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Despite worldwide dissemination of New Delhi metallo-β-lactamase1 ( bla NDM-1), outbreaks remain uncommon in China. In this study, we describe the characteristics of the outbreak-related  bla NDM-1-producing  K .  pneumonia  isolates in a neonatal unit in Shandong province, China. We recovered 21 non-repetitive carbapenem-resistant  K .  pneumoniae  isolates with a positively modified Hodge test (MHT) or EDTA synergistic test from patients and environmental samples in Shandong provincial hospital. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) data show  K .  pneumoniae  isolates from 19 patients were clonally related and belong to the clonal groups ST20 and ST17. We note two outbreaks, the first caused by ST20 during August 2012 involving four patients, and the second caused by ST20 and ST17 during January 2012 and September 2013 involving fourteen patients. We found the bed railing of one patient was the source of the outbreak. We verified the presence of the  bla NDM-1 gene in 21  K .  pneumoniae  isolates. The genes  bla CTX-M-15,  bla CTX-M-14,  bla DHA-1,  bla TEM-1 and Class I integron were also present in 18 (85.7%), 3 (14.3%), 18 (85.7%), 19 (90.5%) and 19 (90.5%) isolates, respectively. We also found an isolate with both  bla NDM-1 and  bla IMP-4. All of the isolates exhibited a multidrug-resistance phenotype. The β-lactam resistance of 20 isolates was transferable via conjugation. In addition, we show the resistance of 21  K .  pneumoniae  isolates to carbapenem is not related to lack of outer-membrane proteins OmpK35 and OmpK36 nor overpression of efflux pumps. This study provides the first report confirming blaNDM-1-producing  K .  pneumoniae  ST20 and ST17 were associated with outbreak. Early detection of resistance genes is an effective strategy in preventing and controlling infection by limiting the dissemination of these organisms.

Outbreak of Multidrug Resistant NDM-1-Producing Klebsiella pneumoniae from a Neonatal Unit in Shandong Province, China