New Delhi Metallo-β-Lactamase-producing Enterobacteriaceae, United States

We characterized 9 New Delhi metallo-beta-lactamase-producing Enterobacteriaceae (5 Klebsiella pneumoniae, 2 Escherichia coli, 1 Enterobacter cloacae, 1 Salmonella enterica serovar Senftenberg) isolates identified in the United States and cultured from 8 patients in 5 states during April 2009-March 2011. Isolates were resistant to beta-lactams, fluoroquinolones, and aminoglycosides, demonstrated MICs <= 1 mu g/mL of colistin and polymyxin, and yielded positive metallo-beta-lactamase screening results. Eight isolates had bla(NDM-1), and 1 isolate had a novel allele (bla(NDM-6)). All 8 patients had recently been in India or Pakistan, where 6 received inpatient health care. Plasmids carrying bla(NDM) frequently carried AmpC or extended spectrum beta-lactamase genes. Two K. pneumoniae isolates and a K. pneumoniae isolate from Sweden shared incompatibility group A/C plasmids with indistinguishable restriction patterns and a common bla(NDM) fragment; all 3 were multilocus sequence type 14. Restriction profiles of the remaining New Delhi metallo-beta-lactamase plasmids, including 2 from the same patient, were diverse.