AUTHOR=Pathak Ashutosh , Tejan Nidhi , Dubey Akanksha , Chauhan Radha , Fatima Nida , Jyoti  , Singh Sushma , Bhayana Sahil , Sahu Chinmoy 

TITLE=Outbreak of colistin resistant, carbapenemase (blaNDM, blaOXA-232) producing Klebsiella pneumoniae causing blood stream infection among neonates at a tertiary care hospital in India

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1051020

DOI=10.3389/fcimb.2023.1051020

ISSN=2235-2988

ABSTRACT=<p>Infections caused by multi-drug resistant <italic>Klebsiella pneumoniae</italic> are a leading cause of mortality and morbidity among hospitalized patients. In neonatal intensive care units (NICU), blood stream infections by <italic>K. pneumoniae</italic> are one of the most common nosocomial infections leading to poor clinical outcomes and prolonged hospital stays. Here, we describe an outbreak of multi-drug resistant <italic>K. pneumoniae</italic> among neonates admitted at the NICU of a large tertiary care hospital in India. The outbreak involved 5 out of 7 neonates admitted in the NICU. The antibiotic sensitivity profiles revealed that all <italic>K. pneumoniae</italic> isolates were multi-drug resistant including carbapenems and colistin. The isolates belonged to three different sequence types namely, ST-11, ST-16 and ST-101. The isolates harboured carbapenemase genes, mainly <italic>bla</italic><sub>NDM-1</sub>, <italic>bla</italic><sub>NDM-5</sub> and <italic>bla</italic><sub>OXA-232</sub> besides extended-spectrum β-lactamases however the colistin resistance gene <italic>mcr-1</italic>, <italic>mcr-2 and mcr-3</italic> could not be detected. Extensive environmental screening of the ward and healthcare personnel led to the isolation of <italic>K. pneumoniae</italic> ST101 from filtered incubator water, harboring <italic>bla</italic><sub>NDM-5</sub>, <italic>bla</italic><sub>OXA-232</sub> and ESBL genes (<italic>bla</italic><sub>CTX-M</sub>) but was negative for the <italic>mcr</italic> genes. Strict infection control measures were applied and the outbreak was contained. This study emphasizes that early detection of such high-risk clones of multi-drug resistant isolates, surveillance and proper infection control practices are crucial to prevent outbreaks and further spread into the community.</p>