Emergence of NDM-1-producing Klebsiella pneumoniae in Morocco

Objectives: To analyse the mechanisms responsible for multidrug resistance in three carbapenem-resistant Klebsiella pneumoniae isolates recovered from two hospitalized patients and an outpatient from the same hospital in Rabat, Morocco. Methods: PCR and sequencing were used to search for beta-lactamase genes. Clonal relationships between the isolates were analysed by multilocus sequence typing and PFGE. Results: A history of prior hospitalization in the same ward was determined for two of the three patients. The three isolates of K. pneumoniae belonged to the same sequence type (ST), ST15, and were clonally related. All three isolates carried the bla(NDM-1) gene and co-expressed the extended-spectrum beta-lactamases CTX-M-15 and SHV-5, as well as the narrow-spectrum b-lactamases SHV-1, OXA-1, OXA-9 and TEM-1. The bla(NDM-1) gene was located on an similar to 250 kb non-typeable plasmid co-harbouring the bla(OXA-1) and bla(CTX-M-15) genes. No link with the Indian subcontinent could be established for the three patients. Conclusions: This work further emphasizes the spread of NDM-1 producers worldwide.