engleski

Mazzariol A., Bosnjak Z., Ballarini P., Budimir A., Bedenic B., Kalenic S., Cornaglia G.

Objectives: A K. pneumoniae strain, resistant to carbapenems, was isolated in May 2009, from a blood culture of a 40-years-old man, recovered in a surgical intensive care unit of the Clinical Hospital Center in Zagreb, Croatia. The patient had been transferred from another hospital of a neighbouring country after 5 days of hospitalization due to a car accident. The clinical history mentioned antibiotic treatment not including carbapenems (gentamicine, metronidazole and ceftriaxone), and no link to India or Pakistan. We investigated the carbapenem resistance mechanism. Materials and Methods: Antimicrobial susceptibility testing was performed by both Vitek2 and microdiluition, and interpreted according to the latest EUCAST documents. The presence of a carbapenemase was investigated by means of an MBL-etest, hydrolysis of carbapenems and EDTA inhibition of hydrolysis. PCR and sequencing were carried out by standard procedures. Resistance was transferred by conjugation to E. coli J53. Results: The strain was resistant to imipenem and meropenem (MICs 16 mg/L and 64 mg/L, respectively), and to all 3G-cephalosporins (MICs >128 mg/L), and susceptible to ciprofloxacin (MIC 0.25 mg/L) It also harboured a qnrA and a ctx-m-15 genes. The presence of an MBL was suggested by the MBL Etest and confirmed spectrophotometric by EDTA-inhibited imipenem hydrolysis. PCR performed by using primers specific for blaIMP, blaVIM, blaSPM, blaGIM, and blaSIM, did not yield any product. A product obtained with NDM primers was confirmed, after sequencing, to code for an NDM-1 enzyme. The resistance to carbapenems and 3G-cephalosporins was transferred to E. coli J53 by conjugation. Conclusions: To our knowledge this is the first report of an NDM-1-producing K. pneumoniae in Croatia and in the Balkans. The patient had no apparent link to the Indian subcontinent and the strain was isolated before the recent outbreak of NDM-1 producing Enterobacteriaceae. Although several cases reported by a recent pan-European survey showed a clear link to the Balkan region, this is the first documented report of NDM-1 from that area, thus confirming a possible multifocal spread of this enzyme and prompting for a widespread epidemiological surveillance.

Klebsiella pneumoniae; carbapenem; resistant; blood culture

nije evidentirano