Emergence of an Autochthonous and Community-Acquired NDM-1-Producing Klebsiella pneumoniae in Europe

Correspondence Emergence of an Autochthonous and Community-Acquired NDM-1–Producing Klebsiella pneumoniae in Europe To the Editor—The recently identi-tified carbapenemase New Dehli metallo-b-lactamase (NDM-1) in-activates all b-lactams except az-treonam [1]. The corresponding gene that is usually plasmid-borne has spread mostly in Escherichia coli and Klebsiella pneumoniae [1, 2]. NDM-1 producers are multidrug resistant or even resistant to all antibiotics [1, 2]. Whereas contamination with NDM-1 producers is mostly hospital associated, rare cases of community acquisition are known and have been traced to the Indian subcontinent [2]. Here, we report a woman aged 83 years who had cystitis due to a multidrug-resistant K. pneumoniae in June 2011. She had a history of multiple and recurrent episodes of urinary tract infections caused by diverse Enterobacteriaceae that were always treated with narrow-spectrum antibiotics. Because the patient's symptoms tended to to disappear spontaneously and rapidly, the latest cystitis episode had not been treated. K. pneumoniae EDU was resistant to all b-lactams, including carbapenems, as detected with a Vitek-2 automated susceptibility testing system (bioMérieux), with minimal inhibitory concentrations the Clinical Laboratory Standards Institute guidelines [4]. Polymerase chain reaction, sequencing, and plasmid analysis, performed as described elsewhere [5], revealed that K. pneumoniae EDU harbored the bla NDM-1 carbapenemase gene and the bla CTX-M-15 extended-spectrum ß-lactamase gene, which were located on 2 different plasmids (both being approximately 150 kb in size). The isolate coexpressed the CMY-2 cephalosporinase gene, which was located on the bla NDM-1 plasmid. In addition, it possessed the qnrB gene encoding resistance to qui-nolones and the bla OXA-1 gene encoding a restricted-spectrum oxacillinase, both genes being located on the bla CTX-M-15 plasmid. Both plasmids were self-transferable by conjugation, and the bla NDM-1 plasmid was found to be of the IncA/C broad-host range type [6]. Multilocus sequence typing [7] results showed that K. pneumoniae EDU belonged to the sequence type 1, whereas previously reported NDM-1–positive K. pneumoniae isolates were of other sequence types (eg, ST14 and ST147) [6]. Neither this patient nor her husband had traveled to any country in the previous 3 years, including countries with a high prevalence of NDM-1 producers Balkan states, and Middle Eastern nations) [2]. The patient was living in a small-size town in southern France, without special diet (Indian cuisine). Her single foreign contact was a Moroccan maid. She did not have contacts with hospitalized patients and did not have a history of hospitalization within the previous 5 years. Whereas autochthonous …