Klebsiella Pneumoniae Bla(Ndm)(-)(1) Carrying A Class 1 Integron Causing A Hospital Outbreak In A Mexican Attention Center

Introduction: Infections acquired in hospitals are the cause of high morbidity and mortality and with the emergence of resistant bacteria, the problem is greater. The aim of this work was to determine the genetic characteristics and timeline of Klebsiella pneumoniae bla(NDM-1) carrying a class 1 integron involved in an intrahospital outbreak.Methodology: Investigation was made from the first detection of K. pneumoniae bla(NDM-1), strain "466", and the last clone "423". 16S rRNA gene analysis showed that 466 strain and clones were related to K pneumoniae. Extended-spectrum beta-lactamases (ESBL) was detected according to the Clinical and Laboratory Standards Institute (CLSI) and real time-PCR. Typing of K pneumoniae bla(NDM-1) strains was carried by ERIC-PCR and sequencing the variable region of the integrons were performed.Results: A cluster of six resistant isolates of K. pneumoniae bla(NDM-1) was detected in intensive care unit (ICU), internal medicine (IM) and orthopedics (OT). Timeline revealed that the first bacterial identification was in ICU and the last clone in OT service. The array genetic of variable region was "IntI/aadA5-drfA17/qacE Delta 1-Sul1".Conclusions: The evidences highlight the importance of the epidemiological surveillance of Extended-spectrum beta-lactamases (ESBL) strains, as well as the need for molecular epidemiological studies to identify the routes of transmission and the contamination sources within health personnel.