMC-NDM has also typically been associated with the Tn3 transposon in IncFII plasmids (19)(20)(21)(22), and it is not unlikely that linkage of this array with the NDM module originated from an IS26-mediated recombination event, a common mechanism in the mobilization and genetic rearrangement of NDM-related structures (13,14).…”

“…The nosocomial spread of NDM-producing isolates has only been sporadically reported and is likely related to particular clonal lineages (17,(27)(28)(29). Multiple reports, however, have identified community-acquired NDM-producing isolates, suggesting the existence of a hidden reservoir and transmission among colonized carriers (30).…”

Emergence of OXA-162 Carbapenemase- and DHA-1 AmpC Cephalosporinase-Producing Sequence Type 11 Klebsiella pneumoniae Causing Community-Onset Infection in Greece

“…Species identification and initial susceptibility testing were performed with the Microscan system (Siemens Healthcare Diagnostics, Deerfield, IL). MICs for carbapenems were obtained using Etest strips (bioMérieux, Marcy l'Étoile, France), according to the manufacturer's instructions, and interpreted using the updated 2012 CLSI guidelines (8). The K. pneumoniae isolates were highly resistant to ␤-lactam antibiotics, including penicillins, their combinations with inhibitors, cefoxitin, and expanded-spectrum cephalosporins.…”